Dynamic Dialogue with Danny Matranga - 19 - Lyle Mcdonald: PCOS, Birth Control and How Women are Not Just Little Men

Episode Date: April 20, 2020

In this episode, Danny sits down with the fitness industry icon Lyle McDonald. Lyle is one of the industries most prolific authors and has written books on everything from protein to women's physiology. Lyle has been in the industry for decades and has become one of the most sought after intellects in the space. Find Lyle's Work Here: Follow Lyle on INSTAGRAM: Visit Lyle's Website bodyrecomposition.comSupport the Show.

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. 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. Yeah. 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. So I really do appreciate you coming on. But today I want to talk a little bit about female physiology. Yeah. 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 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've 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. 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 sport. 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, 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. And you look back even further, there were German countries that were having all women's sporting events long before 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, it was like one to four. It was just, and the question then became, is it a lack of interest? Is it a lack of accessibility?

And Title 12 in the U.S. said, all publicly, all government funded schools, all public schools, all 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. sports exploded. And within a decade, 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 powerlifting. 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, or in the 80s, if you saw a woman at a powerlifting event, like Jan Todd, who's married to Terry Todd. She was the first in the seventies only because her husband was involved. 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, 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, it's changing. 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. Now, 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, 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 and progesterone, as they start their menstrual cycle, tend to gain more body fat. Women also had differences in how their muscles 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 8 to 10%. In jumping events, women are significantly further behind men, because they're

having to move, basically 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 is at puberty. At that point, the highest level men are about 10% faster, stronger in terms of performance than women. And so it's really, 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 put it on 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 what 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, like I said, 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 who'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, right? So 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, right? The first half, which starts with menstruation, it's called the follicular phase. This is when the follicle,

the egg is developing till 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 and it's luteal phase. And that's because when the egg bursts, it produces something called the corpus luteum, hence luteal phase. All right, so in 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 decreases muscle damage. It controls appetite and hunger significantly. 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. 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. 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. 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, I'm not, these aren't judgmental terms. I'm just sort of comparing them. Even when I say that, you know, women are relatively weaker, slower than

men. I'm not playing the weaker sex. It's just compared. They're different. Of course. Yeah. Just in a performance. I don't want to 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, that it was unwomanly, that the marathon would make their ovaries fall out, that 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 in training. 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 fertil 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 any woman for any woman experiencing it the percentages don't matter because she's having to live through 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 the car all kinds of things can happen cramping and then some woman 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 about it. And sort of as a random note, this is completely, this is just how I give podcasts. A 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't you, 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 like, no, it's just an excuse. 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 weeks cycle, first two weeks of their 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. 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. Mm-hmm. 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 of everything 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 suggested, 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 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 uh 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 you're listeners 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? And then in week three, it comes back down. Cool, diet's working. And then in week four, it all goes wrong. I've been dieting and exercising for a month and my weight's up four pounds. Screw this. It's a real, real, it's a mind game. 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 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 that. And it is, it's a head game. 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. You've been doing everything right. But a biological impedance will be impacted because it's measuring water in one direction or the other. Calipers may be impacted. 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 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 away 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 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 she 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. Now I would say if there's a common pattern, typically women are usually pretty strong within a few days after menstruation. That, my experience has been, that's when performance is the best. There's variability. Typically 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 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 you might have to do it very light, right? 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 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, right? You look at him, you go, okay, yesterday you looked great. And today you look like just

a hot mess during your warmups. 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 hard wiring and under wiring 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, I'm going. physiological hardwiring that men just simply get to say, fuck it. I'm going in. I'm going, I'm going as hard as I can. Yeah. Okay. So I just want to bet something you mentioned that is still a problem. Most strength coaches are still men. 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. Years ago, I read something that the Chinese coaches originally trained the women differently than the men according to the menstrual cycle. And then they didn't. I'm like, 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, 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 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 like strength coaches at the high school level. One of them, the female coaches, when they existed, were less likely to have 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, and it's changing, but it's changing very slowly. Like 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 complete outliers, and they pushed hard for the inclusion of women's sports and as more women came in their daughters 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 this won't and same thing as women are entering coaching and some of the greatest female sports teams

coaches were women. The, I think UT Knoxville, Pat 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 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, 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, 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. Right, 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 it's 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? Here's the difference. Like, you could have done this much more.

