The Dr. Gabrielle Lyon Show

Will I get too bulky?" No. "Is it too late?" Also no. Here's the context: during the menopause transition, women lose lean mass, gain fat, and their muscle becomes harder to build — the same workout and the same protein meal produce less than they did at 30. For years the only conversation has been hormone therapy, yes or no, as if that were the fix. In Part 2 of her menopause series, Dr. Gabrielle Lyon looks at what the evidence actually says builds muscle back.

In this episode:
-Postmenopausal women can build muscle and strength at any age (Frontiers in Endocrinology)
- Up to 8 lbs of skeletal muscle in 12 weeks (J Nutr Health Aging RCT)
- Anabolic resistance: why the same workout and the same meal produce less after menopause
- "I was wrong": hormone therapy vs. lifting, and the conversations with Dr. Donald Layman
- HRT alone and lean mass: a 0.06 kg difference across 12 trials
- Estradiol plus training: bigger quad and fat-free mass gains, maintained at 12 months
- Lift first — the practical translation while the HRT evidence evolves
- Why protein matters more after menopause, and why 60 g spread thin isn't enough
- The RDA (0.8 g/kg) isn't enough to protect bone; ESCEO's 1–1.2 g/kg floor
- Doubling protein to 1.6 g/kg: more fat lost, more lean mass kept
- The 6-step Forever Strong menopause protocol

Sponsor
David Protein — 28 g of protein, 150 calories, zero sugar → davidprotein.com/drlyon, subscribe to save 10% on every order

Find Dr. Gabrielle Lyon at:
- Instagram: https://www.instagram.com/drgabriellelyon/
- TikTok: tiktok.com/@drgabriellelyon
- Facebook: facebook.com/doctorgabriellelyon
- X: x.com/drgabriellelyon
- Apply to become a patient – https://drgabriellelyon.com/new-patient-inquiry/
- Weekly newsletter – https://institute-for-muscle-centric-medicine.ck.page

Chapters:
00:00 Will I get too bulky? Is it too late? Both answers are no
01:09 Postmenopausal women gained up to 8 lbs of muscle in 12 weeks
02:24 Anabolic resistance: more volume, more intensity, more protein
03:34 Hormone therapy or lifting? "I was wrong"
05:16 HRT alone and lean mass: 0.06 kg across 12 trials
06:16 Estradiol amplifies training — it doesn't replace it
07:22 Lift first: what to do while the evidence evolves
10:21 Why protein matters more after menopause (and why 60 g isn't enough)
11:16 The RDA won't protect your bones: the 1–1.2 g/kg floor
12:16 Doubling protein: more fat lost, more lean mass kept
13:22 The Forever Strong protocol, step 1: train 2–3 days a week
14:15 Steps 2–3: 30–50 g protein at first and last meal, impact and loading
15:13 Steps 4–6: hormone therapy with training, body composition, blood work
16:07 You're not alone: the Menopause Challenge

Disclaimer: This podcast is for general informational purposes only and does not constitute medical advice or create a doctor–patient relationship. It is not a substitute for professional medical advice, diagnosis, or treatment. Do not disregard or delay seeking medical advice because of something you heard here.

Most patients are told one thing before surgery: stop all supplements. Duke surgeon Dr. Rebecca Knackstedt says that blanket advice can do harm, and that what you do in the days before surgery changes how you heal.
Dr. Knackstedt is a plastic and reconstructive microsurgeon on faculty at Duke, an MD-PhD researcher and a certified functional medicine provider whose research focuses on surgical prehabilitation: preparing the body, mind, and home before surgery, the way we already do with rehab.

In today’s episode, we discuss:
• What prehab looks like for any operation
• The labs she checks
• Which supplements to keep and which to stop (omega-3s do not increase bleeding)
• Hormones after breast cancer
• Why mammograms still beat thermography
• What chemo does to metabolism
• The questions to ask your oncologist before a treatment decision
• How much protein to eat (no standard exists, and the average woman gets 60 to 70 grams a day, well short of the 100-gram floor)
• Why surgery is catabolic and muscle is your reserve
• Carbohydrate loading before the fasting cutoff and why it can reduce pain
• The five-day window that lowered complications and even mortality in head and neck cancer patients
• Why early walking replaced routine bed rest

Connect with Dr. Knackstedt
Instagram → https://www.instagram.com/surgical_recovery/
Website → https://www.clararecovery.com/

