Barbell Medicine Podcast

In 1889 a French physiologist injected himself with guinea pig and dog testicle extract and published a claim of self-rejuvenation in The Lancet. That announcement kicked off a 200-year medicalization of menopause that ran through leeches and bromides, Premarin, the 2002 Women's Health Initiative, and the contemporary menopause-content space. 
In Episode 1 of our three-part menopause series, Dr. Jordan Feigenbaum and Dr. Austin Baraki walk through what menopause actually is at the hormonal level, which midlife symptoms are menopause-driven and which are not, the KNDy neuron mechanism behind hot flashes (and the new medication that blocks it), and the 24-year follow-up on the WHI that substantially revised the original conclusions. OB-GYN Dr. Loraine Baraki walks the clinical workup, the lab panel she actually orders, and how she handles patients arriving with DUTCH panels and compounded hormone protocols.
If you have heard contradictory things about menopause hormone therapy from your primary care, your menopause coach, and your sister, that is not your fault. The evidence base has been revised in significant ways since the 2002 publication, and most patient-facing summaries are out of date.
Timestamps
00:00 Cold open: 200 years of menopause medicine
03:23 Welcome and roadmap
04:20 The HPG axis, follicles, and the FSH lag
09:11 STRAW+10 staging and the timing of perimenopause
13:47 Austin: the 49-year-old with a hormone panel
20:00 Loraine: the OB-GYN workup
28:00 Symptom attribution: what menopause actually causes
33:46 Austin: the all-estrogen patient
37:58 VMS duration and the KNDy mechanism (Avis, SKYLIGHT)
43:53 Austin: who actually gets fezolinetant
47:22 The WHI 24-year correction (Manson, Chlebowski, Boardman)
01:00:15 Modern prescribing today
01:06:52 Where the menopause-content space gets it right and wrong
01:11:50 Testosterone, compounded bioidenticals, and DUTCH panels
01:24:13 Takeaways
What we cover

The HPG axis and the estrogen shield: what is happening across the 35-year reproductive era and what changes at perimenopause.
STRAW+10 staging: how long perimenopause actually lasts and where most women fall in the timeline.
 Symptom attribution: hot flashes and genitourinary syndrome are menopause. Weight gain, sleep, and joint pain are mostly other things.
The KNDy neuron mechanism behind hot flashes and the new pharmacology that blocks it (fezolinetant, elinzanetant).
The Women's Health Initiative: what the trial actually tested, what the 2002 result said, and what 24 years of follow-up have shown since then. The estrogen-alone arm reduced breast cancer incidence by 22% and mortality by 40% over 20 years.
The timing hypothesis: hormone therapy started within 10 years of the final menstrual period vs more than 10 years out.
Modern prescribing today: transdermal estradiol plus micronized progesterone, and why the formulations matter.
Where the contemporary menopause-content space gets it right and wrong: the undertreatment problem, the zone-of-chaos framing, and the testosterone-for-everything marketing.
Testosterone in women: one guideline-supported indication.
Compounded bioidenticals and DUTCH panels.

Resources
Subscribe to BBM Plus for the full unabridged Direct Line: https://barbellmedicine.supercast.com/
Barbell Medicine coaching and templates: https://www.barbellmedicine.com/
Signal book pre-order: https://www.barbellmedicine.com/shop/learning/signal
Manson JE et al. 18-year mortality from the WHI. JAMA, 2017. https://pubmed.ncbi.nlm.nih.gov/28898378/
Chlebowski RT et al. WHI estrogen-alone arm at 20 years. JAMA, 2020. https://pubmed.ncbi.nlm.nih.gov/32706854/
 Boardman HMP et al. Hormone therapy for cardiovascular prevention. Cochrane, 2015. https://pubmed.ncbi.nlm.nih.gov/25754617/
Avis NE et al. Duration of VMS in the SWAN cohort. JAMA Intern Med, 2015. https://pubmed.ncbi.nlm.nih.gov/25686030/
Lederman S et al. SKYLIGHT 1, fezolinetant. The Lancet, 2023. https://pubmed.ncbi.nlm.nih.gov/36924778/
Johnson KA et al. SKYLIGHT 2, fezolinetant. JCEM, 2023. https://pubmed.ncbi.nlm.nih.gov/37410020/
USPSTF. Hormone therapy for primary prevention. JAMA, 2022. https://pubmed.ncbi.nlm.nih.gov/36318127/
Davis SR et al. Global Consensus on testosterone in women. JCEM, 2019. https://pubmed.ncbi.nlm.nih.gov/31498871/

