Dynamic Dialogue with Danny Matranga - 256 - Women's Physiology Deep Dive: PMS, Birth Control, Menopause, Etc.

Episode Date: January 18, 2023

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And in this episode, we will be covering a variety of topics specific to optimizing women's physiology for health, performance, body composition, and more. This is a compilation of three separate interviews I've done over the course of the last 24 months with two experts that I absolutely love to go to for any questions I have on women's physiology. There's a series of three conversations that will follow in this episode. The first of two are with Lyle McDonald, where we discuss birth control, PCOS, body composition, menopause, and the various phases of the menstrual cycle, followed by a discussion with Dr. Kyle Gillette, where we discuss many of the same issues. Now, one of the things I think is fascinating about this episode in particular is it will be an extremely long episode that I hope will operate as a reference for many of you and also for myself. It's not uncommon that I am asked

a ton of questions about these specific components of female physiology, and I'd love to be able to reference one podcast that covers all of them. So if you're a woman looking to optimize your health, performance, body composition, a personal trainer, or a fitness coach who works with women, or you're a fitness enthusiast who's trying to encourage more women in your life to get more active, this is an episode worth listening to. Thanks so much for tuning in and enjoy. Welcome back to the podcast, everybody. This is your host, Danny Matranga. And today, we are sitting down with Lyle McDonald. Lyle is one of the industry's most sought after authors and experts. And this guy really has a handle on

all things exercise physiology and training. But today we are diving into a topic that I'm particularly excited to share with you, which is women's physiology. Now, while this might be a little bit dense and perhaps scientific at times, I strongly encourage you to stick with me. Lyle has the ability to talk about things at a very high level, but he does tie them all together quite nicely. Today, we talk about everything from the menstrual cycle to birth control to PCOS, even the history of women's sports. This is a fantastic episode, and I promise if you stick through it, you'll love it. Thanks so much to Lyle for coming on and enjoy the podcast. So Lyle, how's it going, man? Very well. Thanks for having me. Excellent. No problem. I've been looking to get you on for a long time. I've listened to most

of your work, read much of your work. And for anybody listening, who's not familiar with Lyle's work, Lyle has kind of been in the fitness internet space, probably as long as I've been alive. And quite frankly, contributing some pretty damn thorough work. You've got several books, several articles, a lot of just really, really detailed stuff that I think you could find. You can't really find somebody who's covered as many topics with so much breadth. So I really do appreciate you coming on. But today I want to talk a little bit about female physiology because I think you speak to this as good, if not better than anybody I've heard. And one thing you've said many times that I really, really think resonated with me and will resonate with the listeners is women are not just small men.

Too frequently they get trained that way or they get, they're, you know, exposed to that type of just general talk in the industry. So what would you say about that? You know, women are not just small men. What does that mean? And expand on that a little bit. Well, a lot, I mean, make, no, I'm pretty sure I didn't come up with that line. Like I've seen other, there's another little terribly written book called They're Not Boys, which is aimed at sort of adolescent athletes. But what I'm getting at is, if you look at the history of of sport from the early days, you know, women didn't really enter sport to a great degree till the 60s and 70s. And what's really actually interesting, there's a I have got a brief history of women in sport on my website.

I look sort of looked at this like you look at the first Olympics in 1896. There were I think it was either zero or one woman. in 1896. There were, I think it was either zero or one woman. There were like four at the next one. And it wouldn't really be till the 50s and 60s till that really started to change. And what's interesting is that it was the Germans and the Russians that were really pushing for more women in sports, because this was about the time that the Olympics was becoming about politics. We were in the middle of the Cold War. They wanted to make the Olympics, whoever won the most medals had the better political ideology.

I know this sounds ridiculous, but that is how they thought. Given the general, given the lesser numbers of women at the elite level, the Germans and Russians, or the Russians especially knew that it would be easier for them to win medals. So not only did they throw more resources into women's sport much earlier, they pushed the Olympic Committee to add more

women's events, because they just wanted more chances to rack up gold medals. And that would end up getting Britain and America to go, well, we're losing politically to the Russians. We need to get more women in the game. It was really, and you look back even further, there were German countries that were having all women's sporting events, long before, you know, more Western countries were doing it. So things in America really changed in the 70s, and with something called Title 12. And at this, because at this point, the ratio of women, of women to men in sport was like one to four. And the question then became, is it a lack of interest? Is it a lack of accessibility? public universities must allow equal exposure to both men and women to all and that just it wasn't just sports it was art it was music they had to have equal amounts of accessibility but that

included sport and women's sports exploded and within a decade it was it was obvious that the reason women or even younger girls weren't entering sport was it just wasn't available. It wasn't a lack of interest. And once they had access, the numbers came up and up and up. And now if we look at the modern era at the Olympic level, it's about 45% women. And this is true in like, it's not quite parity. It's not quite equal. And I think that's because there are certain sports that there just aren't women's versions of in America American football will always skew the numbers but if you look at the grand majority of sports it's about equal one thing I've seen in the industry in my field over the last 25 years is the change in the strength sports look at power lifting look at Olympic

lifting look at even strong man, strong woman, strong person. I don't know what they're calling it now. Back in the 70s, if you saw in the 80s, if you saw a woman at a powerlifting event, like Jan Todd was married to Terry Todd. She was the first in the 70s, only because her husband was involved. Now, they're holding women's only powerlifting events in Texas. And in other, I know in other. Now, there's a, they're holding women's only powerlifting events in Texas, and in other, I know in other places, because there's enough interest. It's been a real, but anyway, the consequence of this was, up until the last couple of decades, most athletes were men, most coaches were men, and realistically, most research was done on men. And that's still the case,

unfortunately. It's something like 80% of research is still done on men compared to women. And in sports, that's always, it's changing. We're seeing, I'm seeing proportionally more research done on women. So, but what that all meant was all the training concepts, all the training ideas were basically developed by men for men. And when women entered sport, they just said, well, we'll just do the same thing. We'll just treat them essentially like smaller, weaker, slower men. in some ways there is truth to this, right? A lot of the differences between women and men do come down to just differences in body composition, right? On average, women have between 8% and 11% more body fat, between 8% and 11% less muscle mass. And this is comparing athletes at the same level, right?

Obviously you can find an elite female that will stomp a recreational male, but we're talking about the highest level. And if you look at the performance differences, they tend to average about 8% to 10%. So there is a primary component of body composition, but there are still profound physiological differences. And what these come down to fundamentally is hormones. and what these come down to fundamentally is hormones, right? If you look at little boys and little girls before puberty, their physiology is pretty much the same. Their performance is pretty much the same. Like there's slight differences. Younger girls have a little bit more body fat than boys even before puberty, but it's about the same. And when puberty hits, that's when the changes occur. Boys under the effect of testosterone gain lean body mass, tend to lose body fat.

Performance goes up. Women, due to estrogen or progesterone, as they start their menstrual cycle, tend to gain more body fat. Women also have differences in how their muscle is distributed, and I'll come back to that in terms of they tend to carry more in their lower body proportionally less in their upper body. And going back to that performance difference, things like running and cycling, the difference is about eight to 10%. In jumping events, women are significantly further behind men because they're having to move basically because you're having to project your body weight. And since they carry more fat, it hurts them much more. And in upper body dominant sports, kayaking, shop hooding, discus, the difference is also much greater because of this differential in upper body muscle mass. But once that happens, and that's when you see the performance differences really develop as

a puberty. At that point, the highest level men are about 10% faster, stronger in terms of performance than women. So it happens at puberty. But that's still a body composition thing, right? So still at a first approximation, we don't see big differences. But there are some. Well, let me back up. And there's reasons for this. If we were to take a woman's muscle and a man's muscle and put it under a microscope, they're mostly the same. There's some slight differences. Women's muscle tends to have a little bit more fat stored in it than men's. Some studies suggest there's differences in fiber type that are called slow and fast twitch muscle fibers. Even that data sets are really variable. Like on average, that's true. On an individual level, it's not.

We took a woman's heart, put it under a microscope. They're identical. Women's are simply smaller and or they have less of it. But the hormonal effects cannot be ignored. And this is probably where the big difference is, right? So if you look at a man's testosterone level, it's pretty much the same. Like, yeah, there's small fluctuations. It changes seasonally a little bit. And as we get older, it goes down. But pretty much when a dude comes into the gym, he's the same dude he was yesterday

and the week before. As I put it to pander a little bit, once guys hit puberty, we're basically just the same jackass till our 70s and frequently until then, right? We're just the same. We're constant, which makes it relatively easy to coach. You always know he's walking to the gym. You know his performance. He may be tired from yesterday or whatever it is. By and large, he's the same.

The impact of the menstrual cycle is profound. And let me sketch that out. The average menstrual cycle runs between 24 and 32 days. We assume it's 28, and I'm going to pretend it is just to keep it simple. It's divided into two phases. The middle is ovulation. That's when the egg is released. The first half, which starts with menstruation, it's called the follicular phase.

This is when the follicle, the egg, is developing until ovulation, when it's released. And then the second half of the cycle, from ovulation to right before menstruation occurs, it's called the luteal phase. And that's because when the egg bursts, it produces something called the corpus luteum, hence luteal phase.

All right, so the first half of the cycle, again, day one is the first day of menstruation, just by convention. Estrogen is dominant. Estrogen starts very low, sweeps up to a peak, comes back down at ovulation. That's that first half of the cycle. Now, estrogen is blamed for a lot of women's problems. But if anything, most of its effects are beneficial. It's anti-inflammatory.

It increases muscular remodeling from training. It's anti-inflammatory. It increases muscular remodeling from training. It decreases muscle damage. It controls appetite and hunger significantly. Right before, and right before ovulation is when women, those three or four days, is when women's hunger for both food and drink is decreased. And I phrased that a little oddly because one of the most interesting trivial things I came when I was researching my book, the idea, well, ovulation is for pregnancy and there's other data. Women are more receptive to giving out phone numbers, their hips, like that's when you're supposed to have sex and get pregnant, right? And the biology changes to promote that. There's also a little spike of testosterone right around them, which I think is to probably make women a little bit hornier.

And the researcher proposed that the reason women's hunger for food and drink goes down during those days is so that their appetites for, let's just say, pleasures of the flesh will go up. Wow, interesting. And there's data to that. If you actually, they did surveys and women basically report that when their hunger and appetite is the lowest for food and drink, that's when their sex drive is highest. And so there's something, and it's all under its hormones affecting, you know, neurochemistry and physiology. Yeah, no doubt. Would you say that that three day lead in to ovulation perhaps might be the best window for performance as testosterone elevates and estrogen climbs kind of simultaneously probably that's been kind of thrown out there

that little bump in testosterone and i'll come back to performance because it does frequently vary uh it's a good question and don't let me forget it all right so that's the first half of the cycle generally good things going on um As one thing I wrote about, I think I'm the only one who even came across this data, is if women are going to start a fat loss diet, they should do it in the first half of the cycle. Because that's when again, hunger and appetite is the most well controlled due to estrogen. That's a good way to get a couple weeks of just, you know, forward momentum and positive reinforcement and everything is really easy because in the second half of the cycle is when it all goes wrong. And I want to make it clear when I use terms like

right and wrong and good and bad, these aren't judgmental terms. I'm just sort of comparing them. Even when I say that women are relatively weaker, slower than men, I'm not playing the weaker sex. It's just compared they're different of course it's just in a performance i don't make sure like that's one of those things that is a leftover of decades and again this history of sport article i talk about the fact that they thought that women could not physically handle the stress of sport but it was unwomanly that the marathon would make their ovaries fall out the training would turn them into men and make them infertile. Like there is a century's worth of this stuff, which in hindsight seems really ridiculous and it mostly is, but there are truths to it in terms of differences

in women and men in training. And this is something that when we come out of the data looking just at men, when women entered sport, they started to get a lot of problems, knee injuries, which I'll come back to. All right, second half of the cycle, the egg is released, the follicle bursts, and I just think that's the imagery in my mind. The egg is available for fertilization. The remainder forms the corpus luteum. That produces progesterone. So during the second half of the cycle, right, so estrogen went up and crashed. In the second half of the cycle, here's estrogen, here's progesterone. They both kind of sweep up to the middle to the end of the third week, and then they come back down. And that fourth week of the cycle, when estrogen and progesterone are both going down is typically

when if a woman's going to experience premenstrual syndrome or premenstrual tension in other countries or the full-blown what's called premenstrual dysphoric disorder which is the severe severe form of pms it's typically going to be in that final week now even there huge variability and i'll come back to this. Some women are incapacitated, right? Some women cannot get out of bed. They're in too much pain. Many will experience, or not many, a percentage will experience suicidal thoughts. That's at the very extremes. That's PMDD. That's premenstrual dysphoric disorder. Small percentage, but that belies the fact that for any woman experiencing

it, the percentages don't matter because she's having to live through it. PMS is a less extreme form and there's all, it can be mood swings. It can be appetite changes. There's obviously water retention that's occurring. All kinds of things can happen, cramping. And then some women will go through that and not have a problem at all. And frequently will not understand what's the issue. I don't experience. And of course, as men, we don't have a clue. We may have experienced it indirectly through our relationships, but we don't have a clue about it. And sort of as a random note, this is completely, this is just how I give podcasts.

Friend of mine told me about this company that made bras and it had all of its male employees, like it would hire men and it would make them wear a weight, a bra weight around for several weeks when they started working there so that they would have some conception of what it was like for women with breasts in terms of the body weight, how they move, low back pain, upper back pain, to give them perspective. Now, it's not the same, but it's something. And I believe, well, I believe two things. One, if men had to experience one or two menstrual cycles and the mood changes, all of them, it would make relationships so much healthier because we would stop just being like, can you not do, this is neurochemical, this is bio, and I know some women are like, no, it's

just an, this is a biochemical, neurological, physiological effect. By the same token, women often can't understand men's relentless A, attitude, and B, sex drive. I've known some women that went on low-dose anabolic steroids, and they're like, I get it now. I get it because their sex drive is relentless. They finally understand why dudes are like this. Anyway, I'm off topic. So four-week cycle, first two weeks of the follicular phase, estrogen is dominant, good stuff. Week three and four, luteal phase. When progesterone is dominant, progesterone is really what causes most of the problems.

It is directly involved in fat storage, specifically in the lower body. These hormonal changes tend to increase appetite and cravings during this part of the cycle. Progesterone not only has its own negative effects, but blocks the effects of estrogen. So you're blocking estrogen's anti-inflammatory effects. You're blocking estrogen's positive effects on muscular remodeling. Mood tends to go down. Progesterone can even increase protein breakdown a little bit. So this is the two weeks of the cycle where I said appetite's typically up cravings are up

now metabolism goes up a little bit but hunger tends to go up further and then of course in that fourth week of the cycle all bets are off right it could be anything from don't experience problem whatsoever to can't get out of bed and on top else, well, let me talk about the dieting thing. This makes the second two weeks of the cycle the worst time to, sorry, the third and fourth week of the cycle, the worst time to start a diet. Your hunger's up, your appetite's up, good luck. I mean, can it be done? Sure. But you're going to struggle for two weeks, which can make it tough to get that momentum, to get that, you know, positive reinforcement of success. Some of you are suggesting, and there's, I think, some truth to this, right? Without getting

off into the flexible eating thing. Since your metabolism, since a woman's metabolism is up by a couple hundred calories, if you are dieting and you want to include a little something, and one paper actually allowed like dark chocolate just like one piece i don't mean eat the bag yeah if that helps you get through those two weeks you've got a few extra calories to play with yeah you have that's one way to project a little bit of a buffer right it's easy to you know not every but whatever but a function of this on top of everything else on top of the mood swings well another big issue is water retention. And this is important for tracking weight loss or fat loss. Because again, for men, it doesn't matter what day we measure. Every Monday is the same as every Monday. Every Friday

is this other than what you are weekly schedule is. For women, every week is different. Typically, body weight will be at its lowest in the first week of the cycle, two or three days after menstruation. It typically goes up a little bit before ovulation. And this is because estrogen makes the body hold more sodium. So if you eat more salt, too little potassium, it tends to be worse. So it'll go up a little bit. And how much it goes up varies. Every woman listening to this knows what I'm talking about. Her numbers may differ from any

other woman's numbers, but she probably, they're probably pretty consistent. In week three, weight typically comes back down a little bit. One of the things progesterone does do that's nice, tends to clear up the skin, tends to cause a loss of water coming out of that bit of it. And then in week four, that's, if a woman is going to retain a lot of water and have a body weight spike, that's when. Because again, these crashing hormones, the body starts to retain more sodium if you're eating a lot of salt, which you probably are because your cravings are off the map or can be off the map. So if a woman is trying to track her weight, let's just say weight loss. We know that weight and body fat aren't the same.

We all know this doesn't change the fact that we all live and die by the scale at the end of the day. I do it. Even I've known hardcore athletes and physique athletes, they all know better. They still go crazy when the scale goes up, right? This is not, this cuts across all neurotic dieters, men and women alike. So a woman starts your diet on week one, right? She tracks her weight, which is still a good metric if you use it correctly, doing everything right. Two weeks later, her body weight's up two pounds or a kilo. I don't know if your listeners are US or non-US. And she goes, what the hell? I'm doing everything right. My coach gave me this. He said it would work. What the hell?'m doing everything right my coach gave me this he said it would work what the hell and then week three comes back down cool diet's working and then week four it all goes

wrong well i've been dieting and exercising for a month and my weight's up four pounds screw this yeah it's a real real it's, it's a mind game. Yeah. And what that means is that while this dude can technically track his results week to week or every two weeks, women have to wait a month. You have to compare the same week to the same week. Week one, three days after menstruation, whatever you pick, week one to week one, week two to week two. So women have to wait longer under those conditions. And what you, or or you what you can do

track for a couple of months see what your normal patterns are and you just have to adjust it if you know that your body weights up three pounds roughly kilo and a half right before ovulation you just got to factor that in and generally i just say just don't get on the scale week four just just don't nothing good can come of it by and large, just track weeks one, two, and three, but you have to be comparing. This is not something men deal with. No, I love the women with it. And it, it, it is, it's a, it's a head game. Um, and even measuring body composition, many methods will be thrown off by water retention, right? If you're using a tape measure, which is another good way.

Well, every woman listening to this, or most women, know, you know, they're called cankles. They know that their lower body, their calves and ankles will swell. And it's water retention. It doesn't make it suck any less. And don't hear me as ever being dismissal. I'm not saying, oh, it's only water. It's only waterway.

It doesn't change the fact that it is mentally stressful. Yeah. Those don't fit right. You don't feel it is what it but you throw a tape measure around there it's going to go up even doing everything right but uh biological impedance will be impacted because it's measuring water in one direction the other calipers may be so even tracking actual body composition i just saw a paper that dexa right dual energy x-ray absorptometry, if you drink a ton of water right before it, it will overestimate your lean body mass and underestimate. Water can throw up all of these. So if you're tracking body comp or taking pictures or whatever you're doing, you have to be consistent. So there's one major issue in terms of body composition. There's also the performance issue. Now, some women don't know that, again So there's one major issue in terms of body composition. There's also the

performance issue. Now, some women don't notice, again, there's huge variability. Some women don't notice any difference across the cycle. Others notice small differences. And other women, enormous differences. I'm embarrassed to say about 15 years ago, I had a significant other, and during week four, her performance would crater like literally couldn't lift like weights that used to be warm-ups and me being an idiot male coach went what do you mean you can't lift the lift the weight what's wrong with you because even then i had my head on my own butt until i watched it and watched it went okay started looking into it then and i was like, ah.

And then I adjusted her training based on, and what I found was that in week four, her coordination went out the window. Her strength was down. Her performance was down. So I would just make that an easy week. We would go far. We would just go goof off and do machines at 60%. And then as soon as she started,

she would come back and she would hit PRs in three days. But I had to track that pattern. Yeah. Now I would say if there's a common pattern, typically women are usually pretty strong within a few days after menstruation. My experience has been that's when performance is the best. There's variability. Typically it goes down a little bit right before ovulation, which is a little weird.

A testosterone spike should help, but you've got a lot of other stuff going on, right? If you're training someone who's in what I will call a gravity sport, right, where they're having to move their body weight up against gravity, whether it's jumping, running, riding a bike up hills, climbing, a few pound, kilo and a half body weight increase can wreck performance right anybody that can do chins you can do like you can do five or whatever with body weight and your body weight's up two or three pounds one like it makes a stat so that is that is a factor typically so it may go down a little bit right for ovulation may come up a little bit again right after probably

due to that testosterone a little bit delayed effect and then if it's going to be bad usually the worst week will be week four yeah women's coordination can go out the window so if you're doing very complex activities you might not be able to do it or you might have to do it very light right uh their performance just generally may be down. There is also the psychological component. And I want to tread very carefully here with my words. Because again, I don't want people to mishear what I'm saying, right? I'll give a better example.

I have a therapist, or did at one point, and we talked about this when I was writing my book. And he goes, yeah, when I'm, when I'm, when I have male patients, I know who I'm getting every day. When a female patient comes in, I won't know till five or 10 minutes in. And if all of a sudden, a conversation that was normal the previous session has her in tears, well, that's who I'm has her in tears, well, that's who I'm treating today. I'm not saying he's treating her negatively or judging. As a coach, we're doing the same thing, right?

