Barbell Medicine Podcast

Barbell Medicine
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  1. 1d ago

    Sunday Morning Protocol 2049: A Halloween Story About Optimization

    A Halloween story about a man who does every wellness protocol, then an honest grading of each one. Dr. Jordan Feigenbaum tells the story of Dale Mercer, Unit 4471, who lives through a fully optimized Sunday in the year 2049: morning light panels, cold plunges, a 31-capsule supplement tray, grey-market peptides, methylene blue, an eccentric-only lifting machine, a protein IV timed to the anabolic window, sleep and readiness scores, a glucose sensor, mouth tape, Zone 2 with lactate pricks, and a 174-degree sauna. Then Jordan grades each one on a zero-to-five pumpkin scale. He covers what the studies actually tested, where the evidence is thin or tied to the companies selling the product, and the few places with real risk, like methylene blue with antidepressants and mouth taping with a blocked nose. The takeaway is plain: lift weights in a challenging way, do conditioning that improves your fitness, sleep enough, and eat a health-promoting diet in the right amount. Most of the rest is optional. The story is inspired by Rick Sieman's 1973 motorcycle magazine column "Sunday Morning Ride … 1984." Timestamps  00:00 WELLNESS ad 00:26 Sunday Morning Protocol 2049 11:23 Where this episode came from, and the pumpkin scale 12:45 Morning sunlight and cold plunges19:44 Supplements: magnesium, lion's mane, NAD, antler velvet, creatine 25:21 Peptides and methylene blue 30:27 Eccentric overload, slow tempo, and the anabolic window 34:40 Sleep trackers, HRV readiness scores, and CGMs 41:56 Mouth tape, Zone 2, and saunas 47:44 What actually worksResources Buy the book, Signal: https://www.barbellmedicine.com/shop/learning/signal/Free Vital 5 Action PlanNew Barbell Medicine Hybrid 5K and 10K Run + Lift ProgramsBarbell Medicine coaching and templates: https://www.barbellmedicine.comGet early access, ad-free listening, and exclusive content here: https://barbellmedicine.supercast.com/Creatine: Benefits, Side Effects & Safe Consumption: https://www.barbellmedicine.com/blog/what-is-creatine/Barbell Medicine Guide to Protein: https://www.barbellmedicine.com/blog/barbell-medicine-protein-recommendations/How to Measure, Use and Improve Your Heart Rate Variability: https://www.barbellmedicine.com/blog/heart-rate-variability-hrv/Burke TM, Markwald RR, Chinoy ED, et al. Combination of light and melatonin time cues for phase advancing the human circadian clock. Sleep. 2013;36(11):1617-1624. doi:10.5665/sleep.3110Auger RR, Burgess HJ, Emens JS, Deriy LV, Thomas SM, Sharkey KM. Clinical practice guideline for the treatment of intrinsic circadian rhythm sleep-wake disorders: advanced sleep-wake phase disorder (ASWPD), delayed sleep-wake phase disorder (DSWPD), non-24-hour sleep-wake rhythm disorder (N24SWD), and irregular sleep-wake rhythm disorder (ISWRD). An update for 2015: an American Academy of Sleep Medicine clinical practice guideline. J Clin Sleep Med. 2015;11(10):1199-1236. doi:10.5664/jcsm.5100van Maanen A, Meijer AM, van der Heijden KB, Oort FJ. The effects of light therapy on sleep problems: a systematic review and meta-analysis. Sleep Med Rev. 2016;29:52-62. doi:10.1016/j.smrv.2015.08.009Thompson A, Batterham AM, Jones H, Gregson W, Scott D, Atkinson G. The practicality and effectiveness of supplementary bright light for reducing jet-lag in elite female athletes. Int J Sports Med. 2013;34(7):582-589. doi:10.1055/s-0032-1331160Pjrek E, Friedrich ME, Cambioli L, et al. The efficacy of light therapy in the treatment of seasonal affective disorder: a meta-analysis of randomized controlled trials. Psychother Psychosom. 2020;89(1):17-24. doi:10.1159/000502891Burns AC, Saxena R, Vetter C, Phillips AJK, Lane JM, Cain SW. Time spent in outdoor light is associated with mood, sleep, and circadian rhythm-related outcomes: a cross-sectional and longitudinal study in over 400,000 UK Biobank participants. J Affect Disord. 2021;295:347-352. doi:10.1016/j.jad.2021.08.056Manson JE, Cook NR, Lee IM, et al. Vitamin D supplements and prevention of cancer and cardiovascular disease. N Engl J Med. 2019;380(1):33-44. doi:10.1056/NEJMoa1809944Srámek P, Simecková M, Janský L, Savlíková J, Vybíral S. Human physiological responses to immersion into water of different temperatures. Eur J Appl Physiol. 2000;81(5):436-442. doi:10.1007/s004210050065Cain T, Brinsley J, Bennett H, Nelson M, Maher C, Singh B. Effects of cold-water immersion on health and wellbeing: a systematic review and meta-analysis. PLoS One. 2025;20(1):e0317615. doi:10.1371/journal.pone.0317615Buijze GA, Sierevelt IN, van der Heijden BC, Dijkgraaf MG, Frings-Dresen MH. The effect of cold showering on health and work: a randomized controlled trial. PLoS One. 2016;11(9):e0161749. doi:10.1371/journal.pone.0161749Cameron BE, Steele J, Bradley WJ, et al. Post-exercise recovery methods: a systematic review and meta-analysis. SportRxiv. Preprint posted September 19, 2026. doi:10.51224/SportRxiv.1070Roberts LA, Raastad T, Markworth JF, et al. Post-exercise cold water immersion attenuates acute anabolic signalling and long-term adaptations in muscle to strength training. J Physiol. 