Is It Too Late to Build Muscle in Menopause? No. Here's What the Studies Show

Dr. Gabrielle Lyon (0:00)

I don't want you to think about just hormone therapy alone. Hormone therapy doesn't really build muscle, but it's amplifying the training effect. What matters more? Is it hormone therapy or is it lifting? We know much less about women than we do about men, but one thing that we know is training is the key. And there is a use it or lose it phenomenon.

As we age, protein is undoubtably the most critical macronutrient, but it is very difficult to get the protein that you need. You or someone you love is likely under eating protein.

Can a 50-year-old woman build more muscle than she had at 30? This is a question I get asked probably every other day when a woman starts lifting weights. Will I get too bulky? And that answer, friends, is no. And the second question I get is, is it too late? That answer is also no.

All humans, regardless of age, postmenopausal women included, can build muscle and strength at any moment in their life. A meta-analysis in Frontiers and Endocrinology found that postmenopausal women reliably increased lean mass with structured resistance training. Even better, a 12-week randomized control trial in the Journal of Nutrition, Health and Aging found that postmenopausal women training with free weights gained roughly, and I did this calculation, up to eight pounds of skeletal muscle in 12 weeks. Both strength went up on squat and deadlift, and it went up substantially. When we think about skeletal muscle and menopause, anabolic resistance around menopause is real. And what is anabolic resistance? Anabolic resistance is the inefficiency of your muscle to respond to a stimulus. Anabolic is to build. It doesn't just mean muscle. It could be build any tissue, and your muscle becomes resistant to that building. And when we think about what are we building, we think about mechanical overload, mechanical tension. We're building mass. And then on a much smaller level, we're thinking about amino acids and muscle protein synthesis. So the micro level of building anabolic resistance. Aging is one of the things that we believe causes, and I say we, and this is really in the totality of evidence, anabolic resistance rides along with aging muscle.

And this simply means that one would have to address their training and their nutrition to continue to provide a stimulus. So essentially, what I'm saying in a roundabout way is a well-designed program, is a well-designed program. Whether you are a post-menopausal woman or an andropausal, which is not a real thing, man, higher volume, higher intensity, and a meaningful protein intake is required.

If you are new to training, then you get a better response. It's the newbie gains, whatever your age is. If you are a, you know, experienced person who's been lifting for a very long time, it might take a lot of effort to have incremental improvements. But the next question that we have to ask if we're talking about muscle as it relates to menopause is what matters more? Is it hormone therapy or is it lifting? And many people, including myself, wanted to believe that hormone therapy would be the primary muscle intervention. And that lifting heavy would only work if hormones were on board. And I got to tell you, I've had so many conversations with my mentor, Dr. Donald Layman, regarding this. I mean, so many that he was like, Gabrielle, you are becoming annoying. I was like, well, what are you talking about? I believe that they must have hormones on board and that hormones are the key to making muscle better. And I was wrong. This was a really good learning experience for me because I did some of this early research when I was in my undergraduate collecting urine at the University of Illinois, where they were working on these studies with post-menopausal women. And they didn't use any hormone replacement. And I had a preconceived notion that these hormones were required to make meaningful metabolic changes, meaning to increase or even maintain skeletal muscle. And frankly, I was wrong. And it was again, an early lesson that just because you believe something and you can make it make sense mechanistically, it doesn't mean that it will hold up in the science. And a meta-analysis of 12 randomized control trials published in JAMA Network Open examined hormone therapy's effect on lean body mass just on its own. And the pooled results showed essentially no independent effect. Again, there are challenges with these studies because of the sensitivity, but this is what the data showed. And the difference was six hundredths of a kilogram, which is clinically meaningless. And, you know, every individual trial clusters around the line of no effect. So this is about as neutral as you can get, as you will find this in the medical literature. And here's what Don Layman would say. He would say, well, Gabrielle, it takes years to develop sarcopenia. How are we going to be testing in a sensitive enough manner to show that lifting and protein and hormone replacement therapy even make a difference? I just want to highlight that the medical literature will show mixed results, but in part that hormone therapy doesn't make a huge difference. But hormone therapy appears to do something when it is paired with training. And a study in Frontiers in Physiology gave postmenopausal women transdermal estradiol alongside 12 weeks of resistance training, and compared it with training plus placebo, meaning just training alone. The estradiol group showed larger gains in their quads with greater fat-free mass gains, and similar findings held up 12 months out, meaning what they did, their gains maintained. So it looks like hormone therapy doesn't really build muscle, but it's amplifying the training effect. So overall, I would say that the exact effect of menopause replacement therapy is still evolving, and in our medical practice at Strong Medical, we track body composition and hormone therapy appears to help. It does. And I'm currently working on a data set with my colleagues at Baylor. To look at this properly, I will report back as soon as I have those results, that even without those results, the practical translation is the following.