Sponsors
• Perfect Amino by BodyHealth, https://bit.ly/4wZgg6N, code LYON20 for 20% off your first order
• Timeline Mitopure → https://bit.ly/4x18cm5, for an extra 20% off
• Lola Blankets → lolablankets.com (http://lolablankets.com/), code: DRLYON for 40% off select blankets (limited time)

Find Dr. Gabrielle Lyon at:
• Instagram: https://www.instagram.com/drgabriellelyon/
• TikTok: tiktok.com/@drgabriellelyon
• Facebook: http://facebook.com/doctorgabriellelyon
• X: http://x.com/drgabriellelyon
• Apply to become a patient – https://drgabriellelyon.com/new-patient-inquiry/
• Weekly newsletter – https://institute-for-muscle-centric-medicine.ck.page

Chapters:
00:00 Prehab saves lives and money. So why isn't it standard of care?
01:05 Meet Dr. Rebecca Knackstedt: Duke microsurgeon and functional medicine provider
05:35 The patient who changed everything, and why good surgery isn't enough
08:34 What prehab is, and the exercises to do before any surgery
12:14 Hormones after breast cancer, rising rates in young women, and real risk factors
18:42 Chemo, metabolic syndrome and why body composition matters
23:13 The end of bed rest, and the labs that matter before surgery
27:04 Mammograms vs. thermography, and absolute vs. relative risk
34:12 Protein before surgery: 2 g/kg, track 3 days, never under 100 g
38:43 Supplements to take, and why "stop all supplements" is wrong
44:40 Preparing the mind: anxiety, sleep, anesthesia depression, expectations
51:21 Red light, saunas, hyperbaric oxygen, wound vacs, scars and pain control
1:04:59 Surgery is catabolic: muscle as your glucose reserve
1:07:34 Carb loading, the 5-day window, probiotics and the surgery go-bag
1:14:15 Why prehab isn't standard of care yet, and why she's hopeful

Disclaimer: This podcast is for general informational purposes only and does not constitute medical advice or create a doctor–patient relationship. It is not a substitute for professional medical advice, diagnosis, or treatment. Do not disregard or delay seeking medical advice because of something you heard here.

Menopause is changing your body, but the part nobody talks about isn't hot flashes. It's muscle. Women lose lean mass fastest in perimenopause, the loss probably starts closer to 35, and no pill, patch or injection fixes it.

In this solocast, Dr. Gabrielle Lyon explains what estrogen, testosterone and FSH actually do to your metabolism, why a 50-year-old body can still build muscle, and the training and protein protocol to start now.

Join the Menopause Challenge →
https://drgabriellelyon.com/menopause-challenge/
[Use Code 25OFF through Sept 27]

Thank you to our sponsors:
- Rula, therapy covered by insurance → rula.com/drlyon

Find Dr. Gabrielle Lyon at:
- Instagram: https://www.instagram.com/drgabriellelyon/
- TikTok: @drgabriellelyon
- Facebook: facebook.com/doctorgabriellelyon
- YouTube: youtube.com/@DrGabrielleLyon
- X (Twitter): x.com/drgabriellelyon
- Apply to become a patient – https://drgabriellelyon.com/new-patient-inquiry/
- Join my weekly newsletter – https://institute-for-muscle-centric-medicine.ck.page
- Pre-order my new book - https://www.amazon.com/exec/obidos/ASIN/1668085623

Chapters:
00:00 Menopause is changing your body — but it doesn't have to change your life
00:59 The suitcase story: today is about muscle, not hot flashes
01:47 Hormone therapy, yes or no? Why that's the wrong first question
03:36 What menopause is, when it arrives, and 40% of your life after it
04:37 When lean mass really starts to fall — and why testing misses it
06:46 Testosterone vs. estrogen: no two women go through it the same way
08:40 Anabolic resistance: why the muscle-building switch gets sticky
10:31 Estrogen, joints and injury risk (Dr. Jocelyn Wittstein)
13:27 Less muscle, nowhere to put carbs: the lean prediabetic patient
14:19 Falls, fractures, heart disease, and muscle as an early bone signal
16:14 Visceral fat, energy expenditure, fat oxidation and FSH
18:02 Test your blood — and pull the levers you control
19:00 The starting protocol: 2–3 days a week and the movements to keep
20:30 Menopause changes your body, not your life — the Menopause Challenge

