Menopause Part 4: Training, Protein, Cortisol, Hormone Therapy, & Bone Density

Is there really a “menopause-specific” way to train, eat, and supplement — or is most of it marketing? In the finale of our 4-part menopause series, Drs. Jordan Feigenbaum and Austin Baraki go straight to the evidence on building muscle and bone before, during, and after the transition.

We cover whether menopause blunts your response to lifting (the Isenmann 2023 head-to-head trial and the 2026 meta-analysis of ~4,000 women say it doesn’t), the one-index-card prescription that actually works. Then we work through the loudest claims in the space — cortisol “wrecking” your fat loss, anabolic resistance, the protein and creatine hype, hormone therapy as a cure-all, and “you need a different paradigm” — steelmanning each before we push back. We close with the strongest case in the whole space: heavy lifting for bone density (the LIFTMOR trial), the pelvic-floor evidence, your three biggest fears answered, and how to tell a good coach or clinician from a bad one.

Claims discussed are associated with Stacey Sims, Mary Claire Haver, Mindy Pelz, and the broader functional-medicine space. We push back on the claims, not the people.

Timestamps:

0:00 The 90-year-olds who tripled their strength
1:10 Why this matters: heart disease and falls, not vanity
2:28 Can women still build muscle after menopause? (Isenmann 2023)
7:31 Does menopause blunt your gains? The 2026 meta-analysis
8:49 Is it menopause, or just individual variation?
14:42 The estrogen "shield" and the mechanical override
18:31 Does hormone therapy replace training? (the 2021 estradiol trial)
22:44 What actually works: the whole prescription
24:18 Program details: frequency, volume & insulin sensitivity
30:22 Nutrition: protein and the 2026 review
35:06 Creatine, vitamin D & calcium
43:29 Anabolic resistance: mostly overstated
47:22 Clinical case: the supplement-stack patient
52:23 A short history of wrong advice for women
53:38 Claim 1: "Lift heavy or lose your bones" (Stacey Sims)
1:01:09 Claim 2: the cortisol myth
1:15:18 Clinical case: the cortisol-anxious patient
1:18:20 Claim 3: "It's all hormonal, HRT fixes it" (Mary Claire Haver)
1:20:45 Testosterone in women: what it does and doesn't do
1:21:51 Claim 4: "Menopause needs its own paradigm" & the SWAN data
1:24:48 Bone density done right: the LIFTMORE trial
1:33:07 Does heavy lifting wreck your pelvic floor?
1:38:59 Your three biggest fears, answered
1:40:44 Green flags & red flags

Resources:

Menopause Series Part 1 : https://www.youtube.com/watch?v=yzk0IkTy0WM
Menopause Series Part 2 — https://www.youtube.com/watch?v=YKAlamIOiwU
Menopause Series Part 3 — https://www.youtube.com/watch?v=jzoNMQaBAcI
Hypercortisolism episode - https://open.spotify.com/episode/7tDdUi8dDFWjMYx0fRJdOz

Barbell Medicine coaching and templates: https://www.barbellmedicine.com

Signal book pre-order: https://www.barbellmedicine.com/shop/learning/signal/

Isenmann (2023) https://doi.org/10.1186/s12905-023-02671-y

Isenmann (2026) https://doi.org/10.1016/j.jsams.2026.01.004

Fiatarone (1990) https://doi.org/10.1001/jama.1990.03440220053029

Fiatarone (1994) https://doi.org/10.1056/NEJM199406233302501

Dam (2021) https://doi.org/10.3389/fphys.2020.596130

Markofski (2015) https://doi.org/10.1016/j.exger.2015.02.015

Orsatti (2022) https://doi.org/10.1016/j.exger.2022.111904

Walter (2026) https://doi.org/10.1186/s40798-025-00954-2

dos Santos (2021) https://doi.org/10.3390/nu13113757

Myung (2021) https://doi.org/10.3390/nu13020368

Dote-Montero (2021) https://doi.org/10.1111/sms.13999

Ravussin (2015) https://doi.org/10.1093/gerona/glv057

Cadegiani (2016) https://doi.org/10.1186/s12902-016-0128-4

Greising (2009) https://doi.org/10.1093/gerona/glp082

Islam (2019) https://doi.org/10.1016/S2213-8587(19)30189-5

Testosterone in women review (2026) https://doi.org/10.1080/09513590.2025.2592402

NAMS nonhormone position statement (2023) https://doi.org/10.1097/GME.0000000000002200

Vasomotor exercise meta-analysis (2022) https://doi.org/10.1080/13697137.2022.2097865

Greendale (2019) https://doi.org/10.1172/jci.insight.124865

Watson, LIFTMOR (2018) https://doi.org/10.1002/jbmr.3284

Skaug (2024) https://doi.org/10.1249/MSS.0000000000003278

Skaug (2021) https://doi.org/10.1007/s00192-021-04739-5

Dumoulin (2018) https://doi.org/10.1002/14651858.CD005654.pub4

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