Now, there's a lot of auto-regulation. You look at him, you go, okay, yesterday you looked great, and today you look like just a hot mess during your warm-ups. And we adjust the training. But what you may see with many female trainees or female trainees may see in themselves is a very systematic repeatable pattern. Yeah. So I just want to jump in here because I think this is absolutely fantastic, particularly because so much of this is multifactorial. It's societal, right? It's baked into the hardwiring of American sport, American

physical culture. Women not really being included into much of this stuff until, like you said, the 70s and 80s, at least at a recreational level, let alone at a high level. Right. That's within the last two, maybe two and a half decades. It's very recent. So you don't have a lot of education around it. For many of the women listening to this, they might be aware that they have these fluctuations but they've never had them qualified or quantified in the way that you just did. So, that's massive particularly because to the point you made, even a coach who's quite qualified and maybe has tremendous success with some clients might be annihilating his female clients simply because this stuff just isn't out there,

at least at the level it probably should be given some of this hardwiring and underwiring that's going on. Yes. So what are, given that to the point you just made, some of these things are repeatable. They become patterns that you can observe. What are some things that a female who perhaps doesn't have a coach can do with auto-regulation, with training strategies to kind of work with this built-in physiological hardwiring that men just simply get to say, fuck it, I'm going in, I'm going to the gym. Yeah, I'm going as hard as I can. Okay, so I just want to back something you mentioned that is still a problem. Most strength coaches are still men.

Yeah. It is a field that is dominated by men. It is changing oh so slowly. And there's also, I think, a big difference depending on the – at the higher levels of sport, right? Once you get into beyond the recreational, even the high school level or junior high i think you're seeing more attention to this there is also an unfortunate issue at the highest

levels of sports once you introduce the anabolic steroids you can train the women like men anyway uh years ago i read something that the chinese coaches originally trained the women differently than the men according to menstrual cycle and then they didn't i'm aha, that's when they brought the hard drugs in. And we'll come back to that when we talk about PCOS. I don't want to spend too much time on this. But at the lower levels of sport, you have, you know, let's face it, a lot of high school coaches or strength coaches, they're just the guy that played sports. I mean, it's just, I've seen some really appalling papers that looked at this, at like strength coaches at the high school level. One of them, the female coaches when they existed were less likely to have this, to be expected to have the same academic credentials.

The female athletes were not given anything to do during the summer because a lot of people still just don't take women's sports seriously. Yeah. And it's not right, but it is right. I'm not saying I, and it's changing, but it's changing very slowly. Like we we've kind of opened Pandora's box in this. That's a really bad comparison because Pandora's box was bad. We've opened the window on this because now that the trend is starting, once women got into sport, it can't ever go back. Yeah. Because, and this even started in the 70s. You go back and look at some of those pioneering female athletes, Martina Navratilova, oh, who is the other? There were several that they were completely, complete outliers,

and they pushed hard for the inclusion of women's sports. And as more women came in, their daughters, the younger, saw that and went, wow, you mean I can do that? You mean that's a thing? And then they got into it. And now we're a couple generations deep. And same thing, as women are entering coaching. And some of the greatest female sports teams' coaches were women.

I think UT Knoxville had Summer had some summer yes thank you which an aunt of mine had an absolute like crush on she was one of the most winning coaches in history yeah because of how because she had she knew how to handle the female basketball team and so that's changing and it's getting better a lot of this information still hasn't really. So anyway, your question, how can, what can women do with this? Well, one is I can speak in generalities and I can speak in averages, but that will not describe any individual woman's experience. Like I said, some women listening to this are like, this guy's full of shit. I don't experience any of this.

And others are like, oh my God, you mean when my coach told me I was being lazy, it was my physiology telling me, right. And I'm not saying either of you are right or wrong about that. It's just every woman is going, there's so much more individuality. So what I would generally recommend, and I saw a paper about this, they took high school soccer players, female high school soccer players, what they did is they gave them the same workout for a month, identical on whatever the workout was during the week. They just repeated it. And they looked at things like rating of perceived exertion. I'm sure they looked at like heart rate and things of that nature in soccer. But that's other than just noting it, that's probably the best way to do it. And everyone will have to be your own best scientist or their coach or both ideally. Ray, you know, how are you feeling? What's your motivation? Is my body

weighed up? But if you do, let's just say, give yourself the same workout. Let's say you're just, you're a strength trainer and you typically do a weekly workout split of whatever it is. Just keep everything static for a month and record. Was there a difference in how difficult it was, right? Did I have to work harder this week? And again, there's other barriers. Did I sleep well? Did I eat enough?

Am I stressed out because we're in the middle of a global catastrophe? There's a lot going on, but track that. And what you may see, right? So like, let's say here's here's the workout right and i'm going to use that generic pattern i described in week one let's say it's like here's the workout and it's this easy right here's the difference like you could have done this much more now in week two maybe you're not as strong, you're a little bit closer to your limits. Week three, maybe it gets a little bit easier.

And then week four, you may even find that you go in and you can't even complete the workout. Well, you've just established your own pattern of strongest, little weaker, stronger. Oh, my God. Yeah. And that would be a way to get, I mean, mean, you can always, you can auto-regulate. That can take some practice on an individual day. Go in. How do I feel? Warm up. I mean, I've told people that before. Frequently, the best workouts you have are when you feel the worst. Yeah. You go in and you warm up and you feel, and I go, warm up. And if you still feel like dog meat,

go home or do an active recovery and go home. But once women identify these patterns, I think they're more consistent than not. Now, what I think of general experience, and let me back up to some research. If you read the research on menstrual cycle and performance, it generally says there's no effect. There's no over. The problem is if I take 10 women and five do fine and five get cratered, the average is zero.

Yeah. They're also typically looking at endurance sports. Now, endurance sports are a whole different thing because most endurance training is submaximal. Even when I felt terrible, I could always go put in two hours on the bike. You can always do it. When you're looking at more maximum levels of performance, it's very, very different. Right. So bodybuilding training, right?

Let's say eight to 15 repetitions. Even if your strength is down a little bit, you can probably get through the workout. It may take a little, it may be a little bit harder, right? But if you're normal 100% and you're training at 80% and you're down at 90%, you can do it. It'll suck more, but you can do it. If you're looking at a power lifter, an Olympic lifter, someone doing that maximal effort, right? Let's say you're trying to do triples at 90%. So here's your week one. You can do that.

Week two, if your strength is at 90%, that's an impossible workout. It's what was a triple is now a maximum. In week three, maybe you're at 95%. You might get through it. And if in week four, your maximum is down to 85%, you can't even do one. So I think you tend to see a lot more profound differences at the higher ends. And that's what you also see when you start looking, you know, if you're looking at interval training, sprints training, that's when you see the big differences. When you're trying to work at 100% output, if your normal 100% is at 90%, you can't do the workout.

Physically, you cannot do it. And once you get that pattern, well, let's say you're a power lifter. You know, you're strongest, a little bit weaker, stronger, and everything goes wrong. Well, this is your heavy week. This is your light week, moderate week, moderate heavy, and this is your – make that your deload week. Yeah. Boom.

Now you have found a way to adjust your training because you can't adjust your physiology to your training, right? That's just the thing. If this is your pattern, we can't fix it it and i hate to use those terms because it's not it's not a problem it's not broken but we can't change that physiology short of putting steroids in or birth control and this will make the transition yeah does affect this what we can do is fit the training or the diet to your individual response no i quite like that like that. And there's actually, there's one paper, this came out after I did all this work on diet,

where I came up with my whole premise, which real briefly, women tend to use more carbs for fuel in the first half of the cycle, less in the second. So you can eat a little bit higher carb diet week one, a little bit lower protein stay in you, just dietary fat, and that tends to help things.

And then a paper came out that did exactly what I had come up with and they did find that the results were better because women were better able to adhere to it yeah right because if during the second half of the cycle you are trying to follow this really hardcore diet while your appetite cravings are up you are fighting with your own physiology can it be be done? Sure. But if that's not working, if that's failing, you can adjust the diet to fit your individual physiology. And in the long term, that works better. But first, you have to identify your own pattern. No, I quite like that, particularly in regards to strength sport or high level power work like sprinting or track and field. You're looking at a situation where essentially the first

two weeks of your training are somewhat similar. There's a drop off from week one to week two. Yeah, but it's not major. Yeah. Yeah. And then you get a little bit of a bump in week three. So, you can front load the higher intensity work followed by a pretty consistent deload. And I don't think it's unreasonable to say, hey, you go about 21 days of moderate to high training and you you take about seven days off. Yes. And then go ahead. Yeah. With, with hypertrophy training, the first two weeks of the cycle, you're perhaps a little bit more sensitive to carbohydrate, which lends itself great for that glycolytic type, higher volume work. Yep. And maybe you front load your volume and then perhaps you, you add in some intensifiers or things on week three where

you're maybe not as glycolytic, but you have the ability to really push and then you fade and you drop off towards the back end, which for most women, what I found is the exact opposite of how they train intuitively because there's a goal to consistently do more, again, multifactorial, baked into the societal underpinning of how everybody thinks they need to be better, better, better. Absolutely, yes. And it sounds to me like working with your physiology in the long run is going to be exponentially more healthy and more fruitful for your gains than simply pushing, pushing, pushing with the goal of getting better every week. Because it's just not built that way physiologically. Yes. And on that note, just briefly before we transition, there are about five or six studies that have looked at adjusting weight training to the

menstrual cycle. And with the exception of one, which is like a weird blood flow restriction study, what they found is that the growth and strength response is generally higher in the first half of the cycle. So what they do is they're like, okay, you're going to train five days a week, the first two weeks of the cycle, and then once a week in week three and four, or we're going to reverse that. We're going to do five days a week in the second half of the cycle. And then one just distributed three, three, three, and three. What they find is that there's like a 30% or greater increase in muscle growth and strength front loading that volume into the first two weeks.

Even compared to a more, and I'm not saying that women are not getting gains in the third and fourth, they're not getting as much. And sort of to your point, right? There is this mentality, I have to be better every week, or every day or whatever it is. And in some cases, like I said, and some men can do that, at least briefly, right? And women are fighting with an inherent physio. And again, also, if they've been told that, ah, you should always be able to just suck it up just butch up there if they're a woman that in the fourth week of the cycle are really decimated physiology they're going to be that much more decimated when they're told

you need to suck it up and go yeah and physiologically not psychologically as much but physiologically they can't do it. You're telling that you basically, you're just telling them to do something that at that time, the body is not physically, you know, it happens with over-trained athletes too. Athletes dig themselves too deep in a hole and the athlete themselves is, okay, I'm underperforming. I should push harder.

And their coaches are like, why are you so slow? Why are you so lazy? And they are trying to do something that they are physically at the moment. Whereas what they need is to listen to that and take a few easy days or take the easy week and come back. And then there'll be that much. It takes a while to learn that lesson. Hey, guys, just wanted to take a quick second to say thanks so much for listening to the podcast. And if you're finding value, it would mean the world to me if you would share it on your social

media. Simply screenshot whatever platform you're listening to and share the episode to your Instagram story or share it to Facebook. But be sure to tag me so I can say thanks and we can chat it up about what you liked and how I can continue to improve. Thanks so much for supporting the podcast and enjoy the rest of the episode. All right. So birth control is insanely complicated. And I'm going to try to give a very short version of this in as much as this is possible. So birth control fundamentally provides synthetic versions of women's hormones, right? There's a synthetic estrogen, although lately there's at least one version that uses a bioidentical form. And I think as we go, that will become more common. And then there is a synthetic form of progesterone called a progestin. Now the estrogen is easy. They have typically used something called ethinyl estradiol.

It's about five times more potent than estrogen. Back in the original early days of the pill in the 70s, they used very high doses. Now they use very, very tiny doses, usually between about 15 and 25 micrograms. Where things get complicated is the progestins, because there are at least eight different kinds across four different generations based on when they were developed. four different generations based on when they were developed. So first, and they vary in their potency, in their effects in the body, because a very complicated thing about progesterone is it can act like other hormones in women's body. It binds to the progesterone receptor.

But because of how it's structured, it can bind to the receptor that normally binds testosterone, the androgen receptor. It can bind to the cortisol receptor, and it can bind to the receptor involved normally binds testosterone, the androgen receptor. It can bind to the cortisol receptor, and it can bind to the receptor involved in water balance. And each generation tends to hit those differently. And this, it impacts on their overall effects, their side effects, everything. Now, the ones I'm going to focus on in terms of performance have to do with its effects at the testosterone receptor, okay? What's called the androgen receptor. The first three generations

of synthetic progestins are androgenic. That means they bind to that receptor and send some sort of signal, right? And that's why if you go back to early types of birth control were notorious causing acne, which is a common effect, right? Androgenic just means those are the masculinizing effects, right? It's why men get body hair and acne and oily skin, and this can happen in any, whenever you increase androgenic signaling. Women who take steroids often get that. Women with polycystic ovary syndrome, which hopefully we have time for, can get that. The newest progestin called drospirinone, it is antiandrogenic. So it binds to that receptor but either blocks the normal signal or sends the opposite signal. Women love it.

It tends to clear up the skin. It tends to make the skin less oily. It often causes a little bit of weight loss, although it's dehydration. Found in Yaz and Yasmin are two of the brands. And tends to make the skin less oily. It often causes a little bit of weight loss, although it's dehydration. Found in Yaz and Yasmin are two of the brands. And I don't know, there's a million different brands. Okay, so here's where it gets unbearably complicated. First, we'll just talk about

oral contraceptives, the pill. Technically, oral contraceptives, well, all forms can either be combined. They have a synthetic estrogen and a synthetic progesterone, or progesterone, progestin only. There's no such thing as estrogen only birth control. It is used for like hysterectomies, they'll use that for hormone, but there's no such, so it's either both or progestin only. So we look at combined birth control, the pill, the majority of them are combined. They have both synthetic estrogen and progesterone. There's one

called the mini pill that was a progesterone only. I don't even know how much. Usually that's used in cases where women can't medically take synthetic estrogen. I don't know exactly medical stuff. Originally, oral birth control was taken 21 days on and seven days off. It's called the withdrawal period. Now here's a super bit of bizarre trivia. There is no reason physiologically for that week off. It's called the withdrawal period. Now here's a super bit of bizarre trivia. There is no reason physiologically for that week off. Back in the 50s when this was being developed,

scientists, mostly men of course, but some women, basically felt that women would feel more natural if they bled for a week. And the bleeding from birth control is different than a normal menstrual cycle, but there was no physiological reason for it. And in recent, in more, the more modern era, most people take it continuously. You just don't go off. And that's become far more common. Yeah. Now, even there, most birth control is 21 on seven off some are 24 4 and i think there's a 26 2 so that's just oral birth and they all vary in slightly in how much synthetic estrogen but what type and how much of the progestin are involved and there's just dozens of these things yeah all right so that's oral birth control. Now, tends to be very effective,

but there were problems practically. You have to take the pill about the same time every day. Women would travel and forget. There were reasons that it wasn't ideal. So that led to the development of other forms that were meant to be sort of easier. So one is the patch. Patch is just a topical. You put it on once a week and you wear it three weeks on, one week off. I think they're using that continuously, but don't swear me to that. I won't. There's the cervical ring. Yeah.

Same thing. It is inserted into the vagina. It releases hormones, and it is also used once a week. I actually know you think you wear it for three weeks straight. Maybe it's three on, one off. Don't remember offhand. But these are basically, now we don't have to worry about it daily. We just worry about weekly.

All right. There's the shot, Depo Provera. Depo Provera is a once every three months shot. And if I have time to cover it, I think it should be taken off the market. It has all of the worst side effects of any of these compounds in terms of weight gain, can impair bone mineral density. Its only advantage is that it's easy. It's one shot once every three months, and then you're done. It's easy to go off of. You don't want to stop taking it, you stop taking it. It uses a very high dose, very early generation, very harsh

progestin. It's been in use for 50 years and I don't know why they haven't developed anything else. I don't. That's my least favorite. Yeah. There's, there is the implant originally called Nexplanon and now called Implanon. It was a little plastic thing, small incision in the back of the arm. It releases the synthetic progestin, much less harsh than Depo, for three years. So if you know that you want contraception for three solid years, for whatever reason, I'm not going to talk about why women use birth control for any number of reasons. Frequently, it's for just to prevent unwanted pregnancy, but it may be to control their menstrual cycle. I've read that some women will use it to control their cycle so that,

and this is going to sound horrible, but it's what I've seen in the literature, and what women report so that they are not menstruating when they're, say, on vacation or on holiday, and you can just take that where you will. It's just a reality, right? To control mood, it's used in severe cases of blood, Like there are reasons that are not just, many athletes will use it to regulate their cycle. Yeah. Because going back to the menstrual cycle, imagine you're a high performance athlete at the Olympic level, world championship.

You have trained your ass off for years. And that championship, that Olympic qualifier, that Olympic trial falls in a week of the cycle where you've already established that your performance is shit. Yeah. What do you, you know what?

Tough. They don't get to reschedule that. Even weight class athletes. If you're trying to cut weight and make weight for powerlifting, Olympic lifting, if that competition falls in a week where your body weights up, you got to work that much harder. Yeah.

What's the answer? Tough. That's it. Birth control is often used to regulate that interesting so that's that's the implant on next one on three solid years uh finally is the hormonal iud right there are there's a there's a there's a non-hormonal iud it's a little copper t-shaped thing yeah it is a minor surgery they They insert, basically blocks the tubes. The sperm is just a barrier method, but there's also a hormonal version that releases synthetic progestin locally. Now the hormonal ID is interesting. All the other forms release hormones into the bloodstream.

And they work through two main mechanisms. One is simply to shut off women's normal hormonal cycles. Yeah. Basically to prevent the egg from being released in the first place. No egg, no pregnancy. Yeah. The synthetic progestin also thickens the cervical mucus. It makes it more difficult for sperm to get in there. And the mini pill, which is that progestin, is one of the least effective. Interesting. It's not strong enough to shut down ovulation, it but i don't even know how much it's used it was a very early development the hormonal iud is totally local yeah women will still have a menstrual cycle they will still have the normal hormonal fluctuations because the

hormones don't get into the bloodstream all right so those are all the major types they all use some of them are combined some of them are progestin only generally the longer acting forms are progestin only for reasons but they all yeah they all contain progestin yes period end of very types yeah and but that's the piece that essentially says to the body no egg drop uh well kind of what it is is that without getting so the the hypothalamus the pituitary which are controlling hormone release and something called fsh follicle stimulating hormone and lh luteinizing hormone those get shut down okay basically the follicle it's just like in men men take steroids and shut that down and and just things they stop producing sperm and all

that so but they they they just always there's always a progestin present i think i think some of it it might be related to cervical cancer don't swear me to that but for some reason estrinol doesn't get the job done okay so but the difference is they each have different types of progestins depo provera is that harsh first generation yeah the others use either second or third. To my knowledge, there's no long acting form that uses that fourth generation. Yes, they'll probably develop it. So this brings us to the two big questions that women always ask, body weight and body fat and performance or trainability. Let me do the first one first, the body weight and body fat first there is an old idea that

birth control causes an increase in body weight it's been around for decades and it was certainly the case with the first generation now they've and a lot of that was estrogen causes water retention so frequently there's a weight from that and that alone now if you look at the studies big big meta-analyses if you look at the average weight gain from birth control it's usually a couple pounds average and that's the key word so you look at the individual studies the range is staggering found a couple papers that looked at like different forms in one study the the biggest weight loss was like 32 pounds. Wow. The biggest weight gain was over 60 pounds in a year. Unbelievable.

30 kilos. But part of one of the things they see is that you see the same variation with non-hormonal athletes. So again, I don't want to sound, I'm not dismissing any individual woman's experience. And some physicians feel that one out of four women are more prone to weight gain than others. And some physicians feel that one out of four women are more prone to weight gain than others. It seems to be more lifestyle related because there's like two studies in athletes who are presumably controlling their activity, controlling their appetite or controlling their food intake. You don't see these changes generally, but there is huge variability.

Now, Depo, the shot, average weight gain, seven pounds, doubles the risk of obesity because it's severe. Like I said, that's the one that I would always, unless there's some really good reason to be on it, I would always recommend it. But on average, now there's another component I forgot. This is about oral birth control. Instead, it gets so complicated, I can't remember it all. control can become in one of four types there's only two that matter what's called monophasic levels of the hormones are the same the whole way through there's something called triphasic where estrogen goes and then it goes up and comes back down but the progesterone goes up and up and up they're trying to mimic

the the standard menstrual cycle the triphasic of the two have the worst because again we talked about this progesterone tends to have very negative effects that high dose week has been shown to cause fat gain over several months when i looked at all the performance studies if there was one type that was absolutely the worst in terms of either decreasing performance acutely or decreasing trainability in the long term making gains. It was the triphasic birth control. So again, that's one that unless there's some really good reason to be on it, if you're going to be on oral birth control, monophasic is the better choice. For making gains. Yes.