2015;593(18):4285-4301. doi:10.1113/JP270570Piñero A, Burke R, Augustin F, et al. Throwing cold water on muscle growth: a systematic review with meta-analysis of the effects of postexercise cold water immersion on resistance training-induced hypertrophy. Eur J Sport Sci. 2024;24(2):177-189. doi:10.1002/ejsc.12074Liu G, Weinger JG, Lu ZL, Xue F, Sadeghpour S. Efficacy and safety of MMFS-01, a synapse density enhancer, for treating cognitive impairment in older adults: a randomized, double-blind, placebo-controlled trial. J Alzheimers Dis. 2016;49(4):971-990. doi:10.3233/JAD-150538Lopresti AL, Smith SJ. The effects of magnesium L-threonate (Magtein) on cognitive performance and sleep quality in adults: a randomised, double-blind, placebo-controlled trial. Front Nutr. 2025;12:1729164. doi:10.3389/fnut.2025.1729164Schuster J, Cycelskij I, Lopresti A, Hahn A. Magnesium bisglycinate supplementation in healthy adults reporting poor sleep: a randomized, placebo-controlled trial. Nat Sci Sleep. 2025;17:2027-2040. doi:10.2147/NSS.S524348Mah J, Pitre T. Oral magnesium supplementation for insomnia in older adults: a systematic review & meta-analysis. BMC Complement Med Ther. 2021;21(1):125. doi:10.1186/s12906-021-03297-zMori K, Inatomi S, Ouchi K, Azumi Y, Tuchida T. Improving effects of the mushroom Yamabushitake (Hericium erinaceus) on mild cognitive impairment: a double-blind placebo-controlled clinical trial. Phytother Res. 2009;23(3):367-372. doi:10.1002/ptr.2634Surendran G, Saye J, Binti Mohd Jalil S, et al. Acute effects of a standardised extract of Hericium erinaceus (Lion’s Mane mushroom) on cognition and mood in healthy younger adults: a double-blind randomised placebo-controlled study. Front Nutr. 2025;12:1405796. doi:10.3389/fnut.2025.1405796Prokopidis K, Moriarty F, Bahat G, McLean J, Church DD, Patel HP. The effect of nicotinamide mononucleotide and riboside on skeletal muscle mass and function: a systematic review and meta-analysis. J Cachexia Sarcopenia Muscle. 2025;16(3):e13799. doi:10.1002/jcsm.13799Chen F, Zhou D, Kong AP, et al. Effects of nicotinamide mononucleotide on glucose and lipid metabolism in adults: a systematic review and meta-analysis of randomised controlled trials. Curr Diab Rep. 2024;25(1):4. doi:10.1007/s11892-024-01557-zBrakedal B, Skeie GO, Derad C, et al. Nicotinamide riboside for patients with early-stage Parkinson disease: the NOPARK randomized clinical trial. JAMA. Published online 2026. doi:10.1001/jama.2026.18828Sleivert G, Burke V, Palmer C, et al. The effects of deer antler velvet extract or powder supplementation on aerobic power, erythropoiesis, and muscular strength and endurance characteristics. Int J Sport Nutr Exerc Metab. 2003;13(3):251-265. doi:10.1123/ijsnem.13.3.251Syrotuik DG, MacFadyen KL, Harber VJ, Bell GJ. Effect of elk velvet antler supplementation on the hormonal response to acute and chronic exercise in male and female rowers. Int J Sport Nutr Exerc Metab. 2005;15(4):366-385. doi:10.1123/ijsnem.15.4.366Cox HD, Eichner D. Detection of human insulin-like growth factor-1 in deer antler velvet supplements. Rapid Commun Mass Spectrom. 2013;27(19):2170-2178. doi:10.1002/rcm.6678Delpino FM, Figueiredo LM, Forbes SC, Candow DG, Santos HO. Influence of age, sex, and type of exercise on the efficacy of creatine supplementation on lean body mass: a systematic review and meta-analysis of randomized clinical trials. Nutrition. 2022;103-104:111791. doi:10.1016/j.nut.2022.111791Prokopidis K, Giannos P, Triantafyllidis KK, Kechagias KS, Forbes SC, Candow DG. Effects of creatine supplementation on memory in healthy individuals: a systematic review and meta-analysis of randomized controlled trials. Nutr Rev. 2023;81(4):416-427. doi:10.1093/nutrit/nuac064Xu C, Bi S, Zhang W, Luo L. The effects of creatine supplementation on cognitive function in adults: a systematic review and meta-analysis. Front Nutr. 2024;11:1424972. doi:10.3389/fnut.2024.1424972Wilding JPH, Batterham RL, Calanna S, et al. Once-weekly semaglutide in adults with overweight or obesity. N Engl J Med. 2021;384(11):989-1002. doi:10.1056/NEJMoa2032183Jastreboff AM, Aronne LJ, Ahmad NN, et al. Tirzepatide once weekly for the treatment of obesity. N Engl J Med. 2022;387(3):205-216. doi:10.1056/NEJMoa2206038Poolton JT, Minett J, Kazmi A. Human evidence for BPC-157 in orthopaedic and regenerative medicine: a systematic review of efficacy and safety. Acta Orthop Belg. 2026;92(3). doi:10.52628/92.3.15837Reichel C, Gmeiner G, Thevis M. Detection of black market follistatin 344. Drug Test Anal. 2019;11(11-12):1675-1697. doi:10.1002/dta.2741ClinicalTrials.gov. Search results for BPC-157. National Library of Medicine. Accessed October 2026. https://clinicaltrials.gov/search?term=BPC-157Rodriguez P, Zhou W, Barrett DW, et al. Multimodal randomized functional MR imaging of the effects of methylene blue in the huma