Mentioned
- Dr. Jocelyn Wittstein on estrogen, joints and injury risk → https://youtu.be/ILyzNTjZTGI
- Juliet & Dr. Kelly Starrett on floor sitting and mobility → https://youtu.be/QOjzh-711Q0
- SWAN (Study of Women's Health Across the Nation)
- The Lancet Diabetes & Endocrinology review on lean mass and chronic disease
- ESCEO guidance on muscle and bone

Disclaimers: This episode includes paid sponsorships. The Dr. Gabrielle Lyon Podcast and YouTube are for general information purposes only and do not constitute the practice of medicine, nursing, or other professional health care services, including the giving of medical advice, and no doctor/patient relationship is formed. The use of information on this podcast, YouTube, or materials linked from this podcast or YouTube is at the user's own risk. The content of this podcast is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Users should not disregard or delay in obtaining medical advice for any medical condition they may have and should seek the assistance of their health care professional for any such conditions.

Your testosterone number matters at every age, but most men never learn what theirs should be. Mayo Clinic urologist Dr. Tobias Kohler explains why ~500 is the target, why 1,000 is already running hot, what 2,000+ does to the heart, and why a randomized trial found lifting without steroids beat steroids without lifting. Plus: the blood test that catches heart risk your cholesterol panel misses.

Dr. Kohler returns for his second appearance (his first, on erections, testosterone and muscle mass, is one of the most-watched episodes in the show's history). This time: why men's longevity is roughly 50 years behind women's; the Princeton IV consensus he co-chaired, which treats ED as one of the strongest predictors of a future heart attack and points young men toward a coronary calcium scan; the 0–12 ceramide blood test that changes with your behavior; how to get a testosterone baseline that actually means something; what redlining to 2,000–3,000 does to the heart, the set point and the skin; Peyronie's disease, Viagra vs. Cialis, the pills-to-implant ladder, sexual rehab after prostate surgery, and a patient who got stronger with zero testosterone.

In this episode:
- Why ED is a blood-flow problem "until proven otherwise," and who needs a calcium score
- The ceramide test: what it measures and the score that sends you to a cardiologist
- Statins, LDL goals and testosterone
- Baseline T at 25, the ~500 target, why 1,000 runs hot
- The 1980s trial: exercise vs. high-dose testosterone vs. both
- Tolerance, the new set point, and the irreversible side effects
- Trading obesity for sarcopenia in the GLP-1 era
- Peyronie's disease: not cancer, not an STD
- Pills, shots and implants; what 90–95% satisfaction means
- Penile rehab after prostatectomy

About Dr. Tobias Kohler
Tobias S. Kohler, MD, MPH, is Professor of Urology at Mayo Clinic, a fellowship-trained andrologist with 25+ years of clinical and surgical experience and 250+ peer-reviewed publications. He co-chaired the Princeton IV Consensus Guidelines on ED and cardiovascular disease, co-founded the EROS penile implant registry, and co-edited Contemporary Treatment of Erectile Dysfunction (2nd ed.).

Dr. Kohler's first episode → https://youtu.be/__xtrUa3Dck
Clip: Why Every Man Should Prioritize Muscle Mass → https://youtu.be/PgBntuDnzTQ

Chapters:
00:00 Men are dying earlier — the penis is the check-engine light
02:01 Men's longevity is "50 years behind"
03:26 Boys stop seeing doctors — the Office of Men's Health
09:09 Princeton IV: ED predicts heart attacks; calcium scans; Cialis
10:46 The ceramide blood test your cholesterol panel can't replace
15:19 Ceramides, muscle, and knowing if your exercise works
20:51 Statins, testosterone, and your LDL goal
24:01 GLP-1s and "what's the risk of doing nothing?"
25:32 Testosterone: ~500 target, 1,000 too hot, 2,000+ and the heart
28:49 Check your T at 25 — but only if you feel good
29:19 Why steroids won't make you a pro athlete
31:52 Tolerance and the set point redlined men can't escape
35:18 The trial: lifting without steroids beat steroids without lifting
38:58 Steroid cocktails, arrhythmias, WrestleMania mortality
42:42 Irreversible side effects
45:45 Obesity to sarcopenia in the GLP-1 generation
47:51 Peyronie's disease explained
50:53 Viagra vs. Cialis
52:20 Penile implants: the knee-replacement analogy
54:17 Pills, injections, surgery: how long each works
57:15 Sexual rehab after prostatectomy
1:01:08 Fertility and the questions to ask before cancer treatment
1:03:20 The patient who got stronger with zero testosterone