So that's the weight gain thing. The triphasic tend to cause some fat gain. The Depo-Provera is the worst of the lot. On average, there's a few pound, which tends to be water, which again, it's easy to go, it's only water weight, but that doesn't reflect the world that we live in. Performance athletes, again, they have to move against gravity. Three pounds when you're climbing, if you're a cyclist and you're climbing a hill, go put a three pound weight in your pocket and watch your power outputs drop, right? Male climbers in the tour are like 120 pounds at five foot eight, right? The lighter, the better. A few pounds makes a huge difference. So saying that it's only three pounds of water

is still missing the point. And usually when women go off it, that goes's only three pounds of water is still missing the point and usually when women go off it that goes away and some of that depends on the dose of estrogen and probably sodium there's probably ways to ameliorate that like i said that drospironone tends to cause a little bit of weight loss but it has its own other set of issues so by and large the effect seems to be on average minimal especially if you're controlling your eating uh and activity levels like so not saying any individual woman might not have a response to it um again huge variability but that's the average seems to be fairly minor mostly water weight goes off goes away when you go off of it except triphasic birth control except for depo

okay performance and gains here's where not only is there not a lot of data but off of it except try phasic birth control except for depo okay performance and gains here's where not only is there not a lot of data but most of it's garbage the stuff especially in endurance training it's a little bit better in the strength training stuff it's so badly done it's like we measured performance of the thumb muscle at different types of like there's a lot of that they do stuff that is just not measuring anything that's important and when i looked at this i wrote a little booklet called birth control and athletic performance to try to get this information out there the studies on like strength and hypertrophy the few that exist are just like all over the map and don't make any sense to me. Some of them suggest that the second generation progestins are better than the third. Another one suggests that the third progestin is better.

Some suggest that it's the estrogen level and there's no really coherent picture. I will say that drosperinone, that fourth generation, is antiandrogenic, right? We know that testosterone is important to responses. Yeah. That one, there's not any direct data on, but I would say that's going to be the worst from a trainability standpoint. That's the biggest gains killer. Correct.

And what is that primarily? You had mentioned this a couple of times that it's not in a long-term form or a, uh, as far as I know, drosperinone is only in oral birth control. Okay. It's only being used in that one. So that, and it's Yaz and Yasmin are two of the primary, primary brands. And it's always, it's entertaining that this is just a whole separate thing. When you look at how stuff is marketed to women versus all birth control, they find these names that are kind of like, it's like Yasmin. It sounds like Jasmine. It's just like it's pink and it's fluffy and it's just like marketing teams are amazing.

Anyway, off topic. So that's probably going to be the worst of the others. And realize when they've done these studies, the differences in gains are not staggering. Right. And realize when they've done these studies, the differences in gains are not staggering. Right? One of the first papers I came across was like, okay, over eight weeks, on average, birth control inhibited gains compared to control. But we're talking about a kilo here.

We're talking about a couple pounds. Then when they divided it up, they found that one form of birth control allowed, it was, the difference in gains, it was like half the kilos, like a pound over eight weeks, right? So if we're talking about recreational female athletes, we're talking about non-competitive, non-high performance athletes, this may not matter to you, right? The potential benefits of birth control may far outweigh the disadvantage. Now there's a couple other I want to mention before I sum this up. You may gain a little bit less muscle, but if you're not trying to get as jacked as humanly possible and set powerlifting records, you may not get it down, right? You're 5% down. Now, there is an effect that is not talked about nearly enough, and that is because of these hormonal differences, all forms of birth control lower women's

testosterone levels by anywhere from 30 to about 50%. You can cut it in half. Wow. Now, there's kind of an idea floating around that, oh, testosterone isn't important in women, and it's not true. Even small differences in the normal range make a huge difference. And some forms of birth control due to the synthetic estrogen decrease what's called free testosterone significantly. So in many women, some percentage of women experience

a loss of sex drive and a loss of sexual function probably due to this. Now, I don't know what, why it's somewhat, I suspect it's right. Women's testosterone ranges from 30 to 70 nanograms per deciliter if you're a woman at 70 you cut that in half you're still in the middle range you're a woman at 30 and you cut that in half you're the equivalent of a dude with very low testosterone of course things are going to get impaired that can't help performance and that is a consideration and all forms of it do it to one degree. There's slight differences, but they're just not that big. And others have proposed, remember we talked

about the whole spike in testosterone at ovulation. Some researchers have theorized that, well, that may be part of adaptation too. We're going to eliminate that. So there is a consideration there. I know very anecdotally, I know one female power lifter who came off of birth control, her testosterone levels tripled in several months. And she had been stagnant for years and she put like 25 kilos on her total in a year, which doesn't sound like much, but for a small female at the top, that's a lot. I know another female power lifter, of the best her ob-gyn put her on depo pervera and told her it will not hurt your performance and she lost a year of

training because depo takes months to clear because it's so long it's like anabolic steroids it will stay in the body for months and really messed her up so So these are anecdotes. So now we've got a problem. Let's say you're a high-performance female athlete. You see these huge performance differences, right? Because we could also look at it, if a woman loses a week per month of effective training, that's 52 weeks a year. That's a lot. Now, yeah, you can plan that as a deload and et cetera, et cetera, but that is a big impact. What if she knows she's got a competition showing up

on one of her poor performance weeks? What do you go? Too bad? That's not really reasonable when you've spent your career, your life chasing a goal. But then we have the potential of birth control to impair your gains during training. Some women have to be on it. Many women can become anemic due to heavy blood flow from menstruation. They use it for that. What if you have severe, such severe pain, you can't even train for a week. And there may be a medical reason.

Here's a potential compromise depending on what kind of sport you're in. Most competitive athletes have a competitive season, right? That's three to four months long where the main goal is competing, right? Runners, cyclists, strength athletes is a little bit harder. Powerlifters compete every 12 to 16 weeks or whatever. But if you're sort of a traditional performance athlete, well, you stay off birth control during your primary training phases. So you get the most trainability and then you go on during the three months where you have to you want to control or regulate your menstrual cycle for performance that would be a

contradiction or you find the one you know like i said the hormonal iud well it won't affect performance won't affect like trainability because it's local but it also won't take away the monthly fluctuations so it's like there's a lot of pros and kind again i look at this in this little booklet and someone one podcaster finally said okay this is great you have a female athlete or you have a daughter what would you what would you recommend like just get to the point lyle what would be what would you choose assuming you had had to be on birth control and i would pick oral birth control um that had a low dose estrogen actually i'd pick bioidentical if possible bioidentical estrogen doesn't have quite the

same effects on like free testosterone and stuff. And based on what I think is the case, a, which one? I think it's a third generation progestin. They have the least binding the antireceptor, least likely chance of impacting on testosterone levels. It would be that. So it would be a oral birth control used continuously with a low dose of ideally bioidentical estrogen and a third generation progestin. And you can those up the final thing i will mention and i just forgot what it was going to be what was i going to say you were talking about selecting the best birth control sure and i was but i was going to say some uh and i now have forgotten. Oh, yes. One thing that has been studied with regards to this, DHEA, dihydroepiandrosterone, right, is a primary androgen in women. In men, it's pointless.

Women produce androgens in their adrenal cortex, and this is a problem. It is converted to testosterone within muscle cells. Two or three studies have shown that DHEA supplementation will return testosterone levels to normal for women on birth control wow that's pretty 25 to 50 milligrams now can have androgenic side effects of course start low it is a banned substance so be aware of this but that is a way to potentially reverse this if that is an option. No, that's actually really interesting, particularly because DHEA is a testosterone precursor primarily, correct? Yes.

And so much more effective in women whose testosterone production has been impacted than men whose has not. Yes. Well, and also just in men, DHEA just isn't that big of a deal and the difference is very, very tiny. I've got one paper. And in women, DHEA levels show like a linear relationship with leg strength and in men it doesn't have any effect whatsoever so yeah so dhea does stuff good stuff for women but again can have side effects start

with a smaller dose assess your time again if you go that route yeah if you live in australia you're out of luck because you can't get any of the cool stuff i think it's actually a perfect segue talking about testosterone to lead us into pcos which i'll let lyle explain what pcos is but just from yes my standpoint as a coach uh when i first started working in the industry seven eight years ago i didn't know what pcos was and not a lot of people talked about it. And, you know, year after year, the murmurs started to become whispers and the whispers started to become now what I would call a dull roar. And it seems like it's become exponentially more common. People are aware of it. And I've heard upwards of 10 to 20% of women might be dealing with PCOS. So talk a little bit about what it is, how it impacts female physiology, and maybe even if there are pathways for women to find out if

this is something they're dealing with and therapies for it. Yeah. All right. So PCOS stands for polycystic ovary syndrome, which is becoming a rapidly less than accurate name, ovary syndrome, which is becoming a rapidly less than accurate name, and I'll explain why. So PCOS is, it's one of the most common reproductive dysfunctions. Like when women go to fertility clinics, PCOS, I believe, is the most singular, most common cause of infertility in women. Don't swear me to that. It's been a while since I looked at that statistic. Oh, here's what I've got. In fact, roughly 15 to 20% of all women who were found to be infertile suffer from PCOS. It's extremely common and often goes undiagnosed. Now PCOS is diagnosed according to what's called the Rotterdam criteria, because I think Rotterdam was where they got together and decided to work all this out. There are three

primary symptoms that can define PCOS. And if you have two of those three, you are considered to have PCOS. Now, one of them is having multiple cysts on the ovaries, polycystic ovary syndrome. One is hyperandrogenism, elevated androgen levels, and this includes testosterone, DHEA. there's a couple of smaller ones that nobody, androstenedione, that I'm just going to refer to them as androgens. And this can be measured either clinically, like blood work, right? So I mentioned that the average testosterone range for women is 30 to 70 nanograms per deciliter. At the extremes of PCOS, you can see double those levels. You may see as high as 150.

Now, to put that into perspective, the low normal range for men is 300 nanograms per deciliter. Excuse me. So at the extremes of PCOS, women will not approach men's testosterone levels, but they can be double. And I'll talk about why this can be both good and bad. but they can be double. And I'll talk about why this can be both good and bad. It can also be indicated by there's elevated androgen levels tend to cause very characteristic physical changes. And it is masculinization. You frequently will see increased body hair, oily skin, acne. Very common is women will have more of a male pattern, male body fat pattern. It's called central fat patterning where they store more around the gut visceral fat.

So it can be determined by either blood work or by sort of clinical presentation. And then the other end is menstrual cycle dysfunction. One of which is called oligomenorrhea, right? So the standard menstrualal cycle 24 to 32 days oligomenorrhea means one menstrual cycle every 35 to 90 days and then you may also see a menorrhea which is a or an ovulation or a menorrhea which is a loss of the menstrual cycle so those would also but the deal what remember what i said you'll have to have two or three of those yeah so you can technically have pcos without having multiple cysts it's quite a shit name when you really think about it isn't

it well and i think and what happened is i think the original term from decades ago was they saw this first clinical manifestation and there's sort of a push now because what you can get is you can get four different types type one you have all three, multiple cysts, hyperandrogenism, menstrual cycle dysfunction. Type two, no cysts, hyperandrogenism, menstrual cycle dysfunction. Type three, multiple cysts, hyperandrogenism, androgenism, no menstrual cycle dysfunction. Type four, multiple cysts, no hyperandrogenism, and menstrual cycle right these are all different types and i suspect within many years they're going to come up with different that now they're just like different types and the fourth type is one of is the least common yeah um and roughly 60 percent of women

pcos will have elevated testosterone so that is the i mean it's in three of the So that is the, I mean, it's in three of the four, that is the most common. So typically if you're seeing a PCOS client or PCOS woman, but you'll know, you'll see there are these telltale physical characteristics. So they're probably going to change some of the names to distinguish the, but right now they're just different subtypes. Okay, so PCOS has a number of consequences, right? One of them is obviously infertility because you've got this either complete law, either the egg's not being released, you lose the menstrual cycle completely, or there's just this infrequent cycle.

So that's very common. Biprandionism does cause a bunch of negative side effects. However, for athletes, female high-performance athletes, it's awesome. Yeah, I was about to say that elevated testosterone. Correct. And so we go back a little bit. So early days of women in sport, they started seeing menstrual cycle dysfunction and a couple other things. It's called the female athlete triad. And they kept seeing oligomenorrhea, this irregular menstrual cycle.

And they thought, oh, it's all related. And they started looking more and more and more. And they were like, wait, a majority of the women with oligomenorrhea in sport have elevated testosterone. And originally, they reversed cause and effect. They were like, ah, something about heavy training is raising. No, no, no, no, no. The heavy testosterone, elevated testosterone was already there yeah women with pcos are seen at a significantly increased number in high level sport because they have an inherent athletic advantage yeah which has to be weighed against the negatives

and i will say at least initially i think they tended to be found more in the strength sports. There is often, and again, I'm going to tread very, very carefully in my words here. Personality is determined to a degree by hormone levels. And I'm going to use the terms masculinity and femininity in a way that just descriptive. We know what they mean. I'm not using them to say there's these little bitty boxes. I understand that sex and gender are different. I wish I didn't have to make these kinds of qualifications, but this is the world we live in. So I'm going to use these terms,

not as good, just descriptively. When I have trained PCOS women, there tends to be more of a masculine personality type in terms of there is an aggression there. They are the ones that want to push heavy triples in the squat. They are the ones that want to be involved in more combat type sports because the traditional, and again, descriptive only, the traditional girly girl woman, probably not physically built for that, but probably not psychologically wired for that. They're not the ones that want to go see how much they can put overhead. They may very well be the ones that want to go do a figure contest and wear sparkles.

And again, I know this sounds not trying to say what people may be hearing. This is changing. I said this in a podcast one time and someone was like, yeah, that was true 10 or 15 years ago. However, now women of all shapes, sizes, demeanors, and hormone levels are going into all sports. This has really changed. If you look at powerlifting in the 90s and the early 2000s, it was only women of a very certain type that wanted to go to powerlifting. So realize I'm an old fart and I'm very much gauging by what I grew up during. This is very much different in the modern era. So the generalities I'm talking about are not going to be as true. As another funny bit of trivia, the Russians did this really terrible

study years ago. There's something called the BEM sex identity scale. And basically it's a bunch of really gender norm questions to determine if you're more masculine, more feminine or ambivalent. And what they supposedly found was that women who scored lower, more on the feminine scale, were found more in quote unquote, feminine figure skating, ballet, gymnastics. It was women on the more math throwers, Olympic lifters. And they also found that in general, they could train the masculine, the more higher male scale women more like men.

Because when you insert testosterone into this, you stop seeing the big fluctuations across, because there is no really discrete menstrual cycle. Either it's gone completely, or it's essentially random. When you look at PCOS hormone levels, some days look exactly like a standard menstrual cycle and the others look like static noise. And vice versa, the women that were on the more feminine scale had to be, you had to take into more, and again, there's huge variability. Speaking generalities, this is 40-year-old Russell research. Don't read too much into this, but that is a consideration. Women that are hyperandrogenic, you can very much tend to train more like men both in terms of training structure as well as god how do i put this like i said there is often an attitudinal

difference in that and this gets into the whole issue again of coaching women if you're a male coach and you want to fire up a male athlete, what do you traditionally do? Call them a girl. You ask them, you know, if they left their purse at home, you challenge their manhood. By and large, this doesn't work with female athletes. I mean, it shouldn't be done like this is a leftover of a different time, but by and large, doesn't work well with female. Now, I have had female athletes.

One of them had been a boxer. And I don't mean that bullshit foxy boxing. I mean, go beat the shit out of another human boxing. One of the fiercest athletes I've ever known, great power lifter. She's now an Olympic lifter. Here's how I could get her. I'd be like, I bet you can't do that. I wouldn't challenge her on a sex or gender basis. I would just challenge her personality-wise. I bet you can't lift that. She'd be like, F you. Her training partner had a completely different psychology and I couldn't train her. So there's another, with most men, if they're, that'll work. Not all men, but most men, that'll work. And most women, some women may respond to that type of, that's a whole separate issue all right

so back to pcos hyperandrogenism is common tends to be very beneficial for sport but can cause health issues may cause infertility which if you're a high level athlete that may be a feature and not a bug right because for female athletes pregnancy can be one of the most impactful life experiences they undergo. Not only do they lose a year of training that they have to get back, now they're having to address the issue of having a young child. Something else that's not really taken into consideration with female athletes or in the workplace.

I mean, it's just like, ah, you got pregnant? You're on your own. It's like it's changing. ah you got pregnant you're on your own it's like it is an it's changing so women who get hyper and genetic hypo and elevated testosterone levels that cause infertility that may be a good thing if they're a high performance athlete now if you're a woman with pcos that wants to get pregnant this is a terrible thing and finding ways to fit or the health issues that causes severe insulin resistance causes increased central fat deposition. Interestingly, one of the most, one of the most common approaches to treating PCOS is oral birth control because it cuts, they deliberately

want to cut testosterone. So what is, this is why I don't like to talk in good or bad. What may be detrimental to a performance athlete may be absolutely the best. Now, that won't help her become pregnant, but it will definitely increase her health parameters. Other first-line treatments, metformin, which is an insulin sensitizer, is very commonly used because there's a weirdness where the elevated testosterone causes insulin resistance, then the elevated insulin increases testosterone levels.

So if you can break that loop in the brain, that can help sort of get things. Weight loss tends to improve this. Regular activity improves insulin sensitivity. Even small amounts of central fat loss, you know, visceral fat loss improves things. So with a pcos female whether it's good or bad depends on the context and that will somewhat go how you treat it right because there are considerations i already mentioned one you may not have to make those weekly variations in training they may not be there yeah they might but they may not be but from the standpoint of improving like insulin sensitivity improving those things there

there are dietary and training approaches that can be very effective for pcos women in general when you're insulin resistant training more frequently will be better right exercise improves insulin sensitivity both directly and indirectly, both resistance training and aerobic activity. So whereas someone without PCOS might be fine doing weights and then followed by cardio, with a PCOS woman, I would prefer they alternate and do something every day.

The effect is very short-lived. To improve insulin, this will improve health, this will improve all parameters. Generally, lowering carbohydrates tends to be just, like in the second half of the menstrual cycle. Lower or moderate carbohydrate diets may have benefits. Now, if you look at the research, the studies go, they both work. High carbon, and this is true of most of the work. However, when you look at those studies, the high-carb diets invariably have people, dieters or PCOS women included, eating high-fiber, unrefined carbohydrates,

the stuff that nobody likes to eat. I mean, let's just cut, let's just brass tacks it. You can get the same effect by just moderating carbohydrate intake completely, cutting it to possibly 40% of your time. I don't like percentages, but you might be looking at, you know, one to one and a half grams per pound of body weight, right? So, I mean, it's still 180 to 200 grams. That's more than enough to sustain anything but the highest intensity activity. Increase your dietary protein, moderate amounts of dietary fat. You might be up at one gram per kilo, about half a gram per pound, you know,

divided across your meals. Some studies have used full-blown ketogenic, very low-carb diets. That can be very beneficial because you're helping to basically break that insulin resistance. As you lose body fat, all that gets better. As you lean out, all that gets better. That can help with all, again, for the health health effects there are also a tremendous number of supplements that pcos women can consider there's a bunch of chromium there's a bunch of generic insulin sensitizers the big two are what are called the inositols and there's myro and myo inositol and chiro inositol which they impact some pathway involved in insulin sensitivity down, down with like within tissue. I don't know what it is.

I, at that point, even my eyes glaze over, but those supplements have been studied extensively as a way to improve insulin sensitivity. That will ultimately lower androgen levels that can improve fertility. If such as the goal. Now those might not be the best thing for women who, again,

who are high-level athletes. So in general for PCOS women, the goal should be almost daily activity of some sort, losing body fat or body weight. And note that not all PCOS women carry excess body fat and or are insulin resistant, but the majority of them are. Something like 70%, even lean PCOS women can be insulin resistant and if they're carrying extra excess body fat it's like 95% it's almost universal and honestly the way I said diets up which is fairly high protein and moderate fat carbs are

gonna come down to that level almost invariably you can't like unless you're a cyclist doing 30 hours a week on the bike your carbs are gonna to come down to that level almost invariably. Like, unless you're a cyclist doing 30 hours a week on the bike, your carbs are going to come down no matter what to about that range. But for someone with PCOS, it may be beneficial to go on a short-term, you know, full-blown ketogenic diet to get fat loss moving, to get those, to adjust taste buds. Other things, PCOS is associated with eating disorders for reasons I'm not entirely clear on. Testosterone can increase hunger and appetite, so that can be dysregulated. One paper suggests that PCOS women had lower metabolic rate, two others didn't, so I don't

think there's much to that. All the studies have shown that on a controlled diet, PCOS women can lose weight because occasionally you hear women go, I've got PCOS and I can't. Usually when folks are having trouble, they're not tracking their calories. Again, not trying to dismiss your experience. This is traditionally what I've seen. Can there be exceptions? Always. There can be other things going on.

As a generality, it's usually mistracking food, which is something we all do. Lean, overweight, athletic, sedentary, dieteticians, we all suck at tracking our calories correctly, but that's usually where the problem lies. But those are all sort of ways to, again, address that, again, depending on the goal. And if you're a high-performance athlete, you won the lottery. You won the hormonal lottery because with even a 30, and there's also a subcategory of women that they call subclinically hyperandrogenic. Their testosterone is only 30% above normal, but you still,

it makes them more anabolic. Their muscles recover better. They have more muscle, more strength, higher bone mineral density. These are all benefits from an athletic standpoint, especially in certain sports. Now, you may not make the best ballet dancer with all of that. Those may not be physiological characteristics for that sport specifically. But for anything that's predicated, even swimming, which is very much a power sport, they identified a subpopulation of high-level swimmers that had elevated testosterone levels. And it is sort of a hidden, and that happened to be oligomenorrheic.