Our Sponsors:
* Check out FIGS and use my code wearfigs.com for a great deal: https://wearfigs.com
* Check out Factor and use my code factormeals.com/bbm50off for a great deal: https://www.factor75.com
* Check out Quince and use my code quince.com/bbm for a great deal: https://www.quince.com

Advertising Inquiries: https://redcircle.com/brands

This is the free preview of the May 2026 Direct Line, our monthly AMA for Barbell Medicine Plus subscribers. Three reader questions answered in full.
We open with a mid-30s woman with bilateral shin pain and exertional foot numbness who started creatine a month ago and is asking whether the supplement is the cause. We walk through the compartment syndrome literature, the 2025 case report being passed around online and misinterpreted, what creatine actually does to total body water (and what it doesn’t), the four compartment pressure studies that exist, the Waterman 2013 demographic data on who actually gets chronic exertional compartment syndrome, and the workup we would actually run if this person walked into clinic.
Next, whether splitting your resistance training across the day affects strength and hypertrophy. We cover BBM’s general heuristic on frequency as a distribution tool for training load, the Schoenfeld meta-analyses on frequency (2016 and 2019), the wrinkle on cardiorespiratory fitness and exercise snacks, and where we go off the reservation compared to a strict evidence-based read.
We close with endometriosis for the lifter, including the seven-year average diagnostic delay, the 2022 ESHRE guideline shift away from required laparoscopy, what the menstrual cycle and performance literature actually says (McNulty 2020), why the anti-inflammatory diet narrative is mostly noise, the iron and protein levers that matter, post-operative return-to-lifting timelines, the meet-timing question, and Austin’s clinical case walk on supplement stacks and GLP-1 anti-inflammatory effects. A dedicated full episode on endometriosis is coming this summer.
The full unabridged Direct Line covers ten more questions, including where the GLP-1 strength trials actually are, why DEXA misleads on muscle mass loss, how we arrived at the Vital 5 weightings, the salt sermon for strongman, running shoes for casual runners, hernias and crunches in older lifters, the Bristol Stool Chart, Austin on coaching his residents, and a fresh reading list. Full episode on BBM Plus.
Timestamps:
Question 1 · Creatine and shin pain01:2713:21
Question 2 · Splitting your workout across the day13:2120:29
Question 3 · Endometriosis for the lifter20:29
What we cover:
The clinical workup for chronic exertional compartment syndrome and why creatine is rarely the culprit. The Schoenfeld frequency literature and why training load matters more than the day it’s distributed across. Endometriosis basics including diagnostic delay, prevalence, and the 2022 ESHRE guideline change. Why most endometriosis “diets” don’t have evidence behind them, and which nutrition levers actually matter (iron, protein, energy availability). Post-operative return to training, meet-timing options, supplement stacks, and the role of GLP-1 receptor agonists in chronic anti-inflammatory effects.
Resources:
Subscribe to BBM Plus for the full unabridged Direct Line: https://barbellmedicine.supercast.com/

Barbell Medicine coaching and templates: https://www.barbellmedicine.com/

Signal book pre-order: https://www.barbellmedicine.com/shop/learning/signal/

Waterman B.R. et al. 2013. Risk factors for chronic exertional compartment syndrome in a physically active military population. Am J Sports Med 41(11):2545-2552.
https://pubmed.ncbi.nlm.nih.gov/24036570/

Powers M.E. et al. 2003. Creatine supplementation increases total body water without altering fluid distribution. J Athl Train 38(1):44-50.
https://pubmed.ncbi.nlm.nih.gov/12937471/

Antonio J. et al. 2021. Common questions and misconceptions about creatine supplementation (ISSN position). J Int Soc Sports Nutr 18(1):13.
https://pubmed.ncbi.nlm.nih.gov/33557850/

Bruneau A. et al. 2025. Creatine supplementation associated with chronic exertional compartment syndrome: case report. [TO ADD: PMID once indexed]