    Sunday Morning Protocol 2049: A Halloween Story About Optimization

  2. Oct 21

    How Much Cardio Should You Do? How Much is Too Much?

    How much cardio should you do, and does more of it ever become harmful? Cardiorespiratory fitness keeps improving with training load and nobody has found a ceiling. Getting fitter keeps lowering mortality risk as far out as anyone has measured. The one dose dependent harm that survives scrutiny is atrial fibrillation, and it shows up around six to seven hours a week of hard endurance training sustained for years. This episode goes through the Danish jogging study behind the “fast running is as deadly as sitting on the couch” headlines and why two deaths in forty people can’t carry it, the much larger datasets that found no harm signal, and what changes when somebody measures fitness on a treadmill instead of asking people about minutes. Then atrial fibrillation, coronary calcium and heart scarring in lifelong endurance athletes, the sudden cardiac arrest numbers from 29 million race finishers, whether cardio interferes with lifting, fuel handling, weight loss and metabolic compensation, and bone density in cyclists. It closes with a rewritten version of the cardio guidelines, including volume, intensity, progression, and the fitness and health targets the real guidelines leave out. Timestamps 00:00 The jogging J-curve and the headlines02:42 The Danish study, its confidence interval, and what a MET measures08:02 Better measurement: 15 check-ins and fitness on a treadmill12:51 Atrial fibrillation: the dose, the mechanism, and stroke risk22:06 Coronary calcium and heart scarring in masters athletes25:58 The marathon death story and cardiac arrest rates29:08 How much training it takes to keep getting fitter34:12 Does cardio interfere with your lifting gains39:52 Flux, the athlete's paradox, and liver fat44:12 Cardio, weight loss, and metabolic compensation51:13 Bone density in cyclists and energy availability57:51 Writing the cardio guidelines Resources Buy the book, Signal: https://www.barbellmedicine.com/shop/learning/signal/ Free Vital 5 Action Plan New Barbell Medicine Hybrid 5K and 10K Run + Lift Programs Barbell Medicine coaching and templates: https://www.barbellmedicine.com Get early access, ad-free listening, and exclusive content here: https://barbellmedicine.supercast.com/ 1. Schnohr P, O'Keefe JH, Marott JL, Lange P, Jensen GB. Dose of jogging and long-term mortality: the Copenhagen City Heart Study. J Am Coll Cardiol. 2015. doi:10.1016/j.jacc.2014.11.023 2. Arem H, Moore SC, Patel A, et al. Leisure time physical activity and mortality: a detailed pooled analysis of the dose-response relationship. JAMA Intern Med. 2015. doi:10.1001/jamainternmed.2015.0533 3. Lee DH, Rezende LFM, Joh HK, et al. Long-term leisure-time physical activity intensity and all-cause and cause-specific mortality: a prospective cohort of US adults. Circulation. 2022. doi:10.1161/CIRCULATIONAHA.121.058162 4. Mandsager K, Harb S, Cremer P, Phelan D, Nissen SE, Jaber W. Association of cardiorespiratory fitness with long-term mortality among adults undergoing exercise treadmill testing. JAMA Netw Open. 2018. doi:10.1001/jamanetworkopen.2018.3605 5. Ekelund U, Tarp J, Steene-Johannessen J, et al. Dose-response associations between accelerometry measured physical activity and sedentary time and all cause mortality: systematic review and harmonised meta-analysis. BMJ. 2019. doi:10.1136/bmj.l4570 6. Saulicz A, Abernethy D, Wraith D. Can too much exercise kill you? A systematic review of the risk of a cardiovascular event or death from long term strenuous exercise. Eur J Epidemiol. 2026. doi:10.1007/s10654-025-01353-3 7. Morganroth J, Maron BJ, Henry WL, Epstein SE. Comparative left ventricular dimensions in trained athletes. Ann Intern Med. 1975. 8. Davies CL, Pallikadavath S, March DS, et al. Physical activity, atrial fibrillation and the dose-response relationship: a systematic review and meta-analysis. Eur J Prev Cardiol. 2026. doi:10.1093/eurjpc/zwag535 9. Molina L, Mont L, Marrugat J, et al. Long-term endurance sport practice increases the incidence of lone atrial fibrillation in men: a follow-up study. Europace. 2008. doi:10.1093/europace/eun071 10. Javed W, Botis I, Tomoaia R, et al. Clinical and cardiovascular magnetic resonance characteristics of veteran male endurance athletes with atrial fibrillation: VENTOUX-AF. J Am Heart Assoc. 2025. doi:10.1161/JAHA.125.042308 11. Liu B, Pagan E, Beccarino N, Chang D, Dulmovits E, Beldner S. Voltage mapping and pulmonary vein isolation in master athletes with atrial fibrillation. Pacing Clin Electrophysiol. 2022;45(11):1338-1342. doi:10.1111/pace.14602 12. Guasch E, Benito B, Qi X, et al. Atrial fibrillation promotion by endurance exercise: demonstration and mechanistic exploration in an animal model. J Am Coll Cardiol. 2013. doi:10.1016/j.jacc.2013.01.091 13. Flannery MD, Canovas R, Janssens K, et al. Atrial fibrillation in former world-class rowers: role of environmental and genetic factors. Eur Heart J. 2025. doi:10.1093/eurheartj/ehaf369 14. Johansen KR, Ranhoff AH, Sorensen E, et al. Risk of atrial fibrillation and stroke among older men exposed to prolonged endurance sport practice: a 10-year follow-up. The Birkebeiner Ageing Study and the Tromso Study. Open Heart. 2022;9(2). doi:10.1136/openhrt-2022-002154 15. Apelland T, Letnes JM, Janssens K, et al. Arrhythmia burden, symptoms and quality of life in female and male endurance athletes with paroxysmal atrial fibrillation: a multicentre cohort study in Norway, Australia and Belgium. BMJ Open. 2025;15(8):e100496. doi:10.1136/bmjopen-2025-100496 16. Merghani A, Maestrini V, Rosmini S, et al. Prevalence of subclinical coronary artery disease in masters endurance athletes with a low atherosclerotic risk profile. Circulation. 2017;136(2):126-137. doi:10.1161/CIRCULATIONAHA.116.026964 17. Aengevaeren VL, Mosterd A, Braber TL, et al. Relationship between lifelong exercise volume and coronary atherosclerosis in athletes. Circulation. 2017;136(2):138-148. doi:10.1161/CIRCULATIONAHA.117.027834 18. Kim JH, Rim AJ, Miller JT, et al. Cardiac arrest during long-distance running races. JAMA. 2025;333(19):1699-1707. doi:10.1001/jama.2025.3026 19. Montero D, Cathomen A, Jacobs RA, et al. Haematological rather than skeletal muscle adaptations contribute to the increase in peak oxygen uptake induced by moderate endurance training. J Physiol. 2015;593(20):4677-4688. doi:10.1113/JP270250 20. Molmen KS, Almquist NW, Skattebo O. Effects of exercise training on mitochondrial and capillary growth in human skeletal muscle: a systematic review and meta-regression. Sports Med. 2025;55(1):115-144. doi:10.1007/s40279-024-02120-2 21. Church TS, Earnest CP, Skinner JS, Blair SN. Effects of different doses of physical activity on cardiorespiratory fitness among sedentary, overweight or obese postmenopausal women with elevated blood pressure: a randomized controlled trial. JAMA. 2007. 22. Hickson RC. Interference of strength development by simultaneously training for strength and endurance. Eur J Appl Physiol Occup Physiol. 1980. 23. Schumann M, Feuerbacher JF, Sunkeler M, et al. Compatibility of concurrent aerobic and strength training for skeletal muscle size and function: an updated systematic review and meta-analysis. Sports Med. 2022. doi:10.1007/s40279-021-01587-7 24. Lundberg TR, Feuerbacher JF, Sunkeler M, Schumann M. The effects of concurrent aerobic and strength training on muscle fiber hypertrophy: a systematic review and meta-analysis. Sports Med. 2022;52(10):2391-2403. doi:10.1007/s40279-022-01688-x 25. Feuerbacher JF, Jacobs MW, Heumann P, Pareja-Blanco F, Hackney AC, Zacher J, Schumann M. Neuromuscular adaptations to same versus separate muscle-group concurrent aerobic and strength training in recreationally active males and females. Scand J Med Sci Sports. 2025;35(2):e70025. doi:10.1111/sms.70025 26. Montero D, Lundby C. Refuting the myth of non-response to exercise training: 'non-responders' do respond to higher dose of training. J Physiol. 2017. doi:10.1113/JP273480 27. Mezincescu AM, Rudd A, Cheyne L, et al. Comparison of intramyocellular lipid metabolism in patients with diabetes and male athletes. Nat Commun. 2024;15(1):3690. doi:10.1038/s41467-024-47843-y 28. Keating SE, Hackett DA, Parker HM, et al. Effect of aerobic exercise training dose on liver fat and visceral adiposity. J Hepatol. 2015;63(1):174-182. doi:10.1016/j.jhep.2015.02.022 29. Pearson RC, Cogan B, Garcia SA, Jenkins NT. Effect of prior exercise on postprandial lipemia: an updated meta-analysis and systematic review. Int J Sport Nutr Exerc Metab. 2022;32(6):501-518. doi:10.1123/ijsnem.2022-0043 30. Ross R, Hudson R, Stotz PJ, Lam M. Effects of exercise amount and intensity on abdominal obesity and glucose tolerance in obese adults: a randomized trial. Ann Intern Med. 2015. doi:10.7326/M14-1189 31. Westerterp KR, Meijer GA, Janssen EM, Saris WH, ten Hoor F. Long-term effect of physical activity on energy balance and body composition. Br J Nutr. 1992. 32. Pontzer H, Trexler ET. The evidence for constrained total energy expenditure in humans and other animals. Curr Biol. 2026;36(4):1013-1025.e4. doi:10.1016/j.cub.2026.01.025 33. Nichols JF, Palmer JE, Levy SS. Low bone mineral density in highly trained male master cyclists. Osteoporos Int. 2003;14(8):644-649. 34. Nichols JF, Rauh MJ. Longitudinal changes in bone mineral density in male master cyclists and nonathletes. J Strength Cond Res. 2011;25(3):727-734. doi:10.1519/JSC.0b013e3181c6a116 35. Olmedillas H, Gonzalez-Aguero A, Moreno LA, Casajus JA, Vicente-Rodriguez G. Cycling and bone health: a systematic review. BMC Med. 2012;10:168. doi:10.1186/1741-7015-10-168 36. Abrahin O, Rodrigues RP, Marcal AC, Alves EA, Figueiredo RC, de Sousa EC. Swimming and cycling do not cause positive effects on bone mineral density: a systematic review. Rev Bras Reumatol. 2016. doi:10.1016/j.rbre.2016.02.013 37. Keay N, Francis G, Hind K. Low energy availability assessed by a sport-specific questionnaire and clinical interview indicat