Now, in week two, maybe you're not as strong. Okay, 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, well, I 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 have, what I think of general experience, and I'll, let me back up to some research. If you read the research on menstrual cycling performance, it generally says there's no effect. Yeah. There's no, Oh, 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 8 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 percent 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 yeah right let's say you're trying to trying to do triples at 90 percent so here's your week one you can do that week two if your strength is at 90 that's an impossible workout yeah it's what was a triple

is now a maximum yeah in week three maybe you're at 95 you might you might get through it and if in week four your maximum is down to 85 and even do one yeah 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, your 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, your training, right? That's just the thing. If this is your pattern, we can't fix 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 us. What we can do is fit the training or the diet to your individual response no i quite like that and there's actually there's 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 than the second so you can eat a little bit higher carb diet week one, a little bit lower protein state 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 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. 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. Then 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. And maybe you front load your volume and then perhaps 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. For most women, what I've 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, 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 physiology. And again, also if they've been told that, ah, you should always be able to just suck it up, just butch up. 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. to be that much more decimated when they're told you need to suck it up and go. 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 physical. 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. 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.

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. So first, and they vary in their potency, in their effects, and 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 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, we're notorious for 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 I don't know, there's a million different brands. Okay. So here's where it gets unbearably complicated. First of all, 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 progestin only. There is 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 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 use that, 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. 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. will 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, 7 off. Some are 24, 4. 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 uh you put it on once a week and you wear it three weeks on one week off i i don't 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 through,

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. Yeah. 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 yeah 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 you stop taking it it uses a very high dose very 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 is the implant, originally called Nexplanon, now called Implanon. It was a little plastic thing, small incision in the back of the arm. It releases a 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, is 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. 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 qual 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 stating 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

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 insert basically blocks the tubes the sperm can't it's just a barrier method but there's also a hormonal version that releases synthetic progestin yeah locally now the hormonal id id is interesting all the other forms release hormones into the bloodstream yeah 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. It's not strong enough to shut down ovulation, but I don't even know how much it's used. It was a very early development. The hormonal IUD is totally local. 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 contain progestin.

Yes. Period, end of story. Of varying types. Yeah, 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 and performance or trainability let me do the first one for 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, the 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 when you look at the individual studies, the range is staggering. Found a couple papers that looked at different forms. In one study, 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 methods. 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 it seems to be more lifestyle related because there's like two studies and 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, that's 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 against. But on average, now there's another component I forgot. This is about oral birth control.

Like I said, it gets so complicated complicated i can't remember it all birth 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 nothing 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 pounds, 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, that 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 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 and activity levels. Like I said, not saying any individual woman might not have a response to it. Again, huge variability, but that's the average. Seems to be fairly minor, mostly water weight. Goes away when you

go 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 read 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 drospirin on that fourth generation is anti-androgenic, right? We know that testosterone is important to responses. Yeah. Any, 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 the gen 4 and what go ahead what is that primarily you would mention this a couple times that it's not in a long-term form or a uh it's 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 yazmin are two of the primary primary brands and it's always it's entertaining this is just a whole separate thing when you look at how stuff is marketed to women Yaz and Yasmin are two of the primary brands. And it's always, it's entertaining. 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. Yeah. 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? That 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 firms of birth all forms of birth control lower women's testosterone levels by anywhere from 30 to about 50 percent 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 yeah so in and many women some percentage of women experience a loss of sex drive and loss of sexual function probably due to this. Now, I don't know 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 and you cut that in half, you're still in the middle range. If 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. Another female power lifter, one of the best, her OB-GYN put her on Depo-Provera 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 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. 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 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 cons. 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 recommend? Yeah, I was about to ask the same question, 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 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 look 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 yeah and then it's pointless women produce androgens in their adrenal cortex and this is a 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 good. 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 tolerance. Again, if you go that route. Yeah. And 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 my standpoint as a coach, 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. 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 are found to be infertile suffer from PCOS. It's extremely common, and it 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 and 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. 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. we'll 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, sort of clinical presentation. And then the other end is menstrual cycle dysfunction,