Schoenfeld B.J. et al. 2016. Effects of resistance training frequency on measures of muscle hypertrophy: a systematic review and meta-analysis. Sports Med 46(11):1689-1697.
https://pubmed.ncbi.nlm.nih.gov/27102172/

Schoenfeld B.J. et al. 2019. How many times per week should a muscle be trained to maximize hypertrophy? J Sports Sci 37(11):1286-1295.
https://pubmed.ncbi.nlm.nih.gov/30558493/

ESHRE Endometriosis Guideline Development Group. 2022. ESHRE guideline: endometriosis. Hum Reprod Open 2022(2):hoac009.
https://pubmed.ncbi.nlm.nih.gov/35350465/

McNulty K.L. et al. 2020. The effects of menstrual cycle phase on exercise performance in eumenorrheic women: systematic review and meta-analysis. Sports Med 50(10):1813-1827.
https://pubmed.ncbi.nlm.nih.gov/32661839/

Our Sponsors:
* Check out FIGS and use my code wearfigs.com for a great deal: https://wearfigs.com
* Check out Factor and use my code factormeals.com/bbm50off for a great deal: https://www.factor75.com
* Check out Quince and use my code quince.com/bbm for a great deal: https://www.quince.com

Advertising Inquiries: https://redcircle.com/brands

Most cases of low testosterone in modern men are not a problem with the testes. The number is downstream of body composition, sleep, and energy availability. The wellness-clinic algorithm walks past every one of them.

Jordan and Austin walk through what actually drives men’s testosterone down, the mechanisms behind it, and the modifiable levers that bring it back up. MOSH, the leptin and Kisspeptin pathway, the aromatase loop, the sleep apnea picture most clinics never ask about, the GLP-1 and weight-loss data on testosterone recovery, the low energy availability case that hits high-volume lifters harder than they realize, and the closing question of when a standard-dose TRT prescription actually functions as a PED.
This is Episode 3 of our four-part Signal book launch series. Mark, the patient we have been threading from Episode 1, finally gets his diagnosis revealed.
Timestamps
00:00 The 9x stat and Mark's diagnosis revealed
 02:10 How body fat suppresses testosterone (MOSH)
 07:26 Primary vs secondary causes, and Klinefelter
 11:35 Leptin and the Kisspeptin pathway
 14:38 Mark: the body-composition picture
 16:10 The 40-inch-waist case
 20:01 Weight loss, GLP-1s, and does Ozempic raise testosterone?
 24:21 T4DM: adding testosterone to lifestyle
 28:35 Sleep, OSA, and Mark's diagnosis
 38:39 TRT in untreated sleep apnea
 41:47 Can you train your testosterone down? (LEA / EHMC)
 50:12 Replacement dose vs PED
 55:47 Four takeaways
 57:46 Episode 4 preview and book pre-order

What we cover:
•         How body fat suppresses testosterone at two different points in the HPG axis, and why the loop is self-reinforcing
•         The leptin and Kisspeptin pathway most clinics never address
•         Mark’s case: a 45-year-old with a 240 ng/dL afternoon draw, no workup, and an immediate prescription
•         Primary versus secondary causes, and why Klinefelter syndrome is the under-recognized one to not miss
•         Weight loss dose-response: how much testosterone climbs on lifestyle alone, with GLP-1 agonists, and after bariatric surgery
•         T4DM: why adding testosterone to a structured weight-loss program produced no extra quality-of-life benefit over placebo
•         One week of sleep restriction drops testosterone by about 15 percent in healthy young men; eight days of military field exercises drop it by 50 percent
•         Why CPAP for obstructive sleep apnea reliably improves symptoms but does not always move the lab number
•         The opposite extreme: low energy availability, relative energy deficiency in sport, and the exercise-hypogonadal male condition
•         The lifter calculus: when a textbook replacement dose is functionally a PED in a chronically underfueled trainee

Resources mentioned:
Signal book pre-order: https://barbellmedicine.com/signal
 Training Plateau Action Plan (free): https://www.barbellmedicine.com/training-plateau-action-plan/
 Barbell Medicine programs and coaching: https://www.barbellmedicine.com/
 Episode 1 (Is the Testosterone Crisis Real?)
 Episode 2 (Is Your Testosterone Actually Low?