And it was the testosterone causing that menstrual cycle dysfunction rather than the other way around. So there's just a tremendous amount of nuance, no matter how you slice it, in female physiology. Whether you're on birth control or not, you have a disproportionate number of women that are impacted by pathologies or things like PCOS. And there's just a lot for anybody who's made it this far. They're probably like, wow, you know, this is empowering on one front because I understand that I'm not just a little man. You

know, I don't just need to buck up and train harder. I need to learn how to work with kind of the machinery that I've got. But perhaps, and I'm sure there will be additional questions, women who want to learn more, what are some resources or places that you would recommend they go to kind of expand into this space of having more control and ownership of their physiology? Well, I mean, I'm seeing more and more articles. And as I read them, I'm like, well, they got some of it right anyway. And I'm seeing a lot of, you know, some nonsense and somewhere in between. I mean, I researched, I spent three and a half years writing a book that nearly broke me. And it was because like you said, you'd never heard of PCOS. I'd never considered the menstrual cycle because I was a male athlete.

Why did I have to think about it? I was starting from page one. I had to wrap my head around just menstrual cycle before I could. And so I wrote this book, which is extremely long and it is somewhat technical and it's very dense. And it's volume one of a supposed, it only deals with diet and nutrition. I haven't even gotten to training yet. Yeah.

Because it got so long, I just split it into two volumes it it will tell you everything you need to know about all i i address i don't address pre-pubertal it's not aimed at younger girls because that's just not a topic i want to get into i address the standard menstrual cycle menstrual cycle dysfunction birth control pcos i also talk about the change with aging which is something we didn't have time for yeah right because again men's physiology from puberty to death is not that different right testosterone goes down a little bit when women the change to puberty is profound birth control through some part pcos and then when they hit menopausal age which can be as early as the 40s but maybe in you know the late 40s to early 50s perim hit menopausal age, which can be as early as the forties, but maybe in the

late forties to early fifties, perimont menopause, which is what happens right before, has an early and late phase, which are all a little bit different. Menopause occurs over a year. And that's when her basically a reproductive system shuts down completely. So she goes from having this standard menstrual cycle or whatever prior to that to producing essentially no estrogen or progesterone. No eggs, menstrual cycle goes away completely, but low estrogen is very bad for a woman. Now you have to consider, do I go on hormone replacement therapy? Talk about that in my book. There are supplements that can be chosen.

Some women don't want to go on hormone replacement or can't, and that's something that there is some controversy and i address that in this but that's a whole separate issue what considerations do they have because there are changes in metabolic rate there are changes in metabolism that often make things harder now some a lot of this is age but there are physio becomes harder to mobilize fat from fat cells women tend to shift from lower body fat to central body fat, tend to lose muscle. Estrogen can affect mood, brain function. There can be very negative effects, both in terms of sexual interest, but also sexual function. There can be a loss of lubrication during sex, vaginal

lubrication. There can be a genital atrophy due to a lack of estrogen. And this all leads, this, let's face it, you know, and as when you're younger, you just go, ew, and as we get old, like the reality is sex is part of the human experience throughout the

lifespan. And I read this paper that will just offend and should every woman listening to this because it's so typical. And they asked men, they asked men what their biggest concern was about their partners going a few menopause. And it wasn't health and it wasn't bone mineral density and it wasn't muscle mass. And you can guess what I'm going to say it was.

What is our sex life going to be like? Because no matter what age you are, all the dude cares about it. The big picture on the average is, am I still going to get, be able to get laid? These are all a huge factor for women to consider whether it's hormone replacement, whether it's, and I talk about, you know, soy protein and phytoestrogen and all these supplements. So all of that is in my book. It is, like I said, it's not an easy book to read but i've had so many women tell me this is stuff like i didn't know it's starting out they're like i didn't women are like i don't i didn't know any of this either because it's not taught especially in

america i've got some stuff on my website if you only care about birth control and athletic performance i wrote a little booklet on that available at my store um mine just because you're going to ask my website, bodyrecomposition.com, it's got like 550 articles on everything. Many of them don't address women's issues because they were written years ago. I'm updating that slowly. My store, store.bodyrecomposition.com. I'm very active on Facebook. That's the name of the group. I'm there daily. I also have a number of experts, including a top-notch OBGYN, who can address questions that are outside of my area, usually medical stuff.

So if you've got those issues. I mean, even there, women's reproductive systems can get impacted by so much. Mental stress, physical stress, diet. Dudes just don't. We are truly simple from head to toe from start to finish women can and this is part of why a lot of this doesn't turn up yeah a you have male physicians and their women come in and they look their bloods go your bloods are fine it's on your head that's still very common the old you're histrionic can you maybe not be crazy for a while approach to women's

medicine which women physicians by and large don't have it's funny how that works that women who've experienced this tend to not be quite like that but some of this becomes a diagnosis of exclusion it's like well we ran all this stuff and you're still don't have we don't really know so maybe it's this there's so many possible things that can go wrong. To finish up, a good friend of mine, she's in her 50s now. She had undiagnosed PCOS her entire life. Partly because they put her on birth control at 15 and birth control masked it. She came off that, she went through menopause and everything went wrong. And she finally, in the first doctor she went to was like you're old and the next doctor whose woman did the right testing was like ah you have pcos and

she's on metformin and she's in a regular exercise program and getting everything back to health so women have so many more things that can go wrong and so much variability and women respond differently to birth control what works for one woman they make another woman it may women are listening this going yeah birth control makes me crazy yeah frequently because of the high dose estrogen or what it's doing hormonally can be very very negative and a different kind may be fine but you have to be able to willing to find a doctor that will treat the patient rather than the numbers. And that can be very difficult sometimes.

No, I quite like this. I thought this conversation was fantastic, particularly in just moving the dialogue forward. And I would love to have a second episode where we talk more about menopause or hormonal changes later in life. Because again, being in a position where you can either positively or negatively impact the way women train, look at themselves in such a way, it's

important to move the discussion in the right direction rather than perpetuate where we've been for oh so many decades. So Lyle, thank you so much for coming on today. Again, bodyrecomposition.com. Check the store, buy the books, join the Facebook group. You'll be happy you did. I've been in it for years. It's a good resource. Absolutely. Have a good one, Lyle. Thanks. You too. All right. So there you have it. That was me and Lyle McDonald talking all things women's physiology. Lyle is going to come back in the next four to six weeks, hopefully, so we can bridge the gap and continue down this road talking about things like aging and menopause. We'll stick with women's physiology for a while because it's hot on both of our minds, but there's really no shortage of things Lyle can

talk about, and I hope to have them on fairly regularly. Thanks again so much for listening, guys. If you could do us both a favor, screenshot this episode, share it, and tag us. I would love if more people could hear this. It's incredibly important that we continue to move the conversation forward in regards to women's health and women's training. The more women that are working out, the more women that understand their physiology, and the more coaches, whether they be male or female, that understand that nuance, the better. So please share. Thanks so much for listening, and have a great day. about our amazing sports nutrition partner, Legion. Legion makes the best evidence-based formulas for sports performance, sports nutrition, recovery, and fat loss. I don't recommend many supplements. In fact, I think you can get the majority of the nutrition you need from a whole foods diet. But let's be honest, many of us are either on the go and need assistance, or quite frankly, we're not going to settle for average and we want to get the absolute most we can out of our training. So Legion is the

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towards future orders, which you can use the same as cash. Pretty cool, guys. So head over to legionathletics.com and check out using the promo code Danny to save on all your sports supplement needs. Back to the show. Hey guys, welcome in to another episode of the Dynamic Dialogue podcast.

Today's episode is a highly anticipated follow-up conversation with my good friend Lyle McDonald. Of all the people I know in the fitness space, when I have a question about female physiology, whether it is a question about my client's birth control, about the impact of the menstrual cycle, things like PCOS, or various questions about hormones like estrogen and progesterone, Lyle is my go-to guy. The first episode we did way back in 2020, in the beginning of the pandemic, was the most downloaded episode of the podcast ever. And from that day forward, I knew I needed to get Lyle on the podcast specifically to talk about what we talked about here today, which is the ways in which your menstrual cycle and the various phases impact your training and how your training impacts those various phases, as well as some of the

nutritional nuances that are packed in there, such as does my body use carbohydrates differently in the luteal phase or the follicular phase? And fun fact, it does. You'll learn a lot about that as we go. And we cap today's conversation with a discussion about birth control, particularly which modes of birth control are the best for women who are looking to not only have a contraception in place, but who want to optimize their gains. So this is a conversation I've wanted to bring to you guys for and girls for a very long time. I hope you enjoy it and I'm sure that you'll get a ton out of it. So sit back and enjoy a conversation with the man, the myth, the legend, Lyle McDonald. All right, guys, welcome in to another episode.

I'm here with my friend Lyle McDonald. This is his second time appearing on the show. If you guys have not already listened to episode 19, which released back in 2020, I strongly recommend adding that to your queue to listen to next because these two are going to be very much working in concert to help you get a really good handle on how female physiology is unique, how it impacts training. But today's episode is going to be very specific. We're going to touch particularly on the menstrual cycle and how it plays a big time role in how you train, how you recover, and the results you can expect. So Lyle, my first question for you, knowing that the menstrual cycle is of course uniquely female and every female has a

semi-unique cycle, but there's definitely some consistencies. Yes. What are we really looking at when we hear the term menstrual cycle? What are the different phases? Okay. And what's happening physiologically there? Yeah. So what I'm going to describe is sort of an idealized menstrual cycle, right? Typically, the standard menstrual cycle can last anywhere from 25 to 32 days. We tend to assume it's 28, but it's really not. And vary some women are like machines right if their cycle is 26 days it's all and some women it can vary seems like it gets more consistent with age like younger girls it's very uh it's sort of when the system's kind of coming online

it can be very um just not standardized and it all but depends on the woman. But I'm going to assume it's 28 days just for simplicity. All right. So day one by convention is the first day of menstruation, the first day of bleeding. So the first two weeks of the cycle are called the follicular phase. This is where the follicle, which contains the egg, develops and is released at day 14 at ovulation. Right. So that's the halfway point of the cycle. The second half of the cycle is called the luteal phase, right? So the follicle bursts, releases the egg, it implants, forms the endome.

Something called the corpus luteum and luteal phase. This is sort of in preparation for pregnancy. If pregnancy does not occur, we go into week four, which is typically where, you know, PMS week, if it's going to occur as typically then, and then we start over. All right. So we've got first two weeks, follicular phase, ovulation at the midpoint, and then luteal phase, weeks three and four. So during the follicular phase, estrogen is not only really the dominant hormone, it's really the only hormone, right? so progesterone starts very very low start

of menstruation comes up really gradually to ovulation doesn't change much whereas estrogen starts low starts to come up peaks right before ovulation before crashing back down at ovulation i would mention a few days before and after there's a little spike in testosterone which is probably um i mean, let's face it, all of this is really geared towards reproduction, pregnancy. And I would speculate that that increase in testosterone is probably to increase sex drive, because they're just certain, but that can have potential ramifications from a training standpoint, which is why I mentioned it. All right, so that's ovulation. Estrogen is very low. Progesterone is still low. Testosterone kind of blips.

Women's testosterone is never that high. So we go into the luteal phase. Progesterone starts to sweep up. It's a peak at the end of week three and then falls back down. Estrogen does the same thing, but it's at a lower level than progesterone. And it only reaches about half the level as in the first two weeks so really in the second cycle progesterone is kind of like i'm going to use the term dominant and i don't want people to confuse that with there's this idea of like estrogen dominance and progesterone dominance

that's kind of i say the alternative but it's kind of that that one of the other hormones is kind of overpowering the other yeah so but in that second cycle really progesterone is having the major effect both directly and by blocking the effects of estrogen okay so for all practical purposes first two weeks estrogen is the primary hormone week three and four they both go up the progesterone is still having the major effects all right so what are those effects the first two weeks estrogen it's funny has traditionally gotten blamed for a lot of women's problems with lower body fat. But if anything, most of its effects are positive. Estrogen is anti-inflammatory, helps control appetite.

Many women find that three or four days right before ovulation, their appetite for food and drink is lowered. And it actually appears that so that their appetites for other pleasures will increase. And that's actually been shown in both animals and humans. Estrogen helps remodel skeletal muscle. Very important in women, probably important in men too. Yeah, because I've heard that before, which of course with men, we think testosterone is the only hormone that's going to play a positive role in our muscle building, but estrogen is not a catabolic hormone, is it? Correct. And they found, you know, back in the seventies and eighties, cause men were like, I don't want any estrogen. That's a woman's hormone like that. And when they added anti-estrogens that prevented that they got worse growth.

Like I think a lot of the possible positives of testosterone or hormone replacement or steroids is probably through conversion to estrogen because among other things estrogen promotes fat burning and muscle if you give men an estrogen patch they will use more fat during aerobic activity whoa that will spare muscle on a diet I think that's another benefit for drug using bodybuilders. No doubt. Estrogen tends to also promote fat storage within the muscle, what's called intramuscular triglycerides, but that's not in the actual body fat. So really, and I'm probably forgetting a couple, estrogen's effects are really overall positive. Yeah, definitely. Okay. And then we go into the second half of the cycle

and pretty much everything I just said for progesterone, I'm sorry, for estrogen, progesterone does the opposite. It also improves insulin sensitivity, meaning that carbs are utilized more effectively, insulin works better. So again, in the second half of the cycle, progesterone basically has all the opposite effects on top of blocking progesterone's effects i'm sorry blocking estrogen's effects so progesterone tends to cause some insulin resistance causes small amount of muscle breakdown not huge amounts like protein requirements don't vary enormously but it is there um it tends to promote the use of fat for fuel which sounds sounds like a good thing, and it can

be under certain conditions. I know this seems a little bit confusing, but progesterone, also one of its big effects, is to actively stimulate fat storage in the lower body. There's something called acylation stimulation protein, which I don't want to really get into. Because again, if we think about this through a reproductive sense. The first half of the cycle is to produce the egg and prepare a woman for pregnancy. If she gets pregnant, her body wants to store calories in the hips and thighs because that's what's going to support pregnancy. That's right. So many things happen during the luteal phase, weeks three and four. One is that appetite goes up cravings typically go up and some of this is under the influence of progesterone this gets really complicated like for researchers

to try to figure out what's being caused by progesterone what's being caused by estrogen what's being caused by the fall in estrogen the rise in this the ratio of one to the other it gets you like what they end up having to do is block a woman's hormones completely and then add one back at a time. Wow. So they kind of figured it, but it's, it gets super duper complicated. It kind of doesn't matter in the big picture. These are the things we know occur, which is that. And so like, that's actually a fabulous point. And I do have one question about this because I get this question a lot and i'm sure we're going to get to this eventually but if estrogen or i should say if progesterone actually enhances fat substrate utilization and we have a protein sparing effect in an insulin sensitizing

effect with estrogen uh with regards to nutrition is a weightlifting woman going to be better off eating more carbohydrate in that preliminary phase, that follicular phase? Will she be able to utilize that better for training? Okay. The short answer is yes. And we'll definitely touch on that in terms of how this is impacted. But the short answer is yes. So other things that happen in weeks three and four four since an appetite typically goes up cravings typically go up metabolic rate does go up a little bit right body temperature goes up way back in the day they would use basal body temperature to try to determine fertility it's rough at best okay the problem is that the increase in metabolic rate which is one or 200

calories can be easily overwhelmed by the increase in food intake, which is typically three to 500 in that range, depending on how much control is being exerted. Is that one to 200 per day? Yes. And it has to do with just how many calories like the endometrium and the corpus luteum are burning. And you get into all the same because the question that comes up just in a hypothetical sense, why don't women just develop the endometrium and just keep it? And it's because that would waste 1400 calories

or so in the first two weeks of the cycle for nothing. And women's bodies are nothing if not efficient when it comes to saving calories. So that's why it goes through this seemingly wasteful process every month of building it and breaking it down and excreting it to save energy. So yeah, so in a very, like I said,

I hate to say one hormone is, you know, one is good and one is bad because obviously they're both critically important for women's overall health function reproduction. But in the sense of what we are talking about in terms of fat loss, performance, muscle gain, in that small context, to a very great degree, estrogen is the good hormone and progesterone is kind of the bad hormone. Again, I'm talking about within this very narrow context. No, and that makes a lot of sense, right? I think that we understand that there's quite a bit less

hormonal volatility with men and men just go to the gym. They eat consistently. They train very consistently. But like you said, you could have a cycle that's anywhere from 25 to over 30 days. Every woman's probably going to have fluctuations between those two hormones that are somewhat unique. And so it's not as simple as it is for men. So you end up with a lot of women trying to figure out how do I best navigate this if I'm putting together my training split or if I'm going to the gym. And a lot of people have postulated that you want to stack your intense training in that follicular phase where you're Where you're like, we talked about more sensitive to insulin or more sensitive to carbohydrate. You can probably use that substrate better for glycolytic work, like weight training.

And then maybe you taper down during that luteal phase and you still train, but not as intensely. And maybe you change your nutrition a little bit. Do you think there's any merit to that? Oh, absolutely. Um, uh, and I'll, I'll come back to that. I just wanted to say one thing, like when you're training men, the same guy is walking to the gym every day, right now he may be tired from a previous workout or not sleeping, but basically a man's hormonal levels, testosterone is basically a straight line for, yes. So, you know, there's small fluctuations and throughout the year and it goes down, but in a short term span over your, your training, you're dealing with the same guy every single day. Whereas a woman, her hormones are changing drastically, at least every two weeks. And if you want to really get microscopically managed into it,

there are weekly changes going on. Now, I tend to not get quite that. I think you can overanalyze this, but certainly with women, and even there, like you said, there are unique responses. Some women have huge performance fluctuations, and I'll talk about that. Other women, basically a flat line, or roughly so. In the same way, only a percentage of women suffer from PMS symptoms. That's really a global thing in terms of cramps, mood swings, cravings. Some women suffer it so extremely, they get what's called premenstrual dysphoric disorder. They may be physically incapacitated. They may suffer from suicidal thoughts at the very, and some women don't get experience anything at all. And you will hear women report that, you know, women that don't get it are just like,

I don't get what's the problem. Well, you can't understand what you don't experience. So there is more variability. It's just one more example. And I'll get back to your actual question. A nurse practitioner, I know, and a therapist that I know, the nurse practitioner, when she's addressing mental health issues for some women, she has to throw in an antidepressant in week four, specifically for the suicidal thoughts. My therapist friend says, you know, with men, you always know who's coming in, but with women, depending on, and he's not using this negatively, just like, I don't really know who I'm treating till about 10 minutes in. And it can be very much the same thing with a female

athlete, with a coach. So in the broadest sense, yes. And there's been five or six studies on this where they did what they called either, you know know follicular focus training or luteal have whatever terminology they use and what they typically do is they're like all right we're gonna do 12 workouts a month right we're either gonna do you did like 10 of them in the first two weeks like five days a week and then two of them one a week in luteal phase or vice versa. One study, which I think was probably a little more valid, did either clustered them in the first two weeks or clustered in the second two weeks, or just spread them across the entire month, which I think is probably a more valid comparison. And what the majority of them have

found is that there is a superior growth response and strength response in the first two weeks of the cycle. Now, I'm not saying that there wasn't a growth response or that there were no results in the second half. Simply, if you are going to, you know, focus your training, it does make more sense to put more into that the first two weeks than the third. Like I'm not saying don't train yeah and this is even outside of the performance changes which is this is just looking at it physiologically so there is absolutely something to that now most of these studies are using fairly moderate training loads one of the ones that comes to mind they did like three sets 12 leg press and three sets 12 leg

curl either you know five days a week for two weeks. And yeah, so it's not like you're doing super voluminous workouts, super intense workouts. I'd have to go back and look to see, you know, if it was, but there was certainly a difference. Now, another, another consideration here is how women's performance may or may not vary across the cycle. And by performance, I mean like in terms of their strength, endurance, et cetera. Yeah. So if you look at the research, it all basically says, ah, there's no really apparent pattern. Okay. Now, a lot of that is in endurance training and endurance training is a very different animal than the weight room. Totally. Right. I was an

endurance athlete for years. And even when you're tired, you can go put in the miles, right? It's all kind of submaximal. You can go put in the work, even if you don't feel very good. Yeah. Even, and I don't think they've done a lot, but even with weight training studies, a lot of them are just stupid. I've got a review paper of like 10 studies on the topic and the review says all 10 of these are terrible. I mean, not in scientific terms, basically all 10 of these are low quality, poorly designed, uncontrolled. Some of them rely on women's self-report of where they are in the menstrual cycle. And that's totally inaccurate. They're just terrible studies.