one of which is called oligomenorrhea, right? So the standard menstrual cycle, 24 to 32 days. Oligomenorrhea means one menstrual cycle every 35 to 90 days. And then you may also see amenorrhea, which is an ovulation or amenorrhea, which is a loss of the menstrual cycle. So those would also, but remember what I said, you only have to have two or three of those. 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 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 dysfunction. Type four, multiple cysts, no hyperandrogenism. Menstrual cycle dysfunction. Menstrual cycle, right.

These are all different types. And I suspect within many years, they're going to come up with different, now they're just like different types. And the fourth type is the least common. And roughly 60% of women with PCOS will have elevated testosterone. So that is, 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, 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. Vibrandonism does cause much 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. Now, 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. Women with PCOS are seen at a significantly increased number in high-level sport because they have an inherent athletic advantage, which has to be weighed against the negatives. And I will say 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 yeah right 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. 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 judge, not as good, just descriptively. 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.

Yeah. 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 sport. 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. 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 map 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. Yeah. 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. 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 is an, it's changing. So women who get hyperandrogenetic, 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 common approaches to treating PCOS is oral birth control.

Yeah. Because they deliberately want to cut testosterone in half. So what is, and 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. treatments metformin which is an insulin sensitizer is very commonly used um because as you lose because there's a weirdness where the elevated testosterone causes insulin resistance then elevated insulin increases testosterone levels and becomes 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.

They might, but they may not be. But from the standpoint of improving insulin sensitivity, improving those things, 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 yeah to make to improve this will improve health is to prove all parameters generally low in carbohydrates tends to be just like in the second half of this menstrual cycle lower or moderate carbohydrate diets may have benefits now if you look at the research the studies go they both work yeah high carbon and this is true of most of the work however when you look at those studies the high carb diets invariably have we 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 tax 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. 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 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 not myo inositol and chiro inositol which they impact some pathway involved in insulin sensitivity down down with like a within tissue yeah i don't know what it is i at that point even my eyes glaze over yeah 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 is the goal now those might not be the best thing for women who again who are high level athletes so but but that is 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 excess body fat, it's like 95%. It's almost universal. And honestly, the way I set diets up, which is fairly high protein and moderate fat, carbs are going to come down to that level almost invariably. 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, full-blown ketogenic diet to get fat loss moving, to get those issues, 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, it's 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, dietitians, 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- athlete you won you won the lottery you won the hormonal lottery because with even even a 30 and there's also there's 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. Like 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. That may not, those may not be physiological characteristics for that sport specifically, but for anything that's predicated, even which is very much 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. Yes. But perhaps, and I'm sure there will be additional questions and women who want to learn more, what are some, 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 deals with diet nutrition i mean got to training 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 did 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 p, and then when they hit menopausal age, which can be as early as the 40s, but maybe in the late 40s to early 50s, perimont many pause, 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 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 for 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, a lot of this is age. But there are physical. It 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, 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. They asked men, they asked men what their biggest concern was about their partners going through 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 the big picture on the average is,

am I still going to 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, 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 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. Just because you're going to ask my website, bodyrecomposition.com. I have 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 uh i'm there daily i also have a number of experts including a top-notch ob-gyn who can address questions that are outside of my area usually medical stuff so if you've got those issues because there's all i mean even there women's reproductive systems can get impacted by so much mental stress physical 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. 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 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 fifties now.

She had undiagnosed PCOS her entire life, partly because they put her on birth control at 15 and birth control mascot. She came off that she went through menopause and everything went wrong. Yeah. And she had no, and she finally, in the first doctor she went to, it 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 may make another woman, it may, women are listening to this going, yeah, birth control makes me crazy. 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 him 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.