    How Much Cardio Should You Do? How Much is Too Much?

  3. Oct 8

    How Much Lifting is Enough? How Much is Too Much?

    How much resistance training do you actually need, and is there a point where more stops helping? We trace the "lift weights twice a week" recommendation back to the 1989 study it came from, which found that three days beat two, and to the citation loop that turned it into a guideline anyway. Then we go through the evidence on whether lifting is dangerous, including the heart, injury rates, and the J-shaped mortality curve, and work out where the dose-response actually saturates for strength, muscle mass, bone mineral density, and how your body handles fuel. The short answer is that almost every number in this literature marks where a benefit starts, and very little of it goes far enough to show where a benefit stops. We finish by writing the resistance training guideline the way we think it should be written, with target outcomes, a training dose, and testable targets. Timestamps  00:00 Where the "lift weights twice a week" rule came from 04:18 What actually counts as resistance training 06:56 Does lifting make your heart wall thicker 15:34 Anabolic steroids and the heart 19:16 Injury rates and cardiac arrest at the gym 22:03 How the lifting J-curve got made 28:05 ACSM audits its own recommendation 31:11 Strength: where the plateau actually sits 35:49 Why grip strength can't answer this 41:43 Muscle mass versus muscle function 44:50 Bone, and the turkey wing that settled the dose 49:50 Fuel handling, insulin sensitivity, and the clock 1:00:46 The 2018 guidelines, and how I would write themResources Buy the book, Signal: https://www.barbellmedicine.com/shop/learning/signal/ New Barbell Medicine Hybrid 5K and 10K Run + Lift Programs Barbell Medicine coaching and templates: https://www.barbellmedicine.com Get early access, ad-free listening, and exclusive content here: https://barbellmedicine.supercast.com/ Braith RW, Graves JE, Pollock ML, Leggett SL, Carpenter DM, Colvin AB. Comparison of 2 vs 3 days/week of variable resistance training during 10- and 18-week programs. Int J Sports Med. 1989;10(6):450-454. doi:10.1055/s-2007-1024942. PMID 2628366.American College of Sports Medicine. Position stand: the recommended quantity and quality of exercise for developing and maintaining cardiorespiratory and muscular fitness in healthy adults. Med Sci Sports Exerc. 1990;22(2):265-274. PMID 2355825.Sandercock GRH, Moran J, Cohen DD. Who is meeting the strengthening physical activity guidelines by definition: a cross-sectional study of 253,423 English adults? PLoS One. 2022;17(5):e0267277. doi:10.1371/journal.pone.0267277. PMID 35507575.Shakespear-Druery J, De Cocker K, Biddle SJH, Gasevic D, Bennie JA. Assessment of muscle-strengthening exercise in public health surveillance for adults: a systematic review. Prev Med. 2021;148:106566. doi:10.1016/j.ypmed.2021.106566. PMID 33878352.Zhang Y, Lee DH, Rezende LFM, et al. Long-term resistance training with all-cause and cause-specific mortality: assessing dose-response and joint associations with aerobic physical activity. Br J Sports Med. 2026;60(12):874-883. doi:10.1136/bjsports-2025-110503. PMID 42230125.Morganroth J, Maron BJ, Henry WL, Epstein SE. Comparative left ventricular dimensions in trained athletes. Ann Intern Med. 1975;82(4):521-524. doi:10.7326/0003-4819-82-4-521. PMID 1119766.Naylor LH, George K, O'Driscoll G, Green DJ. The athlete's heart: a contemporary appraisal of the Morganroth hypothesis. Sports Med. 2008;38(1):69-90. doi:10.2165/00007256-200838010-00006. PMID 18081368.Myerson SG, Montgomery HE, World MJ, Pennell DJ. Left ventricular mass: reliability of M-mode and 2-dimensional echocardiographic formulas. Hypertension. 2002;40(5):673-678. doi:10.1161/01.hyp.0000036401.99908.db. PMID 12411461.Pelliccia A, Maron BJ, Spataro A, Proschan MA, Spirito P. The upper limit of physiologic cardiac hypertrophy in highly trained elite athletes. N Engl J Med. 1991;324(5):295-301. doi:10.1056/NEJM199101313240504. PMID 1824720.Spirito P, Pelliccia A, Proschan MA, et al. Morphology of the "athlete's heart" assessed by echocardiography in 947 elite athletes representing 27 sports. Am J Cardiol. 1994;74(8):802-806. doi:10.1016/0002-9149(94)90439-1. PMID 7942554.Pelliccia A, Spataro A, Caselli G, Maron BJ. Absence of left ventricular wall thickening in athletes engaged in intense power training. Am J Cardiol. 1993;72(14):1048-1054. doi:10.1016/0002-9149(93)90861-6. PMID 8213586.Spence AL, Naylor LH, Carter HH, et al. A prospective randomised longitudinal MRI study of left ventricular adaptation to endurance and resistance exercise training in humans. J Physiol. 2011;589(Pt 22):5443-5452. doi:10.1113/jphysiol.2011.217125. PMID 21969450.Utomi V, Oxborough D, Whyte GP, et al. Systematic review and meta-analysis of training mode, imaging modality and body size influences on the morphology and function of the male athlete's heart. Heart. 