Find Dr. Gabrielle Lyon at:
- Instagram: https://www.instagram.com/drgabriellelyon/
- TikTok: @drgabriellelyon
- Facebook: facebook.com/doctorgabriellelyon
- X: x.com/drgabriellelyon
- Apply to become a patient – https://drgabriellelyon.com/new-patient-inquiry/
- Weekly newsletter – https://institute-for-muscle-centric-medicine.ck.page
- Pre-order my new book – https://www.amazon.com/exec/obidos/ASIN/1668085623

Disclaimer: This podcast is for general informational purposes only and does not constitute medical advice or create a doctor–patient relationship. It is not a substitute for professional medical advice, diagnosis, or treatment. Do not disregard or delay seeking medical advice because of something you heard here.

Your testosterone number matters at every age, but most men never learn what theirs should be. Mayo Clinic urologist Dr. Tobias Kohler explains why ~500 is the target, why 1,000 is already running hot, what 2,000+ does to the heart, and why a randomized trial found lifting without steroids beat steroids without lifting. Plus: the blood test that catches heart risk your cholesterol panel misses.
Dr. Kohler returns for his second appearance (his first, on erections, testosterone and muscle mass, is one of the most-watched episodes in the show's history). This time: why men's longevity is roughly 50 years behind women's; the Princeton IV consensus he co-chaired, which treats ED as one of the strongest predictors of a future heart attack and points young men toward a coronary calcium scan; the 0–12 ceramide blood test that changes with your behavior; how to get a testosterone baseline that actually means something; what redlining to 2,000–3,000 does to the heart, the set point and the skin; Peyronie's disease, Viagra vs. Cialis, the pills-to-implant ladder, sexual rehab after prostate surgery, and a patient who got stronger with zero testosterone.

About Dr. Tobias Kohler
Tobias S. Kohler, MD, MPH, is Professor of Urology at Mayo Clinic, a fellowship-trained andrologist with 25+ years of clinical and surgical experience and 250+ peer-reviewed publications. He co-chaired the Princeton IV Consensus Guidelines on ED and cardiovascular disease, co-founded the EROS penile implant registry, and co-edited Contemporary Treatment of Erectile Dysfunction (2nd ed.).

🙌 Thank you to our sponsors:
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📺 Watch the “Dr. Gabrielle Lyon Show” every Tuesday at 9AM EST:
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📱 Connect with Dr. Gabrielle Lyon:
Instagram: https://bit.ly/4uk9adc
TikTok: https://bit.ly/3OFK3kJ
X.com: https://bit.ly/4l3YlaX
Facebook: https://bit.ly/3MBrJso
LinkedIn: https://bit.ly/3N1nrdL
Website: https://bit.ly/3NdV2kT
Books: https://bit.ly/4r6ugZK
Newsletter: https://bit.ly/402QCAj

⏰Chapters
00:00 Men are dying earlier than women the penis is the check-engine light
03:26 Boys stop seeing doctors for 20 years the case for an Office of Men's Health
10:57 Princeton IV: ED predicts heart attacks, calcium scans, and Cialis
12:44 The ceramide blood test your cholesterol panel can't replace
20:37 Cardiac risk calculators, statins, and what your LDL should be
25:38 GLP-1s, fertility, and "what's the risk of doing nothing?"
29:05 Testosterone: the ~500 target, why 1,000 runs hot, what 2,000+ does to the heart
31:44 Check your testosterone at 25 and why steroids won't make you a pro
36:57 Tolerance and the new set point redlined men can't escape
38:13 The 1980s trial: lifting without steroids beat steroids without lifting
42:06 Steroid cocktails, arrhythmias, irreversible side effects, and the sarcopenia trade-off
53:04 Peyronie's disease and Viagra vs. Cialis
57:32 Penile implants: the knee-replacement analogy and the pills-to-surgery ladder
1:02:27 Sexual rehab after prostatectomy and the questions to ask before cancer treatment
1:07:55 Closing: be proactive and the patient who got stronger with zero testosterone

Disclaimer: This podcast is for general informational purposes only and does not constitute medical advice or create a doctor–patient relationship. It is not a substitute for professional medical advice, diagnosis, or treatment. Do not disregard or delay seeking medical advice because of something you heard here.