Like, at what point do you, like, present things? 'Cause hell, I've run thousands of VO2 tests, and I see potential things at this point, but there's not necessarily a study that actually indicates that.

Well, I think you're bringing up a broader issue of the scientific literature and what we do with that versus our, you know, anecdotal experience or observed experience, and both of those have their own strengths and limitations.

So in a scientific study, we are allowed or we, we, we have the ability to control for as many factors as possible.

Now, the more we control it, the more we can confidently attribute a finding to the particular intervention or a particular variable.

However, there's some limitations there.

You know, you think about studies in metabolic wards, for example.

Well, we can really know what's going on in terms of calories in and calories out, in terms of all the con- subcomponents of, of metabolism.

Yeah, what have you seen so far w- in the last few years as well?

[laughs]

Well, when we look at the cycle syncing recommendations that you often see online, they're kind of cookie cutter, "This is your follicular phase," or because estradiol is high in this week or this couple of days, then we should be doing this.

All of those recommendations are not evidence-based.

So any kind of pre-planned change to the type of exercise you're doing or the intensity of the exercise you're doing, let's not, [laughs] let's not implement any of those types of pre-planned ... changes because a lot of those programs really encourage inconsistency because they're saying, "Oh, for this week you should be switching everything up." At, at the most extreme level, they'll say, "For this whole week, you should just do yoga and light stretching." Uh, or, "For this week, you, you know, this is when you should be lifting weights." And when we're changing things up so frequently, then we, we aren't getting adaptation.

We need consistency in order to adapt.

So that is actually kind of delaying your progress if you're just constantly switching what you're doing.

Now, are there times during the cycle where some women might feel weaker or feel worse due to menstrual symptoms? Yes.

Right.

Right.

So, and then, uh, but after that, you can mix it up, and there are some exercises where really high reps are kind of fun, like more single joint exercises, uh, lateral raises for example.

You know, doing a set of 15, maybe even a set of 20, that can be fun.

And I w- I think the message here is that we have the choice, and so there are people who love doing sets of three and four, and that's their thing, and that's great.

And there are other people who would prefer to do sets of 15, and that's great.

Like, the, the fact that we have all of this flexibility in the rep range, in the exercise selection, in the equipment, that makes or it should make resistance training that much more accessible to people.

When the fires hit LA last January, we got several Air Doctors for every room in the house.

What is your thought on that? Is that true? Is there insufficient data in the literature, or do you think that things have been improving, and there is a lot of research on women that we can extrapolate enough from the data to make evidence-based recommendations?

Yeah.

I was working with a lot of women at the time, and I'm looking at some of the literature thinking, "Well, a lot of this is in men." And so when we think about what was happening 15-ish years ago, we were at a point where, especially in the resistance training space, we did need to replicate some of the studies that had initially been done in men, and we needed to explore some of these more female-specific questions.

It's not that the hypotheses weren't worth having.

Mm-hmm

... and between men and women.

So our understanding has evolved, where it used to think, oh, testosterone is, is this huge driver of hypertrophy, and during puberty it is, but in response to training, it's a lot less relevant than we once thought.

And we see that because men and women are gaining similar relative rates of, of muscle despite a 15-fold plus difference in testosterone.

I- is that being looked at with all of the other peptides like the BPC-157 and, and those other new ones that are being injected as well?

Yeah, so the, the most important thing to, to highlight here is that w- when a drug is approved, like your Mounjaro, your Wegovy, y- your Ozempic, like they, these go through pre-clinical trials, meaning rodent studies, and then they will apply to get approval to do a very small human trial.

And then if that seems to go well, then it moves on to a larger human trial and a larger human trial.

And so throughout all of these different stages of clinical trials, then they're able to assess the safety, the efficacy, the interaction with maybe other medications, whether it's okay for somebody with a particular health condition, and how do, how do you dose it? Um, all of those things are kind of just, um, teased out in the, the clinical trials.

And so that is why we can feel pretty confident about these approved peptide drugs.

The issue with, uh, with the vast majority of these wellness peptide drugs is they've never b- been studied in humans.

Or if they have, we're talking about very, very small trials that don't assess the, the long-term safety or efficacy or side effects, and so we're making a lot of leaps by using them in humans.

Um, how would you encourage consumers to critically evaluate all of these peptide claims?

So cortisol specifically is one that's just hot right now.

Well, I think hormones are a very kind of hot topic right now.

