Hormones: The Foundation for Building Muscle
GETTING STRONG TO SAVE YOUR LIFE, PART ONE
Hormones: The Foundation for Building Muscle
If you've worked with me for any length of time, you've heard me say that muscle is the currency of healthy aging. You spend it every day just living, and unless you keep making deposits, the account runs low. Strong muscle protects your bones, steadies your blood sugar, keeps your metabolism running, and is one of the best predictors we have of how independent and capable someone stays into their seventies, eighties, and beyond.
But you can't build muscle on a foundation that isn't there. That foundation is your hormones. This is Part One of a three-part series inspired by "Getting Strong to Save Your Life," a series from Dr. Elizabeth Yurth and dietitian Lacy Puttuck at Boulder Longevity Institute, and it starts where I believe every conversation about strength should start.
The hormones we're talking about
One thing that surprises many of my clients: men and women have the same sex hormones. What differs is the ratio, which depends on sex at birth and shifts over time as production naturally declines. Three of them do the heavy lifting for muscle and bone.
Testosterone gets labeled a "male hormone," but it matters for everyone. It drives muscle building, helps the body distribute and use fat appropriately, supports red blood cell production, and underpins libido. Women make it too, and women feel its absence.
Estrogen gets labeled a "female hormone," and it also matters for everyone. Estrogens support the brain, heart tissue, muscle, and bone. In women the ovaries produce them; in men, a portion of testosterone converts to estradiol and estrone. Men with too little estrogen have weaker bones and more joint trouble, not fewer.
Progesterone balances estrogen in women and protects against estrogen dominance. In men it supports sleep quality, prostate health, and a healthy stress response. It is also the first to fall. Progesterone, testosterone, and estrogen all begin declining around age 25, but progesterone drops fastest, and chronic stress speeds it up further. That's why a relative progesterone deficiency is so common in the people I see, men and women alike.
It's a balancing act
Hormone optimization isn't about pushing one number as high as it will go. It's about getting all three working together. When testosterone is pictured, people tend to imagine oiled bodybuilders on a stage. That image is exactly what happens when one hormone is driven up without regard for the others, and it's a big reason hormone therapy carries the stigma it does.
Estrogen dominance is the most common imbalance I see. It happens when progesterone falls faster than estrogen, and it shows up as anxiety, fatigue, stubborn belly fat, fibroids, low libido, poor sleep, and a long list of symptoms that get dismissed as "just getting older." Restoring progesterone often changes the whole picture, and it needs to be in place before muscle-building efforts can really take hold. An imbalance doesn't just stall progress; it can set you up for injury.
"In range" is not the same as optimal
This is one of the most important things I can tell you. When your doctor says your hormones are "normal," that usually means your number landed somewhere inside the lab's reference range. But reference ranges are built from the population being tested, and testosterone ranges have actually been lowered over the past few decades because so many people are now low. Being in range means you're similar to a lot of tired, under-muscled people. It doesn't mean you're where you need to be to get strong.
In my practice I review labs against functional optimal ranges, and for the hormones that build muscle and bone, that means aiming toward the upper portion of the range, not simply inside it. Optimal and "good enough" are not the same thing.
Let's talk about the cancer question
Much of the fear around hormone replacement traces back to the Women's Health Initiative study from the early 2000s, and to the way its findings were reported. The most alarming conclusions have since been reexamined and largely walked back, yet the stigma lingers and still shapes what many physicians will and won't offer.
Can hormones contribute to cancer? Yes, and so can the hormones your own body makes. Hormones used in replacement are exogenous, but when they're dosed and monitored appropriately they behave the way your endogenous hormones do. The real question is not "hormones or no hormones." It's "are my hormones balanced, and how is my body metabolizing them?"
That's where testing beyond a basic blood panel earns its keep. The DUTCH test, which I use regularly, shows not just hormone levels but the pathways your body is using to break them down. Some metabolic pathways are protective; others are not. Knowing which ones you favor lets a skilled prescriber support the safe pathways and keep an eye on the rest. Optimization is a comprehensive look at what your body is making, how it's using it, and where it needs help, not just adding whatever you're short on.
Start earlier than you think
Hormone therapy is often treated as an "older person" concern, something to consider after menopause or a low-T diagnosis. But if decline begins in our mid-twenties and bone building ends around 21, then waiting until 55 to look means decades of missed opportunity. I'd rather see a baseline at 30 or 40 and watch the trend than meet someone at 60 already in a deficit that's hard to climb out of.
A healthy musculoskeletal system requires balanced testosterone, estrogen, and progesterone. Muscle is fundamental to health; hormones are fundamental to muscle. And muscle, through the myokines it produces, is one of the strongest signals your bones receive to stay dense and strong. It all fits together.
What this looks like in my practice
I'm a health coach, not a prescriber, and that's a role I take seriously. What I do is help you understand your labs, identify where you fall relative to optimal, address the lifestyle and nutrition pieces that support healthy hormone production and metabolism, and coordinate with the prescribing providers I work alongside, including Kiersten Gregory, PA-C, here at our Reno clinic, when replacement is worth considering. Whether hormone therapy is right for you is a decision you make with your prescriber; my job is to make sure you walk into that conversation informed.
If you've been told your labs are fine but you don't feel fine, or you'd simply like to know where you stand, a functional lab review is the place to begin.
Next up in Part Two: feeding muscle, simply. How much protein you actually need, why carbs and fat belong on your plate, and the supplements I reach for again and again.
Inspired by "Getting Strong to Save Your Life" by Dr. Elizabeth Yurth and Lacy Puttuck, Boulder Longevity Institute. This article is for educational purposes only and is not medical advice. Decisions about hormone therapy should be made with your prescribing provider.