Referenced studies:

Wu F.C.W. et al. 2010. Identification of late-onset hypogonadism in middle-aged and elderly men (EMAS). N Engl J Med 363(2):123-135.
 https://pubmed.ncbi.nlm.nih.gov/20554979/
 
 Travison T.G. et al. 2011. The natural history of symptomatic androgen deficiency in men. J Am Geriatr Soc.
 https://pubmed.ncbi.nlm.nih.gov/18454751/
 
 Corona G. et al. 2013. Body weight loss reverts obesity-associated hypogonadotropic hypogonadism: systematic review and meta-analysis. Eur J Endocrinol 168(6):829-843.
 https://pubmed.ncbi.nlm.nih.gov/23482592/
 
 Kounatidis D. et al. 2025. The impact of GLP-1 receptor agonists on erectile function. Biomolecules 15(9):1284.
 https://doi.org/10.3390/biom15091284
 
 Grossmann M. et al. 2024. Testosterone treatment, weight loss, and health-related quality of life and psychosocial function in men: 2-year RCT (T4DM QoL arm). J Clin Endocrinol Metab 109(8):2019-2028.
 https://pubmed.ncbi.nlm.nih.gov/38311835/
 
 Leproult R., Van Cauter E. 2011. Effect of 1 week of sleep restriction on testosterone levels in young healthy men. JAMA 305(21):2173-2174.
 https://pubmed.ncbi.nlm.nih.gov/21632481/
 
 Penev P.D. 2007. Association between sleep and morning testosterone levels in older men. Sleep 30(4):427-432.
 https://pubmed.ncbi.nlm.nih.gov/17520785/
 
 Wittert G. 2014. The relationship between sleep disorders and testosterone in men. Asian J Androl 16(2):262-265.
 https://pubmed.ncbi.nlm.nih.gov/24435056/
 
 Alemany J.A. et al. 2008. Effects of dietary protein content on IGF-I, testosterone, and body composition during 8 days of severe energy deficit and arduous physical activity. J Appl Physiol 105(1):58-64.
 https://pubmed.ncbi.nlm.nih.gov/18450989/
 
 Mountjoy M., Sundgot-Borgen J.K., Burke L.M. et al. 2018. IOC consensus statement on relative energy deficiency in sport (RED-S): 2018 update. Br J Sports Med 52:687-697.
 https://pubmed.ncbi.nlm.nih.gov/29773536/
 
 Areta J.L. et al. 2021. Low energy availability: history, definition and evidence of its endocrine, metabolic and physiological effects in prospective studies in females and males. Eur J Appl Physiol 121(1):1-21.
 https://pubmed.ncbi.nlm.nih.gov/33095376/
 
 Mäestu J. et al. 2010. Anabolic and catabolic hormones and energy balance of the male bodybuilders during the preparation for the competition. J Strength Cond Res 24(4):1074-1081.
 https://pubmed.ncbi.nlm.nih.gov/20300023/
 
 Hooper D.R. et al. 2018. Treating exercise-associated low testosterone (EHMC). Phys Sportsmed 46(4):427-434.
 https://pubmed.ncbi.nlm.nih.gov/30074435/
 
 Hackney A.C. 2020. Hypogonadism in exercising males: dysfunction or adaptive-regulatory adjustment? Front Endocrinol 11:11.
 https://pubmed.ncbi.nlm.nih.gov/32082252/

Our Sponsors:
* Check out FIGS and use my code wearfigs.com for a great deal: https://wearfigs.com
* Check out Factor and use my code factormeals.com/bbm50off for a great deal: https://www.factor75.com
* Check out Quince and use my code quince.com/bbm for a great deal: https://www.quince.com