Many of them will like test, Oh, we tested thumb strength. Yeah. Flexor, my one, my favorite, I love the thumb strength studies or, you know, hand grip strength. And I'm like, okay, great. Test one around back squats, right? Test something that might be relevant. And so I think the pattern I've seen in like apparently some early Russian literature, this is how they did it. As they found that most women were strongest about two or three days into the

follicular phase, right? They're kind of done with PMS. And that's, that tends to be the strongest week into week two, there can be a little bit of a drop in performance. So they would train them a little bit lighter ovulation hits. And again, you've got that little testosterone spike that may be having a little, little little benefit a little bit stronger in week three and then if generally speaking there's going to be a bad week of the month it's going to be week four and any woman listening to this who has experienced what can happen with pms of varying degrees can understand why that's the case right You've got issues with mood, strength, performance, adaptation. There's even coordination issues. So when they've looked at injury rates in athletes,

this is like soccer, basketball, stuff like that. ACL injuries tend to be the highest right after ovulation. There's an increase in joint laxity in the looseness of the joints. So for certain activities, you're very much at risk. There's also can be a lack of a loss of coordination in week four. So doing like super high coordinated complex activities like box jumping or the Olympic lifts can be potentially problematic. So that's, again, that's a general pattern. And I've had athletes that absolutely follow that. Probably the most extreme I've seen. I had an athlete that week one,

she would hit PRs, like without fail. Week two, be down a little bit. Week three, she'd feel better. And week four, she couldn't do more than 60% on machines. Her coordination was just through the crapper. She had no strength. And in it, because I'm a dumb, I was a dumb boy, right? Like mid 2000s. I didn't know. I just would look at it. I'm just like, what's wrong with you? Go lift the weight. Cause I was part of the problem. And I watched it and watched it. And as I started to look into this, I'm like, okay, I see what's happening. And once I had discerned that pattern for her, I'd be like, all right, week one, we're going heavy. Week two, a little bit more quality, drop the intensity. Week three, going to go heavy.

And week four, we're going to go play. And you're just going to do some machine work and keep some movement in. So what I ended up having, rather than try to force the training onto the cycle, which doesn't work, I adapted the training to her individual response. I love that. And so would you say, I think one of the things that I'm really grabbing from this is we know substrate utilization is great in week one. We know that we have quite a bit of capacity for work. So that's where you really want to front load, if you will, some of the more complex movements, some of the more training volume, you might see a dip in that second week, but you can still train pretty hard. The third week, you actually get a little bit of a boost or maybe you stay there. Perhaps that's aided by that small surge of testosterone around ovulation.

And in that fourth week, depending on how you respond, whether that's going to be intense PMS, it's going to be not so intense, you're probably wise to reduce training complexity, maybe reduce training volume. If you're going to deload, that would be the week to deload. Yes, absolutely. Yes. I think that absolutely sort of sums it up in general. Now, one other thing I would add in terms of the performance thing, i think it depends very much on the type of training you're doing right if you're doing predominantly bodybuilding training yeah i mean you know more moderate weights higher

repetitions i don't that doesn't tend to get impacted as much because in kind of like the endurance training thing it's all kind of submaximal, right? So let's say you're doing sets of 12 and it's like 75% of maximum. If your strength is down 5% or 10%, it may be a little bit harder, but you can do the workout. Yeah. If I'm training a power lifter and the workout goal is singles at 90% and their max is down 10%, well, that's now we are doing a max at work. And if I want them to do, you know, even like say triples at 90%, which is a really hard workout and their strength is down 10%, that workout cannot be completed because what should be 90% is now 100. So I do think it depends very much on the type of training you're doing. And I tend to think that heavier stuff. And again, it's just, it's a math thing. If here's your max,

if you're training down here, bodybuilding range, that won't, it'll make it harder. But if you're training here and this drops or even drops more than the goal, you can't complete the workout. And one thing that, that does come up that you've probably seen is whether athlete or not. Right. And I don't want women to think this is only, you know, for high performance athletes, this compact is women who want to train hard can often feel if they are subject to these kinds of performance variations, like either that they're the failure or that their body is betraying them. Like they go in in week four and let's just say that their biology says it's not going

to happen. And then they just are like, I should be able to power through this. Well, no. And then again, you've got this whole opposite thing where it's like, oh, you're just making excuses and using noon and I'm not even going to address you're in the US, you know how crazy that stuff gets. But it's like, as far as it is a biology. And if you were biologically impacted by it, just like if a male athlete came in and whatever, he was under stress, hasn't slept, etc, etc. I wouldn't expect him to power

through it. Because it's just not going to happen for whatever reason if he's over-trained. So I think that's something for women to simply consider. into the conclusion that if you are in a performance or strength sport, it's going to have a much more tangible impact than if you're doing, you know, just base level hypertrophy work. I want to look a little bit better. How do these fluctuations, if they do affect body composition? Because I think that we've talked about the interplay between the psychology and how these hormones affect your mind. And it's certainly not as easy to manage acute changes in body composition. I think for women, for a variety of social, sociocultural reasons, there's a lot more social pressure. And so do we see acute changes in body composition? Because one thing I see a lot with my clients is their, their desire to train from a psychological standpoint is heavily impacted by

the way they feel they look when they wake up that day. Are there, are there things that women could, could glean from this and go, Hey, I need to be more gentle with how I communicate with myself because I'm at this point in my cycle versus this point in my cycle. I think absolutely. And I'd want to go back and make one final point about sort of that menstrual cycle performance thing. And I'd want to go back and make one final point about sort of that menstrual cycle performance thing. You and I can both talk in this idealized theoretical approach, and that's great, but there is so much variance. Ultimately, the women listening to this, or if they have a coach or a trainer, you're

going to have to be your own best scientist, right? You need to keep a couple months worth of data. And what I would generally suggest, like just pick a standard workout, like set up a standard workout week. And I'm going to do this every week for the next month of the next eight weeks, record things like rating of perceived exertion. If you're doing endurance exercise report, you know, check heart rate, check and you, whatever, you can get as deep as you want. You can check motivation. You can check, you know, to see, and you'll start to see a pattern discerned and go, all right, week one, I feel strong, motivated, ready to kill it. Week four, I don't want to get out of bed.

And then you can, A, have an expectational, you know, be, you know, manage expectations for that game. We go, look, if I'm going to, if I'm going to train like garbage, it is what it is. I'm going to go in, I'm going to adjust my training, make sure it's successful, make sure I come out of it. Maybe, you know, if you're in a performance sport, maybe go to, you know, do some light technical work, go do something different so that when you move back into week one, where you're just going to kill it, you'll be ready to really kill it. And just, but that's something that's a pattern. And there was actually a study they looked at, I want to say, younger soccer players, they did that exact thing. They gave them the same weekly workout for a month,

and then looked at, you know, session RP and rating received exertion, all that stuff. Ultimately, that's what you're going to have to do. Yeah, I can tell you what may generally occur, you'll see them say, ah, world records have been set in every week of the menstrual cycle. All older studies, all self-reported. And it's a terrible way of doing things. All right. So to your question, body composition. Absolutely. And again, anyone listening to this who's experienced this, certainly body weight can vary. Typically, it will be lowest maybe day two or three of the follicular phase, right? It tends to go up a little bit before ovulation. That spike in estrogen makes women's bodies hold more sodium. So if they're on a high sodium diet,

they will tend to hold water and their body weight may go up. Week three, it drops back again. Progesterone, one of its nice effects is it antagonizes the receptor involved in water balance. So water tends to drop off. It also antagonizes the testosterone receptor, which again is bad from a performance standpoint, but it's also part of why women that may have issues with oily skin or acne, their skin clears up in week week three because progesterone affects and then in week four usually if there's going to be big water weight gains that because because the spike in estrogen causes the body to hold uh sodium and water the dropping progesterone

does the same thing you get a leave so. So it's same, same end result for two completely different reasons. And again, anyone listening to this knows that if there's a time when their body weight's going to go up, when they're going to feel puffy or have swollen ankles or their clothes not fit, it's probably going to be in, you know, three to five days before menstruation. Yeah. So, yeah. So that is an issue. One thing that can be done is right for ovulation right before, you know, right into week four, you can reduce your sodium and bring up your potassium. That will help a lot. Yeah. Light salt, high potassium foods, don't get straight potassium salt. That stuff is gross. It tastes like aluminum. Do not get half and half light salt or you can get two thirds potassium, one third light salt or regular sodium that can

help. Um, but yeah, absolutely. That can occur. Uh, I've had women, cause I, I talked about this in my women's book about how we might adjust macronutrient intake in general and sort of the, the, the too long did to read version of this is yeah. First two weeks, women's bodies tolerate carbs more carbs should be a little bit higher. should be a little bit lower weeks three and four women don't tolerate carbs as well bring carbs maybe down by maybe 10 five five ten percent and we're not talking about huge differences right yeah about 10 or 10 10 or 20 grams of fat increase which means 25 or 50 grams of carbohydrates down like we're not talking about humongous shifts. And just as an interesting side note, when I was writing the women's book, I looked at all this physiology and that's what I came up with. I was like, first two weeks,

I keep protein pretty stable. Protein should just be set where it should be set. And then go around with the rest of it. And I was like, higher carbs, lower fat week one and two, lower carbs, higher fat week three and four. And then the study came out called the menstrual lean study. Oh boy. And they basically, they compared like traditional government guidelines to a diet that was based around the menstrual cycle. And for the women who there was better adherence, and they did the exact same thing, like what I had derived before I even read it, which is always nice when all of my random theorizing and stuff actually seems to match up with what – and it works better because it makes sense. And the same way that matching training to how you feel in the cycle makes more sense in the long term, giving you a diet that you're not going to be able to maintain because you're hungry and your hunger is off the rails in week three and four, not a good approach. And then even in week three and four is really interesting. They even said, look, your metabolic rate's up a couple hundred calories.

If you want to add a little treat and they allowed, you know, whatever, 100 grams of dark chocolate, whatever it was, you can take advantage of that because it's still within your calorie allotment. Because look, if you're going to have those cravings anyway, you can either fight with them. And if some women get away with that, or you can, you know, and we can even look at that from a fat loss standpoint, right? So let's say you're dieting for fat loss. That was my follow-up. You eat three to four, your metabolic rate's up, whatever, 200 calories extra a day. is my follow-up question. You can eat three to four, your metabolic rate's up, whatever, 200 calories extra a day. There's two ways to look at it. You can eat 200 calories more if you want and still be in the same deficit, or you can keep your calories where they are and get a little,

eat out a little bit more fat loss when the body's using more fat for fuel, assuming it doesn't backfire. That depends on the person. Totally. Assuming it doesn't backfire. Yeah. That depends on the person. Totally. Hey guys, just wanted to take a quick second to say thanks so much for listening to the podcast. And if you're finding value, it would mean the world to me if you would share it on your social media.

Simply screenshot whatever platform you're listening to and share the episode to your Instagram story or share it to Facebook. But be sure to tag me so I can say thanks and we can chat it up about what you liked and how I can continue to improve. Thanks so much for supporting the podcast and enjoy the rest of the episode. I like that a lot because I do think that women have a tendency to punish themselves because I'm not adhering to the deficit. I'm failing my coach. I'm failing my program. I was doing so good. And then just out of nowhere, I really started to struggle with my cravings and I don't understand why that might be. And I love the idea of, Hey, like, you know, we're going to have you in a deficit, but let's give you an extra 200 calories when you can afford

it. Because to your point, it's probably going to increase dietary adherence and it's probably a lot less aggressive on your physiology than just eating, like not eating that additional 200 calories and having to take on a more, I guess we would call it aggressive deficit when hormonally you're probably way less inclined to tolerate something like that. Yes. And in that, and in, in adding to that, and this was something, again, something I came across in some study is women, as I said, women's appetite is most well controlled in the first two weeks of the cycle for me. And from a logical standpoint, this is for someone who's just starting and mood tends to be the best. You tend to not have any of those issues.

If a woman is going to start a new diet or is going to start a new training program, the first two weeks of the cycle are the best time to do it because they're setting themselves up for at least two weeks of relatively easier success, right? If you go, all right, just ovulated, I'm going to start a new diet tomorrow. When your appetite cravings blood sugar blood sugar also gets unstable i forgot to mention that can drive appetite that is the wrong time to start a diet like and i'm not saying you know most people aren't going to want to wait but you need to be aware of that yeah certainly you're going to have to adjust your expectations i didn't look

into it a lot but there's even research that when women decide to try to stop smoking or drinking, their success rates depend on where in the cycle they start. Wow. And I'm not up to it, up on the data enough to tell, say when, but this is all, it's all better to take this into account than not. Absolutely. I mean, you're talking about, do you want to have two weeks of high friction dieting, or do you want to have two weeks of high friction dieting or do you want to have two weeks of low friction dieting? And if you can get 10 to 14 days under your belt, where you're like, I'm rocking, I'm in a rhythm, I have some confidence, you'll do much better in the long run than if you're like, God, I tried that diet for two weeks and every day it was fucking miserable. Yeah, that's exactly, that's absolutely it. And you can even go further than that. I mean, you mentioned one thing. All right, Well, we're going to use, you know, we're going to set the deficit for the first couple of weeks.

But when we know a woman is burning a little few more calories, let's raise calories a little bit. Because, again, that if that improves adherence over week three and four, well, damn, now you've got a month under your belt going into the next two weeks. And now you've got six. Now you've gone through six weeks of hopefully, you know, solid success, you know, even go even further than that. One of the things I've, you know, talked about for God years now, you know, the, the idea of a diet break of, you know, just taking calories to maintenance in between, and they're finally starting to study it. And one of the things I wrote about in the women's book is, you know, if it fits your schedule,

if you're going to do a two week diet break, the time to do that is during week three and four. Yeah. Because you're burning a few more calories. It's hard to adhere to the diet. Go ahead and do that. Calories a little bit higher because maintenance a lot easier to maintain, obviously. Yeah. And boom, you're set.

You start again at the beginning of the follicular phase. Boom, you're right back into two weeks of solid dieting. So we talked a lot about the interplay between the menstrual cycle and training with regards to how these hormones impact your training, but what are some ways that training impacts these hormones? Because amenorrhea is quite a popular topic of conversation. I find that it's very prevalent. I'll check my DMs and I get questions all the time about from women going, wow, you know, I was, I missed my period or I haven't gotten my period or I started doing this diet or that diet. And what ways do, let's

just call it conventional training models and conventional diet culture, the way women tend to approach food if they're not educated dieters, how can those disrupt the cycle that we're talking about? So without getting too far into the weeds, because this is one of those topics you could spend hours on. Yeah. Central cycle dysfunction is depressingly highly common in women. Yeah.

And when women started to enter sports really significantly in the 80s and 90s they started to see these problems where women would either lose their cycle completely amenorrhea or they would develop what's called oligomenorrhea and that's a cycle length between 35 and 90 days an infrequent cycle okay which can be its own issue um and there was all kinds of ideas right it typically was seen in excuse me athletes that emphasize or sports that emphasize thinness, running, ballet, gymnastics. They're now seeing in men slightly more frequently. And it's in runners and horse jockeys of all things, because horse jockeys maintain a terrifyingly

low body weight, like 105 pounds for, you know, I mean, they're, they're short, but even so they starve themselves. And there was like, so all kinds of theories over why the most prevalent one, and it's still around is that it was a body fat percentage thing, which made a certain logical sense, right? They, they had identified already that women, that girls didn't start menstruating until they crossed a critical body fat. women that girls didn't start menstruating until they crossed a critical body fat. So the logic was that, well, women need a minimum of body fat to maintain the menstrual cycle. And again, there's a certain logic to that. Having enough body fat to support pregnancy, to support breastfeeding, to support all of that would seem to be important. Probably my favorite theory,

and I just mentioned this because I think it's funny and again we're talking early days yeah uh chronic nipple stimulation can actually inhibit the menstrual cycle like breastfeeding of a certain pattern can cause women to lose their cycle the way western women breastfeed it doesn't but the way they breastfeed in other countries where the children just, because it raises prolactin levels. Yes, yes. And that inhibits reproduction. They thought that maybe the nipple stimulation from running up and down in a bra. Oh my gosh, that's hilarious. Look, it's very easy to look 30 years ago and go, oh, they were working from the best science of the day.

to look 30 years ago and go, Oh, they were, they were, they were working from the best science of the day. And I imagine the guy who came up with that in the lab thought he was fucking brilliant at that point. Yeah. And just randomly, there is a stunning amount of research into sports broad design because it is a very real issue for women. Yeah. Because there is many women who have larger breast report that breast discomfort is one of their big barriers to exercise. So like this isn't, it's easy for us to, you know, but it's not, it's not a joke. Even in the weight room, this is an issue that guys don't really deal with. Women have large, you know, there are exercise choice considerations.

A woman with larger breasts to do a chest supported row may not be very comfortable. Even bench pressing can be a set. It can change their center of gravity regardless. So this went back and forth and they were like, ah, it was the stress of exercise and it was body fat. The problem was if you're looking at runners, runners are typically running too much, staying really lean year round and eating eating too little so you couldn't really separate one from the other right you've got this whole cluster of things that are happening

many had eating disorders so finally researcher named ann lukes came along and there is a concept called energy availability right so energy availability is calorie intake minus exercise calorie expenditure. Now, this isn't the same as energy balance, calories in versus calories out. You can conceptualize this as being the number of calories that are left over to the body after exercise. Because everything in your body uses calories. Your heart beating, your brain braining, your, kidney, and all that uses up calories. So energy availability, it's what's left after exercise is kind of paid for and certain parts of human

physiology are more important than others. Right? So what do many women with extreme diets report? What their hair and nails stop growing? Yeah. Hair. It's actually called telogen effluvium. I don't know why, but when that's, that's when hair stops growing telogen effluvium go T E L O G E N, which I guess is a hair thing anyway, because not having your hair grow is not going to kill you. Yeah. Immune function does go down in the short term. That's not going to kill you. If your brain stops working, bad things happen. If your heart stops pumping, bad things happen. Well, the reproductive system is not required in the short term. So when energy availability falls too low, that was the theory was that's when, so

Anne Luke's came along and did some really well-controlled studies where she took women, and it was short termterm, five days. And she either kept food intake the same and ramped exercise to create a specific energy availability, or she kept exercise the same and dropped calories. So we created to see what was causing what. Because she had done research showing that if you look at female athletes, some will have a menstrual cycle at 12% and others will lose it at 24. There was no critical, there had to be something else. And what she found was that when her G availability fell too low, whether it's from too much activity or too little food, there were changes in reproductive hormones,

something called luteinizing hormone, which I don't't want to get it's just in one of the main reproductive hormones thyroid hormone crashed cortisol went up there was kind of this global very similar to what occurs in starvation or long-term dieting all right first you do this study just just crush it just super low energy availabilities then she went back and looked at these different thresholds 50 40 30 20 10 and that at this, at 30 kcals per kilogram of lean body mass, right? Body fat doesn't use a lot of calories. There was a critical threshold below which these, these hormonal change. Now they didn't see a loss of menstrual cycle, but it was the hormonal changes that down the road, right? Now there's been a million studies ever since then. And what they find is that it's not quite as clean cut, right? They will find women who are at like 32 who have menstrual,

and it's just between a five day study and long-term. Yeah. In the same way that if I starve someone for five days, their metabolism will crash. We know that. If I then give them a moderate deficit for six months, well, metabolic rate will slow down eventually. It just takes longer. So there is this energy availability threshold, but it can be generated through one of two ways.

A lot of exercise. Because what she also showed was that you can do a ton of exercise as long as you keep food intake up. Yeah. The negative effects. So it really was. And if body fat plays a role, it's secondary, it's indirect. You don't see amenorrhea in women carrying excess body fat. One exception being bariatric surgery, because women lose, people lose like a hundred pounds in a matter of weeks. But you typically don't see the problem till women get below 20, 22%. So body fat is permissive. It is involved. But if you've got a woman at 22% and her energy availability is too low, she may lose her menstrual cycle. Woman at 15% body fat

who's eating enough may be completely fine. So yeah, that kind of summarizes it quite well. And I think what we see a lot is I want to look a certain way. I have a desired aesthetic outcome. And I'm going to ramp up my training. And I am going to ratchet down my calories. And boom, something happened. How, I guess I should say,

how quickly can acute disruption in the menstrual cycle occur if somebody starts the prototypical Western wedding crash diet exercise regimen? I don't necessarily have an answer. I don't know if I can say completely offhand, but women can start like within five to seven days of an extreme change in energy availability, you will already start to see these hormonal changes occurring. So a woman goes, all right, I'm going to just like jump into two hours of exercise and take my calories as low as

I can. By day five to seven, they will see a decrease in active thyroid hormone. They will see changes in luteinizing hormone, which eventually will cause problems down the road. There's this sort of stereotypical hormonal response. So it can be very quick. Now, there's another wrinkle I do want to mention. So back in the early days, right, it was self-reported. And again, they couldn't know what they didn't know. So never, I'm not being critical of 30-year-old research.

