Does Menopause Cause Muscle Loss? | Dr. Lauren Colenso-Semple & Dr. Andy Galpin

Muscle Mass and Strength Changes During Menopause00:00

Nothing happens to strength during menopause. Nothing happens to muscle mass. This holds true regardless of weight loss or lifestyle changes. If a woman does not exercise, or if she used to exercise and then stopped, she will lose muscle mass and strength. When women report losing a lot of muscle during menopause, individual differences are always accepted and their experiences are believed. However, most of the time, the loss is due to a change in lifestyle, diet, exercise, or something else, and not menopause itself, and probably more directly than a specific change in estrogen based on the data currently available.

Sixty to seventy percent of women gain weight during menopause. If body fat is gained without a similar increase in muscle mass, body composition has changed, which creates the appearance of muscle loss when in reality another factor is at play. The original hypotheses generated by rodent models do not apply to menopause in humans. The SWAN study followed people through the menopausal transition and observed a general trend of increasing body fat percentage while muscle mass remained relatively stable during the growth phase, clearly indicating that the absence of estrogen is not the cause.

Recent studies on estrogen replacement therapy compared people who underwent hormone therapy with those who did not and found no differences in their muscle mass. This demonstrates that estrogen replacement does not provide the protective effect or help maintain muscle as expected, even without considering exercise or nutrition.

Testosterone's Role in Muscle Growth02:30

Testosterone does play a role in muscle. The greatest benefit from testosterone occurs during the growth phase, which is the key to knowing when testosterone is truly effective. When testosterone levels are below normal, that does affect the ability to build or maintain muscle. When levels are well above normal, higher exogenous testosterone levels are beneficial, and data from both men and women confirm this.

However, even if normal testosterone level is much higher than another person's level, this does not necessarily mean being stronger or more muscular than them. Going from a certain level to zero is very different from the slight slowdown that comes with age. The same applies to testosterone. If clinically low testosterone exists and then returns to the normal range, that is beneficial. But going from normal to high normal is not the same as going from zero to average, and going from average or high to outside the normal range is different. These two things move independently.

If testosterone level is within the normal range, a slight increase or decrease can alter symptoms such as sex drive, energy, and recovery, whether male or female, but that does not necessarily predict who will gain muscle faster. If testosterone level was very low, perhaps below 200 for men, and then returned to the normal range, that might help, especially in terms of how one feels. If exogenous testosterone levels exceed physiological levels, that would be felt.

The limited data on the effect of testosterone on muscle growth in women, especially postmenopausal women, shows it does not make a huge difference. There might be an effect for sex drive. The doses given to postmenopausal women are designed to be in the very low normal range because the potential side effects of very high doses are not wanted, and there is no need for that in the case of low libido.