Advertising Inquiries: https://redcircle.com/brands

Three weeks of stalled squats. The conventional answer is to switch programs because you've crossed into intermediate territory. The data says something else. In Part 3 of the Progressive Loading series, Dr. Jordan Feigenbaum and Dr. Austin Baraki walk through why the standard novice / intermediate / advanced framework runs into trouble in real training, what the four adaptive systems are actually doing across a training career, and why most of what gets called a stall is impatience with the noise floor at your current strength level.
This is Part 3 of the Progressive Loading series. Part 1 covered why loading should react to demonstrated adaptation. Part 2 covered RPE-based autoregulation and the artificial-momentum approach. Today is the mechanism layer.
Pre-order our book, Signal: barbellmedicine.com/signal
Timestamps
0:00 - Why your lifts aren't moving
1:52 - The novice / intermediate / advanced framework, three claims to test
13:23 - What 17 years of powerlifting data show about how long you keep getting stronger
32:28 - How getting stronger actually works (four systems on four clocks)
38:00 - What early growth is actually made of (the Damas 2016 deuterium study)
50:33 - The connective tissue lag and why early-training injuries happen
58:32 - Why heavy lifting works for bone density (and why "walk on a treadmill" advice misses)
1:05:10 - Why new lifters get hurt 3 to 10 times more than experienced lifters
1:12:56 - Fatigue is at least four different things (and most coaches treat it as one)
1:26:19 - The CNS fatigue myth (and what the data actually says)
1:33:52 - When the bar isn't moving: how to actually diagnose a stall
1:45:51 - Takeaways and next week's tease: leptin and low testosterone

What we cover 
- The novice / intermediate / advanced framework: three claims and why each one fails the data test
- The 17-year IPF strength curve and what the no-kink finding does and does not establish (Latella 2024)
- The four adaptive systems and their separate timescales (neural, muscle, connective tissue, bone)
- What early growth actually is, including the deuterium-oxide finding that most week-3 size is fluid (Damas 2016)
- Why connective tissue lags muscle by six to eight weeks, and why that produces patellar tendinopathy four months in
- The 9.5 vs 0.74 to 3.3 injury rate gap between novice and experienced CrossFit participants
- The CNS fatigue myth and the Skarabot 2018 finding that locates the fatigue in the muscle, not the brain
- Why the LIFTMOR trial result (heavy lifting for bone density in women in their 60s and 70s) is being missed by primary care
- A practical decision tree for stalls: environment first, then load, then program
- Tease for next week: leptin, the HPG axis, and the metabolic driver of low testosterone almost nobody connects

Resources 
Training Plateau Action Plan (free): https://www.barbellmedicine.com/training-plateau-action-plan/
Progressive Loading article series: https://www.barbellmedicine.com/blog/progressive-loading/
Beyond Progressive Overload (Part 2 article): https://www.barbellmedicine.com/blog/beyond-progressive-overload/
BBM Programs and Coaching: https://www.barbellmedicine.com/
Support our work on barbellmedicine.supercast.com
Latella C et al. Using powerlifting athletes to determine strength adaptations across ages in males and females. Sports Med. 2024. https://pubmed.ncbi.nlm.nih.gov/

Del Vecchio A et al. The increase in muscle force after 4 weeks of strength training is mediated by adaptations in motor unit recruitment and rate coding. J Physiol. 2019. https://pubmed.ncbi.nlm.nih.gov/30644584/

Lecce E et al. Resistance training-induced adaptations in the neuromuscular system. J Physiol. 2025.

Balshaw TG et al. Neural adaptations after 4 years vs 12 weeks of resistance training. Scand J Med Sci Sports. 2019. https://pubmed.ncbi.nlm.nih.gov/30474171/

Skarabot J et al. Voluntary activation and agonist EMG amplitude in resistance-trained men. J Appl Physiol. 2021.

Roberts MD et al. Mechanisms of mechanical overload-induced skeletal muscle hypertrophy. Physiol Rev. 2023.

Damas F et al. Resistance training-induced changes in integrated myofibrillar protein synthesis are related to hypertrophy only after attenuation of muscle damage. J Physiol. 2016. https://pubmed.ncbi.nlm.nih.gov/27219125/

Damas F et al. Early resistance training-induced increases in muscle cross-sectional area are concomitant with edema-induced muscle swelling. Eur J Appl Physiol. 2016. https://pubmed.ncbi.nlm.nih.gov/26280652/

Lazarczuk SL et al. Mechanical, material and morphological adaptations of healthy lower limb tendons. Sports Med. 2022. https://pubmed.ncbi.nlm.nih.gov/35657492/

Kubo K et al. Time course of changes in the human Achilles tendon properties. Eur J Appl Physiol. 2012. https://pubmed.ncbi.nlm.nih.gov/22105708/

Watson SL et al. High-intensity resistance and impact training improves bone mineral density in postmenopausal women: the LIFTMOR randomized controlled trial. J Bone Miner Res. 2018. https://pubmed.ncbi.nlm.nih.gov/28975661/

Aasa U et al. Injuries among weightlifters and powerlifters: a systematic review. Br J Sports Med. 2017. https://pubmed.ncbi.nlm.nih.gov/27445362/

Prieto-Gonzalez P et al. Injuries in novice participants during an eight-week start-up CrossFit program. Int J Environ Res Public Health. 2020. https://pubmed.ncbi.nlm.nih.gov/32155747/

Kanayama G et al. Tendon rupture in body builders. Sports Med. 2015.