The best is what they have. And what they saw was there was either eumenorrhea, which is just a regular menstrual cycle, or amenorrhea, the lack of it. Did you say regular or irregular? Regular. Eumenorrhea means regular. E, U just means normal or regular or whatever. Gotcha, gotcha. Latin's been too many years ago. Amenorrhea, A just means normal or regular or whatever that's been too many years ago a

amenorrhea a just means not so a oligomenorrhea which again kind of a different thing or can be that gets into pcls and some other stuff but what they what more recent research has found is that they are there are two what they call subclinical menstrual cycle dysfunctions okay so the first one is what's called a luteal phase defect okay and as the name suggests luteinizing hormone luteal like these are all related right is the luteal phase starts to become i want to say shortened now the cycle doesn't change a woman will still menstruate but the system is already starting to go awry got it the problem is everything looks normal. There's no, and that's why they couldn't pick it up in the early studies. You have to do really

involved blood work. If you like really involved ultrasound to determine this, that's kind of the first stage. And I have a study somewhere and it was like with as little as two to three hours of exercise a week, some women would develop luteal phase defect. So it didn't even take that much. The next stage is anovulation. Now the egg isn't being released because again, these hormones are all starting to go south at this point. And again, there may still be some, there may still be menstruation there. It's not apparent. And, and because of other things that are going on with bone mineral density loss and stuff like these are kind of like silent menstrual site and women may have this and not know because everything looks normal unless a woman's trying to become pregnant and can't or you can get ovulation tests and things of that nature. But these were kind of hidden until it developed into the full blown dysfunction and full blown loss of cycle.

And like I said, oligomanorrhea gets into, I don't know if we have time for that whole conversation. It can develop, short version, it can develop sequentially. It can be eumenorrhea, luteal phase defect, and they go in sequence, luteal phase defect, on ovulation, oligomanorrhea, amenorrhea. But as often as not, this oligomenorrhea is due to women with high elevated testosterone levels which would be something like a polycystic ovary syndrome

because originally they just they didn't know they saw it in athletes then they started looking and they were like well we're seeing this in athletes who are not showing this catabolic physiology who are more muscular who are stronger who are in showing this catabolic physiology, who are more muscular, who are stronger, who are in power sports like swimming. And they looked and they were like, oh, the elevated testosterone is causing, so it can occur sequentially. And the difference is, if a woman's always had an irregular menstrual cycle, like from day one, she probably has PCOS. If a woman has never had an irregular cycle, if it was always normal and then develops, it's part of the sequence. So that's how you

diagnose. That's how you sort of differentially diagnose it. Women with PCOS don't just, you know, now women with PCOS can lose their cycle, but they are coming from that base of the irregular. So anyway, so we've got all of that. So women, even at a subclinical energy availability, right, it's a little bit low, may develop one of these, you know, subclinical dysfunctions, but not develop full blown amenorrhea. And when you get into like all the numbers and the thresholds and all this other stuff, like the only thing that sort of speaks to the 30 is that so all women with amenorrhea have been found to have an energy availability below that 30 K cal per kilogram lean body mass.

However, being below 30 doesn't guarantee that you will develop amenorrhea. Does that make sense? Yeah. So basically what you're saying is not all women who are under 30 are going to see amenorrhea, but all women with amenorrhea are under that threshold. Correct. And the treatment for amenorrhea in this case, and amenorrhea can be caused for any women's bodies or for any number of reasons. This is what's technically called functional hypothalamic amenorrhea because it's a change in hypothalamic hormones.

The treatment is train less and eat more and with good luck getting women to do it but that is that you know when they've taken athletes they give them enough calories to get them back up to like 35 eventually their cycle returns yeah and and some researchers have thrown out that 45 is, is, uh, optimal efficient. However, this is really, if you're not training three, four hours a day, that's going to be way too many calories. That's like 22 calories, you know, per pound of lean body mass. That's way at the extremes. Now something came out of this was like late two thousands. When this first value got thrown out this 30, suddenly the dieting culture said,

never go below that value, which is great in theory. However, if you're trying to, if we're trying to get extremely lean, we're talking contest levels, physique levels, 12%, eventually she's got to cross that threshold. There's no getting around it. eventually she's got to cross that threshold. There's no getting around it. The ideal, the goal is to cross it as late as possible and to stay there for as short a time as possible. Right. Now I'm not saying all women will have to go under this, right? However, if you're trying to get to the extremes of leanness at some point, that's just the realities of dieting. And at that level, that's probably, you know, again, some women do, there's also something after what's 14 years of what's called reproductive age, right? Now this is different than biological age. Reproductive age is the number of years since a woman started menstruating.

The woman started menstruating at 12 and she's 20, she's got an eight-year reproductive age. If at 14 years reproductive age, women's systems become far more resistant to these issues for whatever reasons. That's actually when a woman's pelvis stops developing. So there's something going on there. But the unfortunate reality is most women who are running into this, who are adolescent or, you know, teenage female athletes, early twenties, they haven't reached that point and they're going to run into that problem if they go. But yeah, so let's look at, you know, classic, what I call toxic, toxic dieting culture. I'm going to jump into as much exercise as I can stand and as low calories within

a week problems can start. And even if a menorrhea doesn't happen for a couple months, you're going to see some dysfunction. You will see some dysfunction. And there's actually some women's book. I cited some case studies, uh, of physique athletes, and this is tracking one athlete. So one of them, she started her diet right at the 30 level she was already on too few calories yeah she lost her menstrual cycle within the first month of dieting yeah she did not have a cycle for the next six months of her prep coming out of the diet she decided to do very slow reverse dieting to avoid fat gain yeah She didn't get her cycle back for like another year after the show. So she, she went 18 months without a cycle and there was another,

another physique athlete. They followed. She's, she didn't cross the 30 threshold to like a month before her show. She lost her cycle for a month, came out of the show, bumped her calories, got her cycle back within a month. Now, again, these are case studies. I'm not saying that this proves anything, but it is sort of an example of what we're talking about. There are better and worse ways of going about this type of thing. That's a great point because reverse dieting has become extremely popular, particularly with women who have done a lot of work to achieve a certain level of leanness. And it's very understandable that you would want to maintain as much of that as possible

while you reintroduce calories. But it sounds like what you're saying is if you've had amenorrhea or you're experiencing hormone dysfunction from having ratcheted your calories down too much, a reverse diet is about the slowest way to get back to normal possible. Yes. Because you're staying in a deficit longer and we're not going to normalize anything. So you get at least above that critical threshold. Now you don't necessarily, right. And again, we're, if we're looking at like a physique diet or like classic, you know,

who's getting down to 10% body fat, she is not trying to sustain that forever or shouldn't be right. She should be coming back up to 18 or 20%. Now, if we're talking about a female dieter, who's gotten to let's say 18%, right. Which is lean, but not excessively. So she may have lost her menstrual cycle. If she brings up her calories over the next six weeks, this is six more weeks that she has an insufficient energy availability. Now, the physique dieter has to regain body fat. If they're trying to treat a female runner who's at 12% body fat, yeah, she's going to have to regain some body fat. 18% may not have to regain body fats, but she is going to have to. And what happens is, and we know we've known this for years, right? You can achieve energy balance. It's, it's not a number. It's a moving, it's a

moving target because, and as much as like, this is going to come across as like talking about starvation mode or whatever. So you've got a woman who's at too low of energy availability. Her thyroid hormones are low. Her metabolic rate is lowered because of this. When she comes back up to a sufficient energy availability, it's like 35. And her thyroid hormones improve and all these other things improve. Her NEAT will probably go up because she's not exhausted all the time. She can train more intensely.

Meat will probably go up because she's not exhausted all the time. She can train more intensely. She may still be in energy balance while being at a higher energy availability. Gotcha. So she won't necessarily regain it because that's, of course, the fear. Yeah. Now, I will say, you know, fine. You don't have to bring up calories like immediately.

Would that be ideal? Sure. But if you want to take a week to bring them back in so you don't lose food control, that's fine. This idea of taking six to eight weeks to come back up to calorie balance, all you're doing is potential long-term damage. Yeah. Another thing in that vein, another case study, it's one researcher, Trent Stellingworth. Uh, he, he followed this. Sounds like a porn star, not a research. Yeah, right? He followed this elite female runner for like seven years and tracked everything, her body composition, body fat, bone mineral density, energy, training, blah, blah, blah, blah, blah. And what she would do is out of season, she would stay about 14%, 15% body fat, but with sufficient calories to support her training, to support her progress. And then right before her competition phase, she dropped down to 10 to 12. She would lose her menstrual cycle. Everything would go down, you know, into the toilet. She would compete,

but she would bring it right back up immediately. She'd come right back to 15% sufficient energy availability. And what he found was she set numerous PRs, some records. She never got injured. She was able to stay in her training intensity because she took a very pragmatic approach to it. Yeah, I got to be 12% to compete as a runner, but I'm not even going to attempt to do it because you can't train effectively on calories that low, your recovery's down. So yeah. Now, does this mean that a woman should never do a crash diet? Well, not necessarily. You have to accept that there will be consequences for it.

And if it is done, it should be short term, right? If you want to, you know, because again, I've written a book about crash dieting, but it's like, yeah, if you're a lean woman, two weeks tops. The problem is when women try to do it week after week after week after week without a break. There is also the debatable possibility. What if you insert higher calorie days? Will this offset the problem? There's very limited research on this. This would be something like a refeed, if you will. Right. I've actually gotten really away from that term because it tends to be people like, I just eat every food that's not nailed down. I just think of it as a maintenance day. And I find that I think psychologically that avoids some of the problems people get into.

So, and Luke's again, she's done this, like this is her career, right? This is just what she's done. And she's generated some of the best data on this that's ever been seen is they knew that in animals, if you starved them and then refed them for one day, everything would normalize. Now animals work on a much faster timeframe than we do. Like one day for a rat is like seven days for human. So she took women and she put them on five days of super low energy availability. And then she did overfeed them. It was something like double maintenance. It was like 6,500 calories a day for one day, something just crazy. And there was no change in hormone levels. It did nothing. It's just too small of a window. One day was not enough. Now

there was another study that was actually looking at something completely different. And what they did was three days of total fasting, but I went and mapped it out. And the total deficit was actually about the same three days of no food versus five days. And then just, and they measured hormones and everything went, went into the toilet. And then just for whatever reason, they were like, we're gonna let them eat at maintenance for two days and then remeasure them. And everything had normalized. So two days might be a sweet spot, whereas one day is just insufficient. Correct.

At that, and it may, you know, and it may depend on the degree of low energy. You know, if maybe if it's pure at 10, 10 K cals per kilo, maybe different, we don't have that data. But, and if you look at really what I've said over the years, I don't think that one day per week at maintenance really does much metabolically. I've really changed because I just don't think the data supports it. Or even psychologically. Yeah, I mean, it can, you know, I think two days is better. We then get into debates.

Do they have to be two days in a row? What if you have two days, you know, a Wednesday and a Saturday? Will that offset it? We don't really know at this point. We do know that a two-week diet break will certainly reverse it. Yeah. One of my favorite studies, this is in men, but again, they're starting to see similar phenomenon in men, which has its own issues. They're now, you know, what they used to call the female athlete

triad that had to do with all this, which had to me, the unfortunate acronym of FAT. I think they could have probably done better since it was seen in lean women who were starving themselves, but that's just me. They're now calling it relative energy deficiency syndrome to really emphasize that this is an energy availability issue. Neither here nor there. But in men, there was an old study. It was like Navy SEALs or Army Rangers who went through eight hours of like 16 hours a day of activity, too little sleep, like 400 calories a day, like just, I mean, military training. The end of it, they lost all their body fat, their testosterone levels were castrate, their cortisol was through the roof, their thyroid was crashed, like they showed

the same hormonal profile that you see. They refed them completely for one week while keeping activity high and their hormones basically normalized. So within one week of maintenance calories, that now will that necessarily reverse amenorrhea? No, that's not what I'm saying. However, if a woman wants to do that, maybe we need to put a diet break every six to eight weeks where they take a week and raise calories. Maybe like we talked about, we schedule that. So it's going to happen in the luteal phase. Of course, it's worth mentioning. If a woman loses her menstrual cycle, there is no menstrual cycle dynamics. The hormones aren't changing anymore. They're just all tanked, right? They're just all tanked. Exactly. They're just all in

that place. But if she's still menstruating, there's still a cycle and there's probably some sort of subclinical disorder. Well, maybe do a week at maintenance or even two weeks at maintenance during the weeks three and four, you know, do that every, would be every six weeks or every 10 weeks, right? It has to be alternated. And then that helps to normalize your hormones. And again, diet long enough, get lean enough by keeping calories too low. It's not a matter of if it's going to happen. It's a matter of when it's going to happen. The idea is to prolong that point for as long as possible, but as importantly, to reverse it as quickly as possible. Makes a lot of sense. So

just to circle, go ahead, just to circle the wagons here before we, before I move on to a few quick questions that might not be too quick because they're about birth control, but for women with a conventional healthy menstrual cycle, where we're looking at a follicular phase, ovulation and alludial phase the hormonal variations for healthy women we want to try to if we can for performance training front load it into that follicular phase be a little bit gentler with how we train on the back end for people who are training for physique you're probably going to do a little bit better in the follicular phase, but the style of training isn't as demanding. So you'll be relatively okay. Staying consistent substrate utilization is going to be different. You'll use more carbs in the follicular than the luteal you'll lose. You'll

use fat perhaps more efficiently in the luteal than the follicular body compositional changes, water changes, whether that be fluid or sodium related are going to be all over the place. So it's always a good idea to track your cycle, gauge how you're doing. If you're working with a coach or if you're not, you recommend really getting a good idea of where you are on that 25 to 32 days, getting in a rhythm and tailoring your programming or, and your nutrition to kind of your unique situation to the best of your ability. Correct. And the one thing I would add about sort of, if you're physique training, right, we've now established that kind of any repetition range to a degree will work. Right. And it may very well be said in the follicular phase, when

you're stronger, when your recovery is better, well, you can go a little bit heavier. You can go sets of six to eight or eight to 10. And then in the luteal phase, weeks three and four, when you maybe don't feel quite as strong, well, do your sets of 12 to 15. Love that. Love that. That's awesome. And so there's, you know, and you can do it again, the same thing for performance athletes

to less of a degree. If you're never going to hit PRs in week one, boom, go do it. Go hit your 90% plus for singles and just put it up. Week two, maybe you're doing doubles or triples at 85. Maybe in week three, we're going to do slightly more. You might be a little bit stronger. You might not. And in week four, well, maybe you're just going to go do technical work at 65% if your

coordination is there, right? That way you're at least training productively towards your goal, or maybe not, maybe you don't even have that. And you just got to do, do what you're going to do and do poles or, you know, whatever it is, runners. And we're not going to get into endurance sports, but there's probably places there as well where you're better off, you know, you don't use carbs as well in weeks three and four. High intensity training that require carbohydrates is not going to go as well. Maybe that's when you do more long, slow endurance training. Maybe that's when you really utilize that body's ability to use fat for fuel. Then

weeks one and two, when you've really got the ability to use some carbs well, that's when you do your time trial work and your HI, you know, and cycle it that, like I said, endurance sports, whole separate thing. And again, it's also submaximal. It doesn't matter as much. No, I still, I love the idea of if you're going to, you know, making the assumption, if we train close enough to failure, we're going to get a hypertrophic stimulus, regardless of the rep range. If you want to train in more of a mechanically tensioned focused rep range, like a three to eight, do that during the follicular phase. If you want to stimulate maybe more of the metabolic pathways or those higher rep ranges,

sprinkle those in. And then maybe in that fourth week, like you said, if you want to isolate and do machine work where the movement complexity is very low, you're highly stable. That would be the time to really hammer those things. Absolutely. I love that. Yep. So last question, and this is an interesting one because I get it a lot and it's the interplay between birth control and hypertrophic or muscle building potential. And so I really just want to simplify this as much as I can. Is there a form of contraception that is best for women who are looking to prioritize their muscle growth potential, but also want the benefits of contraception? Right. And the answer is, oh my God, this is so complicated. And the research is so terrible that it hurts me sometimes without getting into that. Cause birth control could be an entire hour to

try to explain it. Yeah. We're going to have to do an episode just on birth control. Yeah. The short version of this that like I said, super quickly is birth control. There's a synthetic estrogen. There is a synthetic progesterone called a progestin. Mainly I'm going to focus on the progestin. Progestin can act kind of like progesterone depending on the type. There's four different generations that have been developed over the years. Type, you know, first generation, second, third, fourth. They all vary in how they impact a woman's body.

But in this context, the main thing is how do they impact the androgen receptor? Are they androgenic or not? Right, androgenic just means masculinizing, right? They're called anabolic androgenic steroids. Yeah. Now, first generation birth control, and we're talking the 70s, got, it caused women to get oily skin, acne,

highly androgenic. So it's basically sort of sending all the bad signal with none of the good signal essentially yeah right second generation was a little bit less androgenic third generation is the least androgenic fourth generation is anti-androgenic meaning that it binds the receptor and blocks it right so that's the main anti-androgenic meaning that it binds the receptor and blocks it right so that's the main anti-androgenic progestins there's yaz well the commercial brands are yaz and yasmin it's called drospironone is the actual progestin women love it it they drop body water they lose weight clears up their skin acne oily skin because it's preventing the testosterone in their body from having any impact. Yeah. That would have the single worst effect on muscle

gains. Great. Of course it would. It makes a lot of sense. It hasn't been studied directly in this sense. And their research on this is all terrible. They're like, who's going to pay for that, right? Well, I mean, they do it, but it's like, cause it's an important question, but a lot of these birth control studies are like, all right, we took 10 women. They were on five different kinds of birth control that are all acting differently in the body. And then we had them compared to, and then we took the data and we smooshed it together. I'm like, you gotta be kidding me. Something like 50% of all women are on birth control and you couldn't find 10 on the same kind. You gotta be joking. Occasionally researchers would be

like, all right, we put them on either a second or a third gen, whatever, like that actually did good research. So probably really the study that, and it's weird, got published as a poster in 2009 and it just got published as a full paper like a week ago. Oh shit. Good timing. I really want to, I really want to email the researcher and go, why did it take this 12 years to get published? I don't know what's going on. Must've been a peer review help. So what they did was they took women, not on birth control and women on birth control and training for eight weeks, hypertrophy training. And what they found is that the birth control prevented muscular gains.

Okay. And the non-birth control gained like three pounds, kilo and a half, something like that. But then they divided it up and they said, all right, the more androgenic birth control, the ones that have a progestin that binds harder to the androgen receptor, gained less muscle. They gained like 0.3 kilos. The less androgenic birth control gained about a kilo. So it was about half a kilo difference. It's a big difference. Yeah. Well, it is and it isn't. All right. If you are an elite athlete, a female powerlifter, an elite Olympic lifter who is trying to maximize your muscle gain and your performance to the highest level that matters.

If you are the, I, I got, I hate to use the word typical or average, cause it sounds really, really demeaning. And I don't mean it in that sense. If you are a female who is training for just general body comment, like, cause trust me, recreational track athletes or trainees will bust their butts just as hard as anybody else. So I'm not, I'm not saying like, that's a lesser goal, but you have to ask yourself, are the benefits of birth control, the potential benefits, whether it's controlling my menstrual cycle, they can help prevent anemia because you're not losing iron in the blood every month. Birth control can have a number of benefit effects. Is that half, is that half kilo muscle different? Does that matter to me? You see the same thing in the aerobic studies.

They're like, all right, this birth control lowers performance by 5%. Does that matter for the average trainee? No. Does it matter for an elite runner? Yeah. So if I were going to make a suggestion, it would be an oral form of birth control, combined oral contraception. The synthetic estrogen doesn't seem to matter much, although one study said it wasn't the progestin at all. It was the estrogen dose.

At this point, tomorrow a study could come out that say everything I'm saying is wrong, and I'll be okay with that. I am drawing inferences from a lot of various research. The problem is that estrogen, the synthetic estrogen, can cause women to hold more water. That shows up as lean body mass. Who the hell knows? And it would be combined oral birth control that had a third generation progestin, which means, I have to look it up. Go for it. Those are, they're called desogestrel, gestidine, and norgestimate-containing pills. Let me share my screen real quick. And then I guess the other form that I'm aware of is somebody with a very rudimentary knowledge of these things is IUDs. Okay, yeah, and that's actually worth bringing up because there are, you've got the other forms of birth control. You got the pills is sort of the most traditional one. You've

got the patch, the ring, the implant, the Nexplanon implant, Depo-Provera. Depo-Provera is awful. I will say that. It is easy because it's a shot once every three months. It causes the most weight gain. It causes muscle loss. It doubles the risk of obesity. It causes bone mineral density loss. I will thump till the end of my day is that that stuff should be taken off the market. Why we are still using a 50-year-old high-potency synthetic progesterone. Has nobody come up with anything better in the last 50? I don't believe that they can't. Just get the researchers, stick them in a lab, and don't give them any pizza until they work this out.

This is not an intractable problem, right? Just you got to motivate them with the right thing. Okay, so the hormonal IUD is different than all the rest of these. All these other forms of birth control are putting synthetic hormones into a woman's body and essentially replacing them. They are causing changes in her, you know, luteinizing hormone, what's called follicle stimulating hormone. All forms of birth control actually lower testosterone by about half,

which is another consideration, lower free testosterone by half. This is why they're used to treat polycystic ovary syndrome, which tends to have to, and it treats the acne, the oily skin, the body hair, all that stuff to reduce the testosterone which is great if you're pcos woman who wants the health benefits pcos women have a

huge advantage in sports yeah they have they may have doubled the testosterone of women so again context anyway the hormonal iud is purely local it releases a synthetic progestin, which thickens the endometrium. It also is a barrier method because it's like a copper IUD, but it doesn't, a tiny, tiny, tiny amount of the synthetic hormone gets into a woman's bloodstream. So woman will still menstruate or hormones will still cycle normally. It should not impact muscle gain or perform. Now, nor will it, if woman's got huge performance variations, nor will it level those out, right? That is another valid reason for a female, because if her performance is doing this and this and this, if you're a female athlete, you may be losing one week, 52, you know, whatever, you may be losing 12 weeks a

year to not being able to train hardly at all. That's a consideration. Many women will use contraceptives, not only for contraception, but to simply regulate their menstrual cycle so that they don't have a week where they're incapacitated so that it level at least levels things out. You have to weigh that. Yeah. There are pros and cons to all of it. I love it. The IUD shouldn't affect muscle gain. It will still provide contraception, but it will not flatten out a woman's hormonal cycles if they're there.