And there's a tendency to attribute everything we have going on to something about hormones, whether it's hormonal fluctuations throughout the menstrual cycle or the changes to the hormone profile that happen when you're on a hormonal contraceptive or the changes that are going on throughout the menopause transition.

And The truth is that while these can certainly change how we feel, which can matter and is something to be aware of, They, you know, in terms of premenopausal, we're typically talking about menstrual symptoms.

And so this idea that we need to be worrying about day to day or week to week hormone fluctuations is just an unnecessary level of complexity that isn't helpful.

It shouldn't be guiding our decision making when it comes to how we eat or how we train or how we think about our body composition.

With the menopause transition, it's a bit more complex because women are experiencing symptoms.

But how would you communicate that to somebody?

No chance.

Right.

I come from a background as a fitness professional, and so my interest in science was rooted in my background as a fitness professional, and at the time, looking at the literature and seeing there was an underrepresentation of, of female participants, and you'll hear a lot of people say that.

You know, "There's no data in women." But there, there is data in women, but at the time, it's true that it was very common to have at least an initial study conducted in young college-aged men.

And so I was really a proponent of, "Hey, let's try to replicate these studies in women." So the idea for the review was what are these potential sex differences that maybe we have an inkling of a mechanism to generate a hypothesis to say, "Is it true or, or could it be true that maybe women can train more frequently? Could it be true that there's some protective effect of estrogen that would allow for faster recovery or, or less muscle damage in response to hard training? And is there something to be said for these hormones that fluctuate throughout the menstrual cycle?" Because we know a ton about testosterone.

We don't know much about estrogen and progesterone, and so if it is the case that men and, and women are gaining muscle size and strength at similar relative rates, clearly testosterone is not the key that, that unlocks the strength and hypertrophy kingdom.

So at the time, there was enough to say, "Here's the list of the kinda could-bes.

What does that mean? How do I figure out what works for me as I'm navigating some basic fitness and nutrition? What should I be paying attention to? Should I be buying t- like, just walk me through what it means to figure out what works for me.

Maybe we just pause on for a moment and just explain what that is.

Sure.

So people know th- know this as, as type 1 and type 2 or these more long and slow or oxidative type fibers and your fast twitch or, or power type fibers.

And it stands to reason that somebody who is an elite endurance athlete tends to have a higher proportion of the type 1, and someone who is an elite strength power athlete tends to have a higher proportion of the type 2, and we see this with both sexes.

So elite athletes of both types in both sexes can have this skewed fiber type distribution.

And, and just to def- define a little bit more what, what fiber type means, a, a f- a muscle fiber is a muscle cell, and the, the cell will express these proteins.

And so the, the protein is called myosin heavy chain, and that, the, that, that...

So within this overall conversation that we're having today about the importance of resistance training and doing some type of cardiovascular training, whether that's like a dedicated exercise session or it's playing a sport, how can a, a woman kind of gauge as to whether she's allowing sufficient time between sessions for the body to adapt and to get the, the progress that we're talking about?

I don't know that they're not creating other issues, but I think we're gonna see tons of this in the years to come.

Menopause hormone therapy, uh, you know, as you said, is not intended to replace, because you're not supposed to have the same hormone levels after menopause that- as you did pre-menopause.

So the goal there with these estrogen-based therapies is really to target symptoms, not to treat to a hormone level.

And there's a wealth of data that this can be really effective for symptom management, which has a ton of downstream effects.

So we don't have good data to, to suggest that it is going to attenuate the loss of muscle mass or increase muscle mass, but if you're somebody who is suffering with, with hot flashes and poor sleep and night sweats, and then you can get some relief from that, then certainly you're more likely to be adherent to your diet or, or going to the gym on a, on... with greater frequency and feeling better.

And so we can't discount the ability to lean on some of these to, to improve the way that you feel.

The testosterone conversation gets a little bit trickier, because right now, it's really only kind of proven to be effective for low sexual desire, low libido in women.

Maybe I'm not up on the latest of these.

Thank you for having me.

I think the biggest mistake is this assumption that everything is extremely different for women and that women need drastically unique recommendations when it comes to exercise or nutrition than men.

I love that.

You should not be training according to your cycle.

And a lot of these programs that are promoted on social media, they promote a style of training where you're constantly switching things up.

So this week you're lifting weights and next week you're doing yoga.

And that's just not conducive to optimal progress and reaching your goals.

that.