Enoka RM, Duchateau J. Translating fatigue to human performance. Med Sci Sports Exerc. 2016. https://pubmed.ncbi.nlm.nih.gov/27015386/

Behrens M et al. Fatigue and human performance: an updated framework. Sports Med. 2023. https://pubmed.ncbi.nlm.nih.gov/

Halperin I et al. Accuracy in predicting repetitions to task failure: scoping review. Sports Med. 2022. https://pubmed.ncbi.nlm.nih.gov/

Skarabot J et al. Neuromuscular fatigue and recovery after heavy resistance, jump, and sprint training. Eur J Appl Physiol. 2018.

Garcia-Ramos A et al. Greater neuromuscular and perceptual fatigue after low-load to failure than heavy-load to failure. 2024.

Minor, Brian MS, CSCS1; Helms, Eric PhD, CSCS2; Schepis, Jacob3. RE: Mesocycle Progression in Hypertrophy: Volume Versus Intensity. Strength and Conditioning Journal 42(5):p 121-124, October 2020. | DOI: 10.1519/SSC.0000000000000581

Our Sponsors:
* Check out FIGS and use my code wearfigs.com for a great deal: https://wearfigs.com
* Check out Factor and use my code factormeals.com/bbm50off for a great deal: https://www.factor75.com
* Check out Quince and use my code quince.com/bbm for a great deal: https://www.quince.com

Advertising Inquiries: https://redcircle.com/brands

Out of 32 symptoms commonly attributed to low testosterone, only 3 actually correlate with it. All three are sexual. The other 29 — fatigue, brain fog, low mood, weight you can't lose, feeling not quite like yourself — are real, but they are produced by something else, and the wellness-clinic funnel runs on getting that wrong.
 
Episode 2 of our Signal book launch series. Dr. Jordan Feigenbaum and Dr. Austin Baraki cover how testosterone actually works, what the number on your lab report is really measuring, and what a real evaluation of low T looks like.

Pre-order our book, Signal: barbellmedicine.com/signal

Timestamps:
00:00 Mark, revisited (cold open)
02:00 How testosterone actually works (HPG axis)
06:14 Why "in range" can still be abnormal
09:24 What your lab number actually measures
12:25 Case: total 230, low SHBG — does this guy need TRT?
17:04 The saturation model — why higher isn't better
21:11 A patient at 480 wants 900: how the conversation goes
28:57 What "in range" actually means (and why 264 is the cutoff)
34:41 The 3 symptoms that matter (out of 32)
37:16 Walking back a 10-symptom checklist
42:31 How a real testosterone workup gets done
46:42 Chasland trial — TRT vs. exercise at low-normal T
49:31 A warning for hard-training men
58:48 Takeaways, tease, and what's coming next 
What we cover:
The HPG axis explained — and why one low total testosterone reading tells you almost nothing about where the problem actually sits.
The difference between total, free, and bioavailable testosterone — and why SHBG, the binding protein the wellness-clinic workup almost always ignores, is what determines whether the number on your lab report is misleading you in either direction.
The saturation model: above roughly 250 ng/dL, the prostate androgen receptor is saturated. Libido follows the same plateau. Pushing a normal man from 500 to 900 isn't doing what the marketing implies.
The EMAS study finding: of 32 symptoms men commonly attribute to low testosterone, only 3 actually correlate. Every other symptom needs a different workup.
How a real testosterone workup gets done — morning sample, fasted, repeat draw, LH/FSH/SHBG to localize and contextualize.
The Chasland 2021 trial: when standard TRT is prescribed properly to middle-aged men with low-normal levels, does it beat exercise? The answer is what most of the wellness-clinic industry is built on getting wrong.
A note for hard-training men: the exercise-hypogonadal-male pattern, what "low-normal" means in someone whose levels are an adaptation to training load rather than a baseline deficit, and why a textbook TRT dose in that man may functionally act as a performance enhancer.
If you have a lab report on your kitchen counter right now, this is what we wrote for you. Signal, the book, drops in May. Pre-order available soon at barbellmedicine.com.