I think it's a perfect place to wrap it up. It's unfair to talk about the menstrual cycle and not in some capacity, talk about the ways that women go to manage it therapeutically with things like birth control. Oh, absolutely. Lyle, wonderful conversation as always. So appreciative of your time. Thank you for having me. There's plenty of women who are going to listen to this and who are going to want to find your work and your resources. Where can they do that? So my website since forever is just called bodyrecomposition.com.

That's where my articles are. My books can be found at store.bodyrecomposition.com. And if you really want to deep dive into this, you know, I wrote the women's book. It's 425 very technical, small font pages. It's not an easy read. But if you really want to dive into the the depths of this um my facebook group is extremely active also called body recomposition um i got a lot of brilliant experts in my group i tend to attract see i got a great ob gyn who can handle the questions that

i'm not you know that i'm not usually medical type stuff um i am on instagram but i mainly post dumb memes and dad jokes. So if you're looking for fitness content, that's not where to go. But yeah, my Facebook group is really where I'm most active at this point. I got a lot of smart people in there. Cool. Hey, thanks again so much for your time. I know this will be really valuable and we'll do a third episode soon. Sounds good. All right, man. Have a good one. You too. All right, everybody. There you have it. Thank you so much for tuning in. And thanks again to Lyle for coming on.

What a resource he is. What a great friend to the show he has been. Cannot wait to sit down with him in the next couple months and record the third episode in this series on women's physiology. If you listen to this and you learn something about it today, or something at all today, please share this episode. There are so many women out there looking to improve their health, their performance, their aesthetics, using resistance training and using nutrition, but using it improperly because they are victims of this nasty diet culture and some of the more pervasive myths and just the lack of nuance that is brought into the discussion when we talk about women's physiology. It's very different from men and we need to begin to evolve the dialogue there and stop treating women like little men. So please, please, please, if you enjoyed the episode, hit subscribe, share, leave me a five star rating and review on the iTunes store if you're an Apple listener. Every little bit helps.

Enjoy and have a great rest of your day. What's going on, guys? Coach Danny here, taking a break from the episode to tell you about my coaching company, Core Coaching Method, and more specifically, our one-on-one, fully tailored online coaching program. My online coaching program has kind of been the flagship for core coaching method for a while. Of course, we do have PDF programming and we have app-based programming. But if you want a truly tailored one-on-one experience with a coach like myself or a member of my coaching team, someone who is certified, somebody who has multiple years of experience working with clients in person online, somebody who is licensed to provide a macro nutrition plan, somebody who is actually good at communicating with clients because they've done it for years, whether that be via phone call, email, text,

right? This one-on-one coaching program is really designed to give you all the support you need with custom training designed for you, whether you're training from home, the gym, around your limitations and your goals. Nothing cookie cutter here, as well as easy to follow macro nutrition programs that are non-restrictive. You'll get customized support directly from your coach's email, or they'll text you, or they'll WhatsApp you. We'll find the communication medium that best supports your goals, as well as provides you with the accountability and the expertise you need to succeed, as well as biofeedback monitoring, baked-in accountability support, and all of the stuff that you need from your coach when you check in. We keep our rosters relatively small so that we can make sure you get the best support possible. But you can apply today by going over

to corecoachingmethod.com, selecting the online coaching option. And if we have spots available, we'll definitely reach out to you to see if you're a good candidate. And if we don't put you on a waiting list, but we'll be sure to give you the best shot at the best coaching in the industry. So head over to corecoachingmethod.com and apply for one-on-one coaching with me and my team today. apply for one-on-one coaching with me and my team today. Welcome in everybody to another episode of the Dynamic Dialogue podcast. As always, I am your host, Danny Matrenga. And in today's episode, I'm joined by Dr. Kyle Gillette. Dr. Gillette is a medical doctor, and we will be discussing some of the nuances around hormonal interplay, physiology, and how hormones influence things like our wellness, our fertility, our body composition, our performance, debunking some myths,

as well as going quite into the weeds on things like women's physiology, birth control, PCOS, and menopause. This is a conversation I've been looking to have for quite some time. So please sit back and enjoy today's discussion with Dr. Kyle Gillette. Dr. Gillette, how are you doing today? I'm doing well. Thanks for having me on. It's a pleasure. Absolutely. So I have for a long time been looking to have somebody on that can discuss some of the nuances of how hormones play a role in our physiology with regards to body composition, with regards to performance. And there are a lot of people in the fitness space who I think speak out of turn, or they're not necessarily operating in their scope of practice when they give hormonal

information or they create hormone-specific content. And I don't think all of those people are doing so in a nefarious way, but there's a lot of interplay here. There's a lot of nuance and having somebody like yourself, who's a medical doctor on the podcast, I think will really, really bring us to a good place. We can have a good discussion about that. But just so my audience can get to know you, tell them a little bit about yourself, your background, what got you into medicine, and why you're so passionate about preventative medicine, not just the kind of medicine and the kind of treatment we see so commonly in Western medical treatment? Absolutely. So I'm Dr. Kyle Gillette. I am

a medical doctor. I am based out of Kansas City. And in general, other than advocating for true preventative medicine, I advocate for a balanced approach. So, you know, supply and demand is the same in every field, whether it's for your health, whether it's cosmetic health, whether it's no tropic health, you know, cognitive health. Whatever it may be, athletic performance, body composition, and people will find a way to meet the demand. And there is a high demand for people talking about and even giving advice about hormones and body composition. So a lot of people tell me that they've gone to their previous doctor and asked about, you know, hormone this, and they've asked about, and they're not feeling great. Do they need this checked? Do they need X checked? Do they need Y checked? And a lot of people are fairly dismissive because there's not really a standard of practice. So, um, a lot of

physicians practice, well, most physicians should practice evidence-based medicine, but a lot of them also go by expert recommendations and different algorithms. And when you're talking about someone that wants to have something other than just preventing pathology, so they want to live optimally and not just prevent a disease, then it becomes a little bit more tricky. And that's where an individualized approach comes in. Yeah, I think that's huge. And this is something that I've experienced quite a bit just with my own interaction with my insurance company or my medical provider, which is if you are unwell or if you are sick, you'll generally get better care and more respect than if you're somebody who maybe is looking to optimize or take their health into

their own hands. And I think running labs or getting labs done and wanting to understand where you're at hormonally is really, really cool. And I think it's something that is indicative of a population that is more conscientious and aware of their health, but it's also a lot to consider, a lot to think about. If somebody is looking to kind of take control

of their health and they want to get that real physiological insight that comes from looking at labs, is this something that they can do easily with their physician, with their insurance plan? Or do you find that it's generally easier for them to go outside of the network, maybe go direct, concierge? There's a lot of different ways. What's the fastest and most efficient way? And then maybe we can even talk about what some labs might be worth looking at for males and females who want to optimize health, performance, longevity, et cetera. In general, it is easiest to get labs done or get genetic testing done outside of your health insurance. There are exceptions, of course,

but usually your health insurance, you know, think of a true preventative medicine. They're probably not going to want to cover your 23andMe or your ancestry.com genetic test. They're probably not going to want to, you know, cover your homocysteine level. So it's usually easier and depending on where you go. So the, I guess the health industry or the medical advice industry is both a good and a service. So there's a lot of places where you can get the good. And then there's also a lot of places where you can get the service, but not ironically or unironically, not many places where you can get both the good of the service. So that's why a lot of people find concierge doctors.

And to be clear, even if you're just talking about family physicians or primary care providers, there is thousands of excellent, there's lots and lots of excellent primary care providers and family doctors. And I've interacted with them and also heard patients talk about their beloved provider. Just not many of them are talking about things like this publicly. Gotcha. And I think that's really fair because it is kind of newer and it's growing, but there is a large section, I think, of the population that is motivated by living better, performing better. And as we become simultaneously more and less scientifically literate, if that's possible,

but it really feels like some people are more scientifically literate. They're more aware. They know what they want to focus on. I know a lot of people who come to me and go, I want to get labs done. In fact, when I posted about my most recent lab panel, I got so many people asking me, what lab should I run? What should I look at? And it's great because it's like, look, I don't know what labs you should run because I don't know what's

going on. But if we're talking about, let's say, relatively active adults, we'll start with females and we can talk about males, but relatively active adults who are looking to optimize performance and body composition, do you have a recommendation as for kind of a, you know, panel or just a couple of markers, five, three, four, five markers that you think are worth looking at for these populations? Yeah. So an easy set of labs that you could arguably say this could potentially optimize the health in some way of almost everyone. You know, you're thinking about what your regular doctor gets first. It's probably a CBC, a complete blood count, a complete metabolic panel,

and, uh, maybe a TSH T3 T4 or free T3 free T4, probably a lipid panel as well. And given the recent evidence in JAMA cardiology, probably an APO B if that LDL is above one 30, jam and cardiology, probably an APOB if that LDL is above 130, um, maybe an APOB right off the bat, um, potentially an LPA, um, you know, maybe not if you don't have the genes for it and you've already gotten genetic testing. Um, so that's kind of an easy way to start and then adding on, assuming that the, um, this individual wants to be a little bit more deep, uh, testing on estradiol. So, and making sure that it's, you know, an accurate assay, um, testing a sensitive assay. So estradiol is kind of like the most active form of estrogen, the second type of estrogen. And it's important in both men and women for prevention of cardiovascular disease.

You don't want it too low. And most people are familiar with what happens when estrogen goes too high. Uh, just think of pregnancy and breastfeeding. So, um, well, not too high in those cases, but in other cases, right. Um, testosterone is important in both men and women, including a free testosterone, um, at times dihydrocystosterone, uh, more so in males than females. Then a sex hormone binding globulin, particularly in males and females on HRT, which kind of includes oral contraceptive pills, kind of a type of HRT. So very important for women on COCPs as well, or combination oral contraceptive pills. That's great. And let's unpack that a little bit,

because you said something that I think is interesting. And that is, so often you'll hear people communicate, especially males, estrogen is bad. I do not want any estrogen because for many men, not just men who are using testosterone replacement therapy, or maybe they're dabbling in the dark side of, let's call it self-administered testosterone replacement therapy. And you can get some aromatization, which for those of you listening is just the conversion of testosterone into estrogen. And if that goes haywire and you end up with too much estrogen, that can be problematic. And so from that, many men parent the ideology that estrogen is bad. And conversely, you'll hear something very similar from women, which is the notion that testosterone is inherently bad for females.

I'd love to unpack that a little bit. What are some of the myths around estrogen in men? Can it be beneficial in any way? And testosterone in women, can it be beneficial in any way, and testosterone in women, and can it be beneficial in any way? Yeah. So a lot of times, here's three kind of truth bombs, I guess. One is that the higher the estrogen in the male without symptoms, including any symptom, but as long as you don't have any symptoms or signs of hyper estrogenism, the higher, the better. Yeah. Secondarily, the lower your IGF one in men and women without symptoms, the better. And then a tertiary is in men, the higher your SHBG in men, the better.

So I'll kind of like dive into those. Women, it's hard to say like the higher the testosterone, the better within men. Maybe so someone would feel phenomenal with male levels within the normal reference range for men, which is several times the average reference range. Or even like three you know, um, three, four standard deviations from the mean of normal female testosterone. That's just where a lot of women feel good. Um,

the main problem with that is that a lot of times it's almost kind of like, uh, a very like light version of a gender transition kind of, because a lot of them do have virilization. They feel so fantastic when they're having the slight deepening of the voice or a slight hirsutism or things like that, then they don't really notice it. Yeah. So, um, yeah, as far as the estrogen in men, it does theoretically decrease your risk of dementia. So men with hypogonadism, low testosterone, and also low estrogen have higher rates of

dementia. Also, men who are obese and then lose weight as they enter the geriatric epidemiological age group, I guess, as they enter the older age group and they're losing weight, they're losing weight. Those men also tend to have very low estrogen and they're also at risk of dementia. And then it also is well known if you're deficient in estrogen and you have increased plaque buildup in the arteries of the heart and the brain and the rest of your system as well. So estrogen in men is actually cardio protective. Yeah. In fact, in women that have premature ovarian insufficiency,

POI, early menopause, if you will, that is one of the main reasons why women's HRT is usually assessed to be more beneficial than harmful is because of the risk of early cardiovascular disease in those individuals. Wow. And so with circling back to women, one part of the female physiology I'm aware of where we do see an increase in testosterone is actually around ovulation. And I've heard multiple people take a stab at why that is. I have a reason that really makes a lot of sense to me, but for women who are active or let's say that maybe they're on a form of contraception or not, but they want to perform really well. What are some things they should know about testosterone and how it interacts with the female physiology? I know when we talk about PCOS, if we get to that, we'll talk quite a bit about it, but what are some baseline things women should know about how testosterone works in their body?

Absolutely. So yeah, testosterone does have a lot of benefits for women. Libido is one of them. Keep in mind that free testosterone and total testosterone matter both in men and women. So when testosterone is bound to any binding protein, including SHBG, it does theoretically help it cross cell membranes earlier because of its lipophilicity. Basically, it can cross cell membranes easier. The blood-brain barrier is a type of a cell membrane. So it definitely matters. It also helps having a high-bounds testosterone. It helps decrease metabolism of testosterone. So a lot of people with very low SHBGs, like individuals on SARMs or DHT derivatives, they metabolize their testosterone very quickly. Or women with PCOS or just in general individuals with hyperinsulinemia have low SHBGs. So SHBG does bind estrogen. So it helps you have a nice, relatively more stable cycle other than, um, you know,

precipitous peaks and troughs, which puts you at risk of things like a premenstrual dysphoric disorder. So like PMPD, um, you know, in general feeling horrible before your menstrual period. So SHBG does bind both estrogens and androgens like testosterone. SHBG is going to be likely, and this depends on your type of synthetic progestin and also your type of synthetic estrogen in your oral contraceptive or any like hormone that you're on. Usually it's going to increase very, very high. usually it's going to increase very, very high. Okay. So when you begin taking, let's call it a normal, fairly typically prescribed form of contraception, this will elicit a spike in sex hormone binding globulin. Yeah. For example, ethanol estradiol levonorgestrel is probably one of the most common generic, I suppose. What's the non-generic name for that?

Or is there a manufacturer that people might be familiar with? I think that's generic in general. Orthotricycline might have those two same synthetic estrogen and synthetic progestins. But yeah, probably the most common one would be the ethanol estradiol, even orgestral. Don't hold me to it being orthotricycline, but I believe that's it. But yeah, anyway, very common to have SHBGs well over 100, often even over 200, and also very common to have undetectable free testosterone levels. Is that because sex hormone binding globulin is so high and the affinity for testosterone is so great that it's

basically vacuuming up all the free testosterone. So you might show zero on a lab. Correct. Gotcha. Yeah. So in my opinion, that's super important for women to keep in mind. Obviously there's things like boron or DHEA, which you can talk to your healthcare provider about if you're a good candidate to lower your SHBG from those means or switching over to other things that maybe they don't have a synthetic estrogen etc but um yeah those are some of the important things to keep in mind about androgens androgens are very important the other thing that some women don't think about but a lot of men do is that women have aromatase enzyme as well and depending on your your caloric intake, your caloric deficit versus surplus, your body fat percentage, even your genetics, your aromatase can be very active or relatively inactive.

So even if you produce a decent amount of testosterone from both your adrenal glands and your theca cells in the ovaries, a lot of it might be aromatizing anyway. Gotcha. So you might not end up with as much as you think, depending on the form of contraception you're taking or depending on some of these genetic variations that take place from woman to woman, sticking with the theme of contraception. A lot of my audience is fairly active physically and probably active sexually. So some form of contraception makes sense for them. And there's multiple different forms, but talking specifically here about oral forms of contraception,

maybe injectable forms of contraception. I know there are pellet forms that are put into the body and they slowly dissolve into birth control. And then IUDs, which there are hormonal forms of IUDs and non-hormonal forms of IUD, which I think are made from copper. And I've heard some old wives tales, I don't know if it's true or not, as to how they figured out copper worked. But of these different types, maybe let's unpack them a little bit. Are some going to more aggressively affect things like body composition, have a greater impact? Because so many women will communicate that hormonal birth control really altered their body composition.

And then are some of these options perhaps better for you if you want the benefits of contraception with as few performance and body composition impacts as possible. Yeah. So this is a topic that I truly love. So thanks for bringing it up. Before we talk about it, I do want to mention that I love how there's this huge movement of naturalism. So avoiding endocrine disruptors avoiding like altering your hormones, especially with synthetic things. And I love that there's like, there's like a solid amount of good naturopathic doctors and chiropractors that practice functional medicine, et cetera. But, um, there's, again, there's gotta always be balance.

So as you mentioned, contraception in general is likely one of the things that really helped society get to where it is today especially as our neonatal mortality rates dropped so um it is a profound amazing public health benefit and uh that's why there's all these different conspiracies about um you know because it's it becomes political or cultural at some point, uh, control, not controlling the population, but giving the people the ability or freedom to choose how and when to conceive can completely change someone's life. So whenever you're talking about like a risk of a different form of contraception, you have to keep in mind

that one of the biggest risks is that it doesn't work. That's right. And for some people just having the most efficacious form of contraception, which by the way, is the implant, the next one on which replaced the implant on it's even more efficacious than a tubal ligation than getting the tubes tied. So for some people that, you know, uh, it would just essentially be, um, devastating to conceive at that point. That's a pretty good option. It's something we don't talk about often, which is that having a child and beginning or starting a family isn't in the, you know, not everybody's positioned optimally for that. And that in the modern world, we have the luxury of being able to choose and it really has propelled society

forward. There's, there's a lot of benefits to having these things. So I love that you touch on that. Yeah. So to talk about some other options, uh, you know, there's combined oral contraceptives that have, uh, you know, estrogens and progestogens in them. There's non-combined ones, which is basically mini pill or micronor, which is one that you have to take very consistently. And there's a new one called slend as well, which is derived from spironolactone actually. Okay. Some synthetic progestins are derived from a 19-nor androgen type ring, almost like nandrolone.