2013;99(23):1727-1733. doi:10.1136/heartjnl-2012-303465. PMID 23474689.Smit DL, Voogel AJ, den Heijer M, de Ronde W. Anabolic androgenic steroids induce reversible left ventricular hypertrophy and cardiac dysfunction: echocardiography results of the HAARLEM study. Front Reprod Health. 2021;3:732318. doi:10.3389/frph.2021.732318. PMID 36304014.Abdullah R, Bjørnebekk A, Hauger LE, Hullstein IR, Edvardsen T, Haugaa KH, Almaas VM. Severe biventricular cardiomyopathy in both current and former long-term users of anabolic-androgenic steroids. Eur J Prev Cardiol. 2024;31(5):599-608. doi:10.1093/eurjpc/zwad362. PMID 37992194.Keogh JWL, Winwood PW. The epidemiology of injuries across the weight-training sports. Sports Med. 2017;47(3):479-501. doi:10.1007/s40279-016-0575-0. PMID 27328853.Aasa U, Svartholm I, Andersson F, Berglund L. Injuries among weightlifters and powerlifters: a systematic review. Br J Sports Med. 2017;51(4):211-219. doi:10.1136/bjsports-2016-096037. PMID 27707741.Page RL, Husain S, White LY, et al. Cardiac arrest at exercise facilities: implications for placement of automated external defibrillators. J Am Coll Cardiol. 2013;62(22):2102-2109. doi:10.1016/j.jacc.2013.06.048. PMID 23933539.Hollings M, Mavros Y, Freeston J, Fiatarone Singh M. The effect of progressive resistance training on aerobic fitness and strength in adults with coronary heart disease: a systematic review and meta-analysis of randomised controlled trials. Eur J Prev Cardiol. 2017;24(12):1242-1259. doi:10.1177/2047487317713329.Momma H, Kawakami R, Honda T, Sawada SS. Muscle-strengthening activities are associated with lower risk and mortality in major non-communicable diseases: a systematic review and meta-analysis of cohort studies. Br J Sports Med. 2022;56(13):755-763. doi:10.1136/bjsports-2021-105061. PMID 35228201.O'Keefe JH, O'Keefe EL, Eckert R, Lavie CJ. Training strategies to optimize cardiovascular durability and life expectancy. Mo Med. 2023;120(2):155-162. PMID 37091937. PMCID PMC10121111.Currier BS, McLeod JC, Banfield L, et al. American College of Sports Medicine position stand: resistance training prescription for muscle function, hypertrophy, and physical performance in healthy adults: an overview of reviews. Med Sci Sports Exerc. 2026;58(4):851-872. PMID 41843416.Ralston GW, Kilgore L, Wyatt FB, Buchan D, Baker JS. Weekly training frequency effects on strength gain: a meta-analysis. Sports Med Open. 2018;4(1):36. doi:10.1186/s40798-018-0149-9. PMID 30076500.Pelland JC, Remmert JF, Robinson ZP, Hinson SR, Zourdos MC. The resistance training dose response: meta-regressions exploring the effects of weekly volume and frequency on muscle hypertrophy and strength gains. Sports Med. 2026;56(2):481-505. doi:10.1007/s40279-025-02344-w. PMID 41343037.Ortega FB, Silventoinen K, Tynelius P, Rasmussen F. Muscular strength in male adolescents and premature death: cohort study of one million participants. BMJ. 2012;345:e7279. doi:10.1136/bmj.e7279. PMID 23144234.Ruiz JR, Sui X, Lobelo F, et al. Association between muscular strength and mortality in men: prospective cohort study. BMJ. 2008;337:a439. doi:10.1136/bmj.a439. PMID 18595904.Timpka S, Petersson IF, Zhou C, Englund M. Muscle strength in adolescent men and risk of cardiovascular disease events and mortality in middle age. BMC Med. 2014;12:62. doi:10.1186/1741-7015-12-62. PMID 24731728.Leong DP, Teo KK, Rangarajan S, et al. Prognostic value of grip strength: findings from the Prospective Urban Rural Epidemiology (PURE) study. Lancet. 2015;386(9990):266-273. doi:10.1016/S0140-6736(14)62000-6. PMID 25982160.Tieland M, Verdijk LB, de Groot LCPGM, van Loon LJC. Handgrip strength does not represent an appropriate measure to evaluate changes in muscle strength during an exercise intervention program in frail older people. Int J Sport Nutr Exerc Metab. 2015;25(1):27-36. doi:10.1123/ijsnem.2013-0123. PMID 24903908.Grgic J, Garofolini A, Orazem J, Sabol F, Schoenfeld BJ, Pedisic Z. Effects of resistance training on muscle size and strength in very elderly adults: a systematic review and meta-analysis of randomized controlled trials. Sports Med. 2020;50(11):1983-1999. doi:10.1007/s40279-020-01331-7. PMID 32740889.Huebner M, Riemann B, Hatchett A. Grip strength and sports performance in competitive master weightlifters. Int J Environ Res Public Health. 2023;20(3):2033. doi:10.3390/ijerph20032033. PMID 36767396.López-Bueno R, Andersen LL, Koyanagi A, et al. Thresholds of handgrip strength for all-cause, cancer, and cardiovascular mortality: a systematic review with dose-response meta-analysis. Ageing Res Rev. 2022;82:101778. doi:10.1016/j.arr.2022.101778.MacDonald HV, Johnson BT, Huedo-Medina TB, et al. Dynamic resistance training as stand-alone antihypertensive lifestyle therapy: a meta-analysis. J Am Heart Assoc. 2016;5(10):e003231. doi:10.1161/JAHA.116.003231. PMID 27680663.Bhasin S, Travison TG, Manini TM, et al. Sarcopenia definition: the position statements of the Sarcopenia Definition and Outcomes Consortium. J Am Geriatr Soc. 2020;68(7):1410-1418. doi:10.1111/jgs.16372. PMID 32150289.Cawthon PM,

    How Much Lifting is Enough? How Much is Too Much?

  4. Oct 2

    Where did the advice to not lift heavy weights come from?

    Nearly every warning you've heard about lifting weights was written down before anybody checked it. We trace where those warnings came from, starting with a Harvard student in 1854 and ending with a curve on a graph that's being used today to argue you can lift too much. Along the way: the men who built themselves with barbells and then sold the public five-pound dumbbells, because iron was expensive to mail and a booklet cost pennies. The muscle-bound myth, which nobody could define when a graduate student surveyed 45 physiologists about it. The 1961 report that took the deep squat out of every branch of the American military, measured with a device its author built himself and never validated. The claim that lifting stunts a child's growth, which no professional body ever actually made. And the argument women got, which was never about injury at all. Timestamps: 0:00 Intro2:33 2,500 years of people picking up heavy things7:24 George Windship and the Health Lift10:56 Blaikie's truck horse and the muscle-bound myth14:59 Bernarr Macfadden19:39 Charles Atlas and Dynamic Tension27:01 Carl Klein, a homemade device, and the parallel squat30:57 Thomas Delorme and three sets of ten35:20 Kids, growth plates, and where the stunting idea came from41:43 Women, "you'll get bulky," and Dudley Sargent in 191250:05 Pregnancy, from 1949 to a 2025 barbell study53:40 The pattern, and the curve on next week's graph Resources: Buy the book, Signal: https://www.barbellmedicine.com/shop/learning/signal/ New Barbell Medicine Hybrid 5K and 10K Run + Lift Programs Barbell Medicine coaching and templates: https://www.barbellmedicine.com 1. Downs DS, Chasan-Taber L, Evenson KR, Leiferman J, Yeo S. Physical activity and pregnancy: past and present evidence and future recommendations. Res Q Exerc Sport. 2012;83(4):485-502. doi:10.1080/02701367.2012.10599138. PMID 23367811. 2. McMurray RG, Mottola MF, Wolfe LA, Artal R, Millar L, Pivarnik JM. Recent advances in understanding maternal and fetal responses to exercise. Med Sci Sports Exerc. 1993;25(12):1305-1321. PMID 8107536. 3. Smith KM, Campbell CG. Physical activity during pregnancy: impact of applying different physical activity guidelines. J Pregnancy. 2013;2013:165617. doi:10.1155/2013/165617. PMID 23476778. 4. American College of Obstetricians and Gynecologists. Physical activity and exercise during pregnancy and the postpartum period. ACOG Committee Opinion No. 804. Obstet Gynecol. 2020;135(4):e178-e188. doi:10.1097/AOG.0000000000003772. PMID 32217980. 5. American Academy of Pediatrics Committee on Sports Medicine and Fitness. Strength training by children and adolescents. Pediatrics. 2001;107(6):1470-1472. doi:10.1542/peds.107.6.1470. PMID 11389279. 6. Stricker PR, Faigenbaum AD, McCambridge TM; Council on Sports Medicine and Fitness. Resistance training for children and adolescents. Pediatrics. 2020;145(6):e20201011. doi:10.1542/peds.2020-1011. PMID 32457216. 7. Gardiner EN. Athletics of the Ancient World. Clarendon Press; 1930:54. See also Gardiner EN. Olympia: Its History and Remains. Clarendon Press; 1925. 8. Heffernan C. The Bybon stone and ancient strength. Physical Culture Study. 2021. Accessed September 2026. https://physicalculturestudy.com. 9. Pausanias. Description of Greece. 6.14.5. Jones WHS, trans. Loeb Classical Library. Harvard University Press. 10. Quintilian. Institutio Oratoria. 1.9.5. Butler HE, trans. Loeb Classical Library. Harvard University Press. 11. Heffernan C. Milo of Croton and the invention of progressive overload. Physical Culture Study. 2026. Accessed September 2026. https://physicalculturestudy.com. See also H.J. Lutcher Stark Center for Physical Culture and Sports, University of Texas at Austin, Milo Bar-Bell Company holdings. 12. Liddell HG, Scott R. A Greek-English Lexicon. 9th ed. Clarendon Press; entry γυμνάσιον. Thucydides. History of the Peloponnesian War. 1.6. Crawley R, trans. 13. Tomlinson RA. Gymnasium. In: Oxford Classical Dictionary. Oxford University Press; 2015. doi:10.1093/acrefore/9780199381135.013.2963. See also Stavrou D. The Greek Gymnasium [thesis]. University of Leicester; 2016:38. 14. Xenophon. Constitution of the Lacedaimonians. 1.4. Marchant EC, trans. Loeb Classical Library. Harvard University Press. 15. Plutarch. Life of Lycurgus. 14. Perrin B, trans. Loeb Classical Library. Harvard University Press. 16. Ollier F. Le Mirage Spartiate. Vols 1-2. Boccard; 1933-1943. Discussed in Rahe PA. The Grand Strategy of Classical Sparta. Yale University Press; 2016. See also Christesen P. Utopia on the Eurotas: Economic Aspects of the Spartan Mirage. In: Powell A, Hodkinson S, eds. Sparta: The Body Politic. Classical Press of Wales; 2010. 17. Pausanias. Description of Greece. 5.16. Jones WHS, trans. Loeb Classical Library. Harvard University Press. 18. Scarborough J. Galen and the gladiators. Episteme. 1971;5:98-111. 