Resources & links
Signal — Feigenbaum & Baraki (Barbell Medicine, 2026): coming soon
Episode 1 (Is the Testosterone Crisis Real?): https://stream.redcircle.com/episodes/b25a8006-57e5-4dc3-b74c-203f6fbcebc1/stream.mp3
Training Plateau Action Plan (free): barbellmedicine.com/training-plateau-action-plan
Barbell Medicine programs and consultations: barbellmedicine.com
To support us and get ad free listening, plus special product discounts, and exclusive content, go to supercast.barbellmedicine.com

Referenced studies
Wu FCW et al. 2010 - Identification of late-onset hypogonadism in middle-aged and elderly men. NEJM 363(2):123-135. [The EMAS 3-of-32 finding]
https://pubmed.ncbi.nlm.nih.gov/20554979/

Bhasin S et al. 2018 - Testosterone Therapy in Men With Hypogonadism: An Endocrine Society Clinical Practice Guideline. JCEM 103(5):1715-1744. [264 ng/dL threshold; first-draw protocol]
https://pubmed.ncbi.nlm.nih.gov/29562364/

Travison TG et al. 2008 - The natural history of symptomatic androgen deficiency in men. JAGS 56(5):831-839. [MMAS: ~50% of initially low values normalize on repeat]
https://pubmed.ncbi.nlm.nih.gov/18308002/

Travison TG et al. 2006 - The relationship between libido and testosterone levels in aging men. JCEM 91(7):2509-2513. [Libido plateau data, Framingham + HIM]
https://pubmed.ncbi.nlm.nih.gov/16670164/

Brambilla DJ et al. 2009 - The effect of diurnal variation on clinical measurement of serum testosterone. JCEM 94(3):907-913. [Why morning, fasted matters]
https://pubmed.ncbi.nlm.nih.gov/19112025/

Morgentaler A & Traish AM. 2009 - Shifting the paradigm of testosterone and prostate cancer: the saturation model and the limits of androgen-dependent growth. Eur Urol 55(2):310-320. [The saturation model]
https://pubmed.ncbi.nlm.nih.gov/18838208/

Trost LW & Mulhall JP. 2016 - Challenges in Testosterone Measurement, Data Interpretation, and Methodological Appraisal of Interventional Trials. J Sex Med 13(7):1029-1046. [Free T unreliability at the low end; equilibrium dialysis as the reference method]
https://pubmed.ncbi.nlm.nih.gov/27210182/

Vermeulen A et al. 1999 - A critical evaluation of simple methods for the estimation of free testosterone in serum. JCEM 84(10):3666-3672. [Calculated free T methodology]
https://pubmed.ncbi.nlm.nih.gov/10523012/

Chasland LC et al. 2021 - Testosterone and exercise: effects on fitness, body composition, and strength in middle-to-older aged men with low-normal serum testosterone levels. Am J Physiol Heart Circ Physiol 320(5):H1985-H1998. [The 12-week trial]
https://pubmed.ncbi.nlm.nih.gov/33739153/

Arun AS et al. 2025 - Reevaluating the Threshold for Low Total Testosterone. Clin Chem 71(5):609-611. [2025 NHANES strength-dissociation reference]
https://pubmed.ncbi.nlm.nih.gov/40066943/

Baillargeon J et al. 2015 - Trends in Androgen Prescribing in the United States, 2001-2011. JAMA Intern Med 175(8):1413-1415. [25% no preceding lab; the 50% no follow-up monitoring gap - referenced from Episode 1]
https://pubmed.ncbi.nlm.nih.gov/26075486/

Our Sponsors:
* Check out FIGS and use my code wearfigs.com for a great deal: https://wearfigs.com
* Check out Factor and use my code factormeals.com/bbm50off for a great deal: https://www.factor75.com
* Check out Quince and use my code quince.com/bbm for a great deal: https://www.quince.com

Advertising Inquiries: https://redcircle.com/brands