Okay. But anyway, those are kind of some of the oral contraceptive options you touched on the, uh, IUD. So there's hormonal ones, there's morenas for, um, you know, uh, women who have had children before or that haven't. Um, and then specifically for no lip risk women, there's, uh, Kyleena's and Skyla's. So those are hormonal IUDs and they're quite efficacious, but typically not, uh, as effective as the implant. And then, uh, there's also a Paragard, which is usually good for about 10 years. The other ones are usually good for five years. And that's the copper one that people know of. Um, you know, the, the ancient copper, I guess,

got it, or the ancient norse goddess i think it's a norse goddess of health was like known for copper because okay has all these healing properties but you know copper is super important for iron utilization as well but it has many different mechanisms of action so that one's um somewhat um controversial because there is a chance that you could kind of like conceive on top of it. And there's also a chance, um, kind of like, uh, ironically a chance that, uh, although it's antibacterial at the same time, you have a higher chance of inflammation or pelvic inflammatory disease when you use it. Um, so it can potentially like even lead to infertility if you have really

bad pelvic inflammatory disease. So it's a really, you know, obviously it's a complicated topic. And talking with a healthcare provider that manages contraception is extremely important for it. I'm also particularly interested in men's contraception. My favorite, which I do from time to time, but not super often is vasectomies. And then there's also a couple different options. There's an implant, which is kind of like really weak anabolic steroids that's, uh, they're doing clinical trials on. So obviously a lot of men are interested in that one. Right. Yeah. Um, fortunately or unfortunately, I doubt that they will, uh, choose one that has any like

clinically significant benefit for body composition. Maybe they should, um, that, that would really work. And then there's also an implant for men that is being talked about as well. Uh, so quite a few. Oh, and also there's essentially a gel vessel gel. I think they're doing trials in India of that one where you put in a polymer and then you inject something, a deep polymerizing agent when you want to reverse it. So, uh, there's a whole host of potential options for men in the future. So there's a whole host of potential options for men in the future. So hopefully the technology for that continues to progress quickly. Yeah, it would be nice to see that men also have the ability to kind of

take the bull by the horns here and accept some responsibility because I've often thought like when you consider the average age at which a woman starts hormonal contraception in this country, it tends to be quite young. Usually women begin taking the stuff that they are going to take it in as early as high school. And it's a form of hormonal modulation, which may or may not be optimal for where you're at at that point in time. And like we talked about, it may be a great idea for you to be having sexual intercourse without having to worry about having a child. But so many women now that I run into as adults are, you know, hey, I want to really take the best care I can of my body, of my physique, of my performance. And I'm wondering

if using exogenous hormones, you know, these dual estrogens or these, you know, forms of oral contraception that are, they're quite heavy in the way they modulate the physiology, you know, these dual estrogens or these, you know, forms of oral contraception that are, they're quite heavy in the way they modulate the physiology. You know, they're wondering if that's still the best option for them. And so I think just highlighting that this is something that you can have a discussion with your doctor about where you can work through and see which of these options is best. I think that's really powerful because I think a lot of women just think if you're on birth control, it's going to mess your body composition up no matter what. And that might not be the case, or there might be some options that could be a little better. Yeah. One interesting thing about birth control is a lot of women tend to carry around

more fluid. So it's not necessarily like peripheral edema. So it doesn't necessarily make your wrists and your ankles swell. Some women say they just feel a little bit more bloated in general. And my theory is that, um, you know, the estrogenic activity and some men on TRT also feel this with higher estrogen, they tend to retain more fluid in all your cells. So even like sarcoplasm, um, has more fluid. I've heard that ectosteroids can have a similar effect. So like terkesterone and beta ectosterone, which are very popular right now. Yeah. So, uh, for some women, for example, uh, potentially let's say there's a, a female and she's a power lifter or she like throws shot put or something or just, you know,

something where mass moves mass a week or two or a month after starting that oral contraceptive pill, she might have an acute benefit just from retention of more fluid and like intracellularly. Interesting. Sticking kind of with female physiology here, I'd like to talk a little bit about PCOS. And PCOS is something that kind of popped up on my radar, I want to say seven, eight years ago. And I didn't really do much with it because, I mean, if you hear about PCOS now, it's very normal, it's very common. But seven, eight years ago, you didn't hear much about this, particularly in my space, probably much more so in your space, because obviously you're working in medicine. But now I hear about it all the time. And I'd say that about 15% to

25% of the women who apply to work with me or my company in their intake forms tell me they've already been diagnosed as PCOS. So this is something that I think is becoming more frequently diagnosed as we better understand it. I know a lot of women are aware of it, or maybe they're concerned that perhaps they have it, or they've heard about it. What is PCOS? How do we diagnose it? Hey guys, just wanted to take a quick second to say thanks so much for listening to the podcast. And if you're finding value, it would mean the world to me if you would share it on your social media. Simply screenshot whatever platform you're listening to and share the episode to your Instagram story

or share it to Facebook. But be sure to tag me so I can say thanks and we can chat it up about what you liked and how I can continue to improve. Thanks so much for supporting the podcast and enjoy the rest of the episode. Yeah, so PCOS is polycystic ovarian syndrome. However, we actually don't need polycystic ovaries to diagnose it. For example, with the Rotterdam criteria, you can diagnose it with just two points of hyperandrogenism and insulin resistance. So like metabolic syndrome. So, uh, it's a spectrum or a continuum. And like you said, a huge proportion of women have it. Um, you know, just like the Pareto principle, the 10 or 20% with the most severe have 80% of the side effects. So those are the people that find out that they're having fertility issues like subfertile. And those are the ones that really struggle with very high body fat percentage or severe symptoms of hyperandrogenism, like hirsutism,

so bad that they could even grow a beard. So that's a very small percentage of people with PCOS. Most people that have it never even know that they have it. So because of it is multifactorial and it's kind of chicken or the egg. So even something like a very high body fat can contribute to PCOS going on oral contraceptive pills or coming off of them can also contribute to PCOS because after you come off it, you're going to have that spike down of SHBG. Usually you have very low SHBG in PCOS and very high LH to FSH ratio. Also, if your mother had PCOS or your mother struggled with like insulin resistance and things like thatG that can also lead to one of the types of PCOS on that continuum or spectrum, usually mild, and it can usually be controlled with lifestyle modifications. Lifestyle modification is usually not to just lose weight and come back in six months. Got it. Which is oftentimes what you'll hear when you're dealing

with something like metabolic syndrome. And I want to highlight that because obviously there are people who just have metabolic syndrome. There are people who have metabolic syndrome and like you said, hyperandrogenism. So they are flagged as PCOS. What are some of the lifestyle interventions? Because one of the things I find very common amongst women who are working or wanting to work with me or wanting to work with somebody in the fitness industry, whether it's a trainer, a coach, a nutrition coach, but their challenge is weight loss with PCOS. What are some of the interventions? Because you said weight loss alone, just lose weight, get out of here, lose weight, come back in six months. That's not very helpful. What are some actionable things that PCOS women who are interested in body fat reduction can do

from a lifestyle standpoint to improve their symptoms and maybe make weight loss a little easier? Because it's understandably more difficult if you're dealing with any of these things that might be flagged on the Rotterdam criteria. Yeah. So I'll make a little bit of a joke. So think of whatever anybody that has PCOS usually tries to do, goes on an absolute crash diet and tries to do a huge amount of cardio. So usually kind of the opposite of that. So think about the benefits of being PCOS, Usually kind of the opposite of that. So think about the benefits of PCOS. Very low SHBG.

You tend to have a normal total testosterone, but a high free testosterone. Yeah. So you're relatively androgenic and you're able to build up a significant, like compared to someone that doesn't, you would theoretically build more muscle than someone that doesn't. Yeah. And it's not even theoretical. I see this a lot. Like I've even flagged clients, not, I've not said like, I think you have PCOS, but I've been like, wow, your strength numbers have increased like insanely fast. And your body fat is staying largely the same. And then two, three months later, they're like, Hey, I'm PCOS. And I'm like,

I am not surprised because PCOS women have the occasional tendency to really perform like they might have elevated testosterone. Anyway, continue. Yeah, no, absolutely. It's completely performance enhancing, but the way that they should address trying to keep a healthy body fat percentage is by increasing their metabolically active lean tissue. So when they do that, they don't have to go on the crash diet. Um, they can do frequent refeeds. Um, they concentrate on resistance training if they're able to more than a, you know, long distance, two hours at a time, cardiovascular training. Sure. And they try to not crash diet to decrease their non-activity. They want to keep their non-activity thermogenesis very high. So those things are especially

important for people with PCOS on a case-by-case basis, partly just depending on what the patient likes, working with their dietician or coach or nutritionist. they could be a candidate for a low glycemic end product diet, which is usually kind of a low carb diet, but a diet that does not lead to like higher fructosamine or glycosylated albumin or A1C. So things like that are, you know, like chips, crackers, cookies, all the things that I like. Highly refined carbohydrates that might spike your blood sugar, right? Yeah. So they're usually a good candidate for that as well. And those things make sense, right? Because instead of working against what's going on physiologically, you're working with

it. And I do find that also for people who are pre-diabetic or type 2 diabetic, that there's always an emphasis on weight loss, which is fair. And then, of course, when the general population thinks exercise for weight loss, which is fair. And then of course, when the general population thinks exercise for weight loss, they think precipitous amounts of cardio, but resistance training does seem to have some really positive impacts on obviously elevating the amount of metabolically active tissue you have because you're building muscle. But it's also one of the only ways that you can go about eliciting glute force activity

in tissue. So if you're resistant to just insulin in general, or I shouldn't say resistant to insulin, but if your insulin sensitivity has decreased because you're either diabetic, type two diabetic, or pre-diabetic, do you just generally recommend resistance training as a lifestyle intervention for that population too? Yeah, I recommend a combination of, and I actually have prescription pads where I write this out, a combination of cardiovascular or aerobic training and resistance or anaerobic training. For most people, I recommend at least two days a week of both, if not three or four days a week of both. And then I have a section on there for the, um, non-activity thermogenesis as well. So fidgeting, whatever you want to call it. Um, but, uh, yeah, they are particularly good candidates for that when you have PCOS and maybe

you're struggling with, uh, suboptimal fertility or something like that, or even body fat. It's kind of like the analogy I make is it's like getting stuck in quicksand and you're trying to get out of quicksand by, uh, like dieting down so that you can like, it's the quicksand is going to come in before you can die it down. You might lose five or 10 pounds, but the quicksand is going to be right. And so you got to dig your way out. And the easiest way to do that is with tools. And a lot of times medications are our tools. So everyone's like, well, if you're on PC, if you have PCOS, do you need to be on metformin contiguously for your lifetime or is metformin evil because it causes B12 deficiencies and gut problems and dysbiosis

of your gut? And the answer for everybody is a little different. And some people are even on topical metformin, but metformin does, it's another one of the things that helps upregulate glute for and glute to both. Um, uh, but yeah, it's a, it's a combination of becoming stronger so that you can dig yourself out and also just using the tool. So sometimes people will benefit more from supplements like berberine or something or brain. Yeah. And yeah inositol so you have

myo-inositol that's more of an insulin sensitizer then you have d-chiro inositol that's more of an anti-androgen so your inositol comes in a combination or sometimes you can get just d-chiro or just myo-inositol so if you're a male you probably want just myo-inositol so maybe don't take that anti-androgen d-chiro-inositol that your partner has. But yeah, that's another good option. Dietary fiber is another good one as well. So there's a whole arsenal of tools. Even supplements like berberine or inositol do have side effects.

So you should chat with your healthcare provider about them before empirically starting them. Um, some people with PCOS will be on, uh, two dozen supplements having side effects of, uh, you know, almost everyone, but at the same time, they won't want to start, uh, you know, 500 megs of metformin twice a week post. So it's kind of ironic to see someone that cares so much about their health that they're trying to avoid the side effects and not realize that there are side effects for over-the-counter products as well. agent. I was like, I'm carbon up. I'm going to pop a berberine with this meal. And I hit the floor. I was so exhausted. I was like, wow, it's very, very potent. It's very effective. And I couldn't agree more with you that we just have a tendency, I think, in the fitness community, in the fitness circle to not be anti-medication, but be pro-supplement or pro-lifestyle intervention first, which I think is really, really more

often than not going to be a good thing. But do not forget that supplements, many of them have a considerable amount of side effects and you should be doing as much, if not more research on those and how they interact with some of the other stuff you may or may not be taking than just what they are supposedly going to do positively. Herbivore is an interesting one. So a lot of people know it's a P-par agonist and each P-par agonist works a little bit on every receptor. So alpha, gamma, delta, each agonist does work on each receptor. You probably mostly P-par gamma agonist, but it's still agonized as the other ones as well. And then it's also a weak GLP-1 receptor agonist, but it's still agonized as the other ones as well.

And then it's also a weak GLP-1 receptor agonist. It's hard to know if that's clinically significant, but GLP-1 receptor agonist, as a lot of people know, there's lots getting FDA approved, and they're helping diabetics and also helping people with obesity significantly. So berberine's a little bit of that. And then it also appears to help decrease conversion of like choline and carnitine to TMAO in the gut. So potentially it will help with that as well. Might be good if you're taking carnitine to maybe pair that with berberine. And then the, the, uh, you were talking about FDA approval for GLP. Uh, are we talking about some eglutide there? a GLP. Are we talking about semaglutide there? Is that one of the primary drugs that falls into that category? Yeah. So semaglutide is one of the newest GLP-1 receptor agonists, and it comes in three forms. It comes in Rebelsis, and I'm not sponsored by them or anything. If they want to sponsor me, then I'll give a talk for them, but I'm not. So we're just talking about it because it works. But yeah, Rebelsys is actually

a tablet with a new technology to where you can take a pill, kind of like you take a thyroid pill first thing in the morning, don't eat for a while and your body can absorb it and you up titrate the dose. And it's for, it's right now it's only indicated in diabetics, but it's just a matter of time until it's indicated for obesity as well and insulin resistance and perhaps fertility. Um, not when you're trying to get pregnant, but before that, and, uh, that's a very potent product. There's also, um, a new one called Wegavy. So Wegavy is, um, Ozempic's, I guess, bigger brother or bigger sister. And it's essentially just a higher dose of injectable semaglutide once a week. There is definitely side effects, risk of certain types of thyroid cancer, risk of pancreatitis, risk of gallstones,

risk of nausea, vomiting, and puking, especially when you drink more than about two alcoholic beverages or eat a big meal, it slows the gut transit significantly. So just think about it. It's a balance. If you slow your gut transit to where it stopped, you're going to have reverse peristalsis and probably be puking a ton. And also your gallbladder is not going to secrete anything. So it's going to get clogged up and have sludge and stones. So it's important to balance all those things. Caffeine can help balance that a little bit, as can other things, maybe some Senna, maybe some Tudka or Udka, which a lot of people are familiar with for its cholestasis benefit. But yeah, no, GLP-1s, I do think that they're the way of the future, and we're probably going to have novel compounds,

and hopefully ones that we don't have to inject more frequently in the near future. I kind of do too. And it's not, you know, I'm somebody whose entire livelihood is theoretically based upon my ability to communicate non-pharmaceutical interventions for obesity and body composition. And I've had numerous clients. One comes to mind that I worked with for a year and she was doing very well with her lifestyle interventions, exercising, watching her diet, reporting her food logs, her weights, her activity. And in a year when we started working together, she was slightly over 300 pounds. And in a year she lost about 15 to 20. And in the second year we were working together, she started some agglutide and she's down 60 pounds. And so, you know, this is something that clearly works. We've seen it in the literature.

I've seen it in practice. And I think it's natural maybe for people to go like, well, just, just work hard. You don't need the drugs. And it's like, it's genuinely not that simple. And if you care about people's health and wellbeing, you know, obesity is not a particularly healthy state physiologically to spend a lot of time in if you can avoid it. So if it's something that helps us at a population level fight against the current epidemic we're living in, I think it could be really beneficial. Yeah. Obese individuals who are stuck in the quicksand, metformin, berberine, those are shovels and GLP-1 receptor agonists are backhoes. So they have a precipitous benefit.

And the patient's still doing all the work by themselves. Totally. They just literally have a better tool to utilize. I love that analogy. Sticking with female physiology, we've talked a lot about estrogen. I've talked on the podcast before about the variances in female physiology that we see around the menstrual cycle with elevations in estrogen, progesterone, elevations of testosterone around ovulation, decreases in some of these hormones and spikes in these hormones

around PMS. But something that almost never gets discussed is menopause. And I know that menopause happens at different rates at different ages for different women. And for men, hormonal changes are fairly simple in that testosterone declines semi-linearly with age. What happens to the female physiology during menopause? And why is it that so many women have such a difficult time with weight loss, body composition during and after menopause? Yeah. So menopause is related to a lot of things. Part of it is when you went through menarche. So when your ovaries started to function, part of it is just genetic and part of it is likely having to do with your environment. Um, what different things that you've

been through as far as, uh, what you've encountered in nature. So as menopause approaches, the ovaries become, um, less responsive to signals from the pituitary, which are FSH and LH. And FSH and LH usually rise. At menopause, usually they're around 50, but they can be slightly higher, slightly lower. Anti-malarian hormone also starts to decrease as a sign of a general sign of ovarian reserve, of ovarian reserve, uh, approaching essentially 0.0. So, um, as those hormonal changes happen, your estrogen and progesterone peaks become more blunted. And often the first thing to decrease is actually a progesterone. So in a normal cycle, which is usually around, uh, 28 days, around day 21 or so in the luteal phase, your progesterone usually spikes up to six or eight. If it's not spiking up above three or certainly five, you're probably not

even ovulating, even if you have a bit of an LH spike around the time of ovulation. So most people, their estrogen will remain a little bit higher, especially women who have higher body fat and their progesterone will drop off. That's why in the perimenopausal time, a lot of women benefit from progesterone to help maintain that balance as they approach menopause and smooth the transition. Uh, so it's also five alpha reduced, um, similar to how testosterone is five alpha reduced to dihydrotestosterone to a dihydroprogesterone. And then it's five off reduced again to five alpha three alpha. And those things help with sleep. So a lot of women note that they have what we call vasomotor symptoms. And, uh, that's basically, you know, you feel warm and you can't sleep. And that's usually a lot due to the ratio between your progesterone and estrogen. Also, progesterone, specifically the withdrawing of progesterone, causes the shedding of the endometrium.

So as your progesterone is not as high, it's not going to be withdrawn as quickly. And that's when women start to note that their cycles take longer because their endometrium doesn't shed because the progesterone just didn't get high enough to withdraw to a point where it would shed. So those are a lot of different things that, um, women note. Um, the progesterone bridge is one thing that's, you know, one trick that's up our sleeve. If the woman also wants or needs, I guess, contraception, a lot of physicians do use oral contraceptive pills actually as a kind of almost a mini bridge into potential HRT in the future. That sounds pretty reasonable. For women who want to ease the symptoms of menopause,

because it can be fairly disruptive to deal with some of these hormonal fluctuations, pause because it can be fairly disruptive to deal with some of these hormonal fluctuations. What are some lifestyle and maybe supplementation form interventions that you've seen to be effective? Yeah, so the most powerful interventions would obviously be hormones. Increasing your LH can potentially increase release of progesterone from the ovary. So you can consider even doing something like Tonkat or Fidoja. Uh, you can also consider, um, doing a progesterone throughout your cycle, but not during menses. You can also consider doing it just the last five days in order to kind of like prevent

the premenstrual symptoms. Some people do it the last five days and during menses if women have significant symptoms during menses as well. But of course, if you do it during menses and the last five days, you're not withdrawing the progesterone. So there's a chance that you'll just delay your menses. So there's a lot of different various strategies of like what to do with your progesterone lifestyle stuff. Um, I always say that the big six is diet and exercise help literally everything. Stress optimization can have a pretty precipitous benefit. So that can control your cortisol and help with natural progesterone release. Sleep optimization can have a pretty significant

benefit as well. So you're going to have more normal release if your sleep is better. Matthew Walker has some amazing info about sleep and the Sleep Diplomat and his podcast. And then another thing that helps is sunlight being outdoors. So that's another good one. And then the last one, the sixth one, maybe it doesn't help as much with progesterone, but it's spirit. So like soul, meditation, prayer, things like that, depending on what you believe, um, those can have a pretty big benefit as your estrogen and progesterone decline, potentially your serotonin can decline as well. Okay.

So, uh, sometimes I'll recommend things like serotonergic probiotics that are proven to increase your serotonin. Your gut produces a lot of your serotonin. Your gut produces a lot of your serotonin. 70% or something crazy like that. Yeah. Some people also take Kana, which is a non-selective serotonin reuptake inhibitor herb, which has various risks and benefits. So there's quite a few things that you could do. It just kind of depends. Really, it depends more on your symptoms and not as much on the actual lab values. I do recommend getting the labs. That way we know that it is related to this or it is not related to this

so that we can rule out other pathologies. I love that. And is it fair to say that weight loss might be more challenging because of some of the fluctuations that we're seeing, but it's not impossible, especially if you focus on getting those big six in order and maybe being a little bit more patient and having some grace. Yeah, that's definitely important. Another thing that is important for both men and women to check is their adrenal gland function. So you go through adrenarche and then menarche as a female. So adrenarche is kind of like your first adrenal steroids kicking in. And that includes progesterone and estrogen and testosterone, DHEA and cortisol.

So some people will go through adrenarche simultaneously with menopause. And for those people, it seems to be particularly difficult. Okay. It's good to know. Just to kind of circle it up here, because I've loved the discussion that we've had today, but misinformation in the health space right now is running rampant in conjunction with a lot of really, really good information. And I have found that unfortunately, when it comes to hormones in particular, there seems to be a lot of misinformation. What are some things that people who care about their health, that are interested in hormones, that want to be making informed decisions should be aware of? What are some red flags that they should look for? And conversely, what are some of the better places to get information about this stuff

if you're hungry to learn more? Yeah. So as you mentioned, this industry is very heterogeneous. And even among medical doctors, there's ones that you probably would want to get your information from and maybe would not want to get your information from. And it's the same thing across the board for any healthcare professional, whether they're a chiropractor or a naturopathic doctor or a nurse practitioner or a physician's assistant or a health coach or a guru. But in general, I recommend people at least start with their kind of like their quarterback. So, you know, the patients, obviously the individuals obviously playing on the field, they can have as many special coaches as they want, like special teams. It'd be, you know, like your guru, your health coach, um, your, uh, you know, nutritionist

dietician, but, uh, the person who kind of like coordinates it all should be a board certified physician or NP or PA, but ideally a board certified physician that you can get along with that kind of like understands your goals and what you want to achieve. It can be a little bit difficult to find, but there's a ton of good ones out there and it's okay to search for one. So if you go to one and then you go to another one and then you go to another one, it's just like finding a good mechanic or, uh, you know, finding a good coach. So a lot of people go to several. And if you find a good one that you're able to keep the rest of your life, that can have a profound beneficial effect on your overall health. I love that. All right, Dr. Gillette for everybody who's

listening, I've seen some of the content you've been producing on Instagram lately. It's really informative. It's really exciting. I'd recommend that they follow you there. But outside of that, how can they keep up with you? How can they perhaps potentially work with you? What's the best way for people to align themselves with a practitioner like yourself, who I think is one of the good ones? Thank you.

Yeah, for now, I'm really concentrated on Instagram at Kyle Gillette MD. I'm sure it'll be a link somewhere. Yeah, I'll link it in the show notes. Eventually, I do want to continue to do more podcasts, potentially even have my own YouTube channel. Yeah. So I do plan to expand across platforms at some point. Good. Well, I think you're really good at what you do. I've learned a lot today and I look forward to potentially talking to you again in the future about some other stuff, man. Thanks so much.