19. Tipton CM. The history of "Exercise Is Medicine" in ancient civilizations. Adv Physiol Educ. 2014;38(2):109-117. doi:10.1152/advan.00136.2013. PMCID PMC4056176. 20. Vegetius FR. De Re Militari (The Military Institutions of the Romans). Book I. Clarke J, trans. 1767. 21. Surviving halteres: a catalogue. EXARC Journal. 2017;(3). Accessed September 2026. https://exarc.net. 22. Talaga M. Physical culture in the Middle Ages: revisiting the disappearance thesis. Cogent Arts Humanit. 2025. doi:10.1080/23311983.2025.2482388. 23. Rawcliffe C. Health and the environment in the medieval hospital. History. 2022. doi:10.1111/1468-229X.13238. 24. Elyot T. The Boke Named the Governour. 1531. Croft HHS, ed. Kegan Paul; 1883:171. 25. Campillo P, Caballero D. Girolamo Mercuriale and the art of gymnastics. Hektoen International. 2020. Accessed September 2026. https://hekint.org. 26. Todd T. The myth of the muscle-bound lifter. NSCA J. 1985;7(3):37-41. Citing Van Doren C. Benjamin Franklin. Viking Press; 1938. 27. Galen. Exhortation to the Study of the Arts (Protrepticus). Chapters 9-14. Walsh J, trans. Medical Life. 1930;37:507-529. See also Xenophontos S. Galen's Exhortation to the Study of Medicine. In: Bouras-Vallianatos P, Xenophontos S, eds. Greek Medical Literature and Its Readers. Routledge; 2018:67-93. 28. Todd J. "Strength is Health": George Barker Windship and the first American weight training boom. Iron Game History. 1993;3(1):3-14. https://starkcenter.org/igh/igh-v3/igh-v3-n1/igh0301c.pdf. 29. Windship GB. Autobiographical sketches of a strength-seeker. Atlantic Monthly. 1862;9(51):102-115. 30. US Patent 46,413. Improvement in graduated dumb-bells. GB Windship, Boston. Granted 14 February 1865. 31. Savage DF. US Patent 28,505. 1860. 32. The Health-Lift Reduced to a Science: Cumulative Exercise, A Thorough Gymnastic System in Ten Minutes Once a Day. New York: Health-Lift Company; 1875. 33. Blaikie W. How to Get Strong and How to Stay So. New York: Harper & Brothers; 1879:99-100. 34. Bryant D. William Blaikie and physical fitness in late nineteenth century America. Iron Game History. 1992;2(3):3. 35. Sandow E. Sandow on Physical Training. Adam GM, ed. 1894:12, 23, 207. 36. Sandow E. Strength and How to Obtain It. London: Gale & Polden; 1897:34, Table 7. 37. Sandow E. Strength and How to Obtain It. Revised ed. London: Gale & Polden; [c1899]. Project Gutenberg ebook 65987. 38. Todd J, Todd T. Requiem for a strongman: reassessing the career of Professor Louis Attila. Iron Game History. 2002;7(2-3):42-55. 39. Pall Mall Gazette. December 1889. Clipping in Attila's scrapbook, Todd-McLean Collection, H.J. Lutcher Stark Center, University of Texas at Austin. 40. Chapman D. Sandow's first triumph. Iron Game History. 1994;3(3):3-8. 41. Robert Hoffman Business Papers finding aid. H.J. Lutcher Stark Center for Physical Culture and Sports, University of Texas at Austin. 42. Hall DT, Fair JD. The pioneers of protein. Iron Game History. 2004;8(3):26-28. 43. Shurley J, Todd J. Joe Weider, All American Athlete, and the promotion of strength training for sport: 1940-1969. Iron Game History. 2012;12(1):9-12. 44. Todd J. Bernarr Macfadden: reformer of feminine form. Iron Game History. 1991;1(4-5):3-8. 45. Yagoda B. The true story of Bernarr Macfadden. American Heritage. 1981;33(1):22-28. 46. Murtha R, Heffernan C, Hunt T. Building American supermen? Bernarr MacFadden, Benito Mussolini and American fascism in the 1930s. Sport in Society. 2020. doi:10.1080/17430437.2020.1865313. 47. New York Times. 6 October 1905:10; 10 October 1905:9. 48. Macfadden B. Macfadden's Encyclopedia of Physical Culture. New York: Physical Culture Publishing; 1912:847. Quoted in Todd T, NSCA J. 1985;7(3):37-41. 49. Danna S. Charles Atlas: muscle man. Iron Game History. 1996;4(4):3-6, 12-14. https://starkcenter.org/igh/igh-v4/igh-v4-n4/igh0404c.pdf. 50. Guide to the Charles Atlas Records, NMAH.AC.0654. Archives Center, National Museum of American History, Smithsonian Institution. 51. Charles Atlas course text, undated later edition. 52. Charles P. Roman: a gloriously healthy life. Chief Marketer. 53. Kannenberg G Jr. The ad that made an icon out of Mac. Hogan's Alley. 1999;2(3). 54. Michigan State University Libraries comic art index, Charles Atlas advertisements. https://comics.lib.msu.edu/rri/arri/atlas.htm. 55. Charles Atlas. Encyclopedia.com. 56. Todd J, Todd T. The conversion of Dr. Peter Karpovich. Iron Game History. 2005;8(4):4-12. https://starkcenter.org/igh/igh-v8/igh-v8-n4/igh0804c.pdf. 57. Murray J, Karpovich P. Weight Training in Athletics. Englewood Cliffs, NJ: Prentice-Hall; 1956. 58. Murray J. John Carrol Grimek: the nonpareil. Iron Game History. 1994;3(3):10-12. 59. Zorbas WS, Karpovich PV. The effect of weight lifting upon the speed of muscular contractions. Res Q. 1951;22(2):145-148. 60. Klein KK. The deep squat exercise as utilized in weight training for athletes and its effect on the ligaments of the knee. J Assoc Phys Ment Rehabil. 1961;15(1):6-11, 23. 61. Sports Illustrated. C

    Where did the advice to not lift heavy weights come from?

  5. Sep 24

    Is It Safe to Train When the Air Is Full of Wildfire Smoke?

    Parts of the country now get a few weeks of wildfire smoke every year, and the obvious question is whether there is a point where the air is bad enough that the workout costs you more than it gives you. We went and looked. There is a real number, it comes from about 1.5 million people, and it is not the number that gets quoted. This is a free preview of Direct Line, our monthly ask-us-anything for Barbell Medicine Plus subscribers. Two of this month's twelve questions are here in full. First: training in wildfire smoke. What PM2.5 is, why the AQI on your phone and the number in the paper are not the same quantity, where the 90-minutes-at-100-micrograms figure comes from and why it is softer than it sounds, what happened when six cities modeled telling people to stay inside, and why your breathing rate during a set of squats matters more than you would think. Second: the effective reps model. A subscriber noticed that if a set only counts when you are within five reps of failure, the triceps in a heavy bench press should not count, and if you are going to count that as a fractional set for the triceps, then a warm-up set counts for the chest. Both cannot be true. We go through the meta-regression on proximity to failure, the 67-study analysis that tested whether an indirect set should count as one, as half, or as zero, and where we actually put our sets. Join Barbell Medicine Plus today: https://barbellmedicine.supercast.com/ Buy the book, Signal: https://www.barbellmedicine.com/shop/learning/signal/ New Barbell Medicine Hybrid 5K and 10K Run + Lift Programs Barbell Medicine coaching and templates: https://www.barbellmedicine.com Timestamps 1:47 The question: is there a point where the air is too bad to train?2:37 What PM2.5 actually is3:05 AQI vs micrograms, and why your phone disagrees with the paper3:50 Where the "90 minutes" number comes from4:54 Austin: what breathing this air does to your lungs9:14 1.5 million adults: does dirty air cancel the benefit of exercise?10:44 Six cities modeled staying indoors. Mortality did not improve.11:22 Lifting vs cycling: breathing rate is the whole mechanism12:33 Indoor air during a wildfire, and what filtration does not fix13:24 Is wildfire smoke worse than city pollution?14:38 What we would actually tell a patient18:35 The question: hard sets, fractional sets, and the five-rep rule19:18 Reps in reserve, hard sets, and fractional sets defined20:19 The meta-regression: no threshold, just a line21:13 Do indirect sets count as half a set?23:08 Would you rather: every set at 5 RIR, or every set to failure?25:22 Why you get worse at judging RIR the further you are from failure28:42 The numbers we use: RPE 7 to 9 for hypertrophy, 4 to 6 for strength29:20 Austin: individual variation dwarfs all of this33:28 Why nobody can measure training load in the weight room Resources Tainio M, de Nazelle AJ, Götschi T, et al. Can air pollution negate the health benefits of cycling and walking? Prev Med. 2016;87:233-236. doi:10.1016/j.ypmed.2016.02.002. PMID 27156248 Ku PW, Steptoe A, Hamer M, et al. Does ambient PM2.5 reduce the protective association of leisure-time physical activity with mortality? A systematic review, meta-analysis, and individual-level pooled analysis of cohort studies involving 1.5 million adults. BMC Med. 2025;23(1):647. doi:10.1186/s12916-025-04496-y. PMID 41310726 Giallouros G, Kouis P, Papatheodorou SI, Woodcock J, Tainio M. The long-term impact of restricting cycling and walking during high air pollution days on all-cause mortality: health impact assessment study. Environ Int. 2020;140:105679. doi:10.1016/j.envint.2020.105679. PMID 32353667 Sun S, Cao W, Qiu H, et al. Benefits of physical activity not affected by air pollution: a prospective cohort study. Int J Epidemiol. 2020;49(1):142-152. doi:10.1093/ije/dyz184. PMID 31504557 Robles P, Araujo T, Brooks D, et al. Cardiorespiratory responses to short bouts of resistance training exercises in individuals with chronic obstructive pulmonary disease: a comparison of exercise intensities. J Cardiopulm Rehabil Prev. 2017;37(5):356-362. doi:10.1097/HCR.0000000000000282. PMID 28858033 Liang Y, Sengupta D, Campmier MJ, Lunderberg DM, Apte JS, Goldstein AH. Wildfire smoke impacts on indoor air quality assessed using crowdsourced data in California. Proc Natl Acad Sci U S A. 2021;118(36):e2106478118. doi:10.1073/pnas.2106478118. PMID 34465624 Aguilera R, Corringham T, Gershunov A, Benmarhnia T. Wildfire smoke impacts respiratory health more than fine particles from other sources: observational evidence from Southern California. Nat Commun. 2021;12(1):1493. doi:10.1038/s41467-021-21708-0. PMID 33674571 US Environmental Protection Agency. Air Quality Index (AQI) breakpoints. Air Quality System code tables. Accessed August 10, 2026. https://aqs.epa.gov/aqsweb/documents/codetables/aqi_breakpoints.html Robinson ZP, Pelland JC, Remmert JF, Refalo MC, Jukic I, Steele J, et al. Exploring the dose-response relationship between estimated resistance training proximity to failure, strength gain, and muscle hypertrophy: a series of meta-regressions. Sports Med. 2024;54(9):2209-2231. doi:10.1007/s40279-024-02069-2. PMID 38970765 Pelland JC, Remmert JF, Robinson ZP, Hinson SR, Zourdos MC. The resistance training dose response: meta-regressions exploring the effects of weekly volume and frequency on muscle hypertrophy and strength gains. Sports Med. 2026;56(2):481-505. doi:10.1007/s40279-025-02344-w Our Sponsors: * Check out Cometeer and use my code BBM for a great deal: https://www.cometeer.com * Check out FIGS and use my code FIGSRX 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 BBM for a great deal: https://www.quince.com * Check out Ten Thousand and use my code PODCAST15 for a great deal: https://www.tenthousand.cc Advertising Inquiries: https://redcircle.com/brands

    Is It Safe to Train When the Air Is Full of Wildfire Smoke?

  6. Sep 17

    Do You Need a Calorie Surplus to Build Muscle? | Dr. Eric Helms

    Most lifters have been told they need to eat in a Calorie surplus to build muscle. That rule has always come with a list of exceptions: unless you're new, unless you're carrying extra body fat, unless you're coming back from time off. Dr. Eric Helms joins Dr. Jordan Feigenbaum to work out what the rule is actually tracking, starting from a question with a real number attached: what does a pound of muscle cost to build? And then, do you need to be in a surplus to build muscle?  Timestamps: 0:00 The rule, and its exceptions2:08 Where "you need a surplus" came from7:12 Heuristics versus theories11:40 Hypertrophy, maintenance, deficit and surplus defined14:58 Body fat as a savings account18:24 How fast anyone can actually build muscle23:39 What sets the ceiling: stimulus, not genetics26:37 Microgravity, astronauts, and a 20 kg barbell31:49 What constrains growth if steroids don't break the ceiling36:44 If training sets the ceiling, what does energy do38:45 What 1 kg of muscle costs to build44:05 Why 3,500 Calories doesn't tell you what to eat44:55 REDs and the dual intervention model47:51 The 2000s bulking studies51:34 Garthe 2013: elite athletes and a 500 Calorie surplus58:30 Protein: 1.6 versus 2.5 g/kg1:03:31 What starvation research shows the body protects1:10:29 Vargas-Molina: maintenance versus deficit1:19:17 What to do if you're lean1:39:34 What would prove this wrong1:57:57 Three buckets Resources: Buy the book, Signal: https://www.barbellmedicine.com/shop/learning/signal/ New Barbell Medicine Hybrid 5K and 10K Run + Lift Programs Barbell Medicine coaching and templates: https://www.barbellmedicine.com Nikolaidis MG, Paschalis V, Margaritelis NV. The energetic cost of building human skeletal muscle. bioRxiv. Preprint posted online August 17, 2026. doi:10.64898/2026.08.17.745156Rozenek R, Ward P, Long S, Garhammer J. Effects of high-calorie supplements on body composition and muscular strength following resistance training. J Sports Med Phys Fitness. 2002;42(3):340-347.Garthe I, Raastad T, Refsnes PE, Koivisto A, Sundgot-Borgen J. Effect of two different weight-loss rates on body composition and strength and power-related performance in elite athletes. Int J Sport Nutr Exerc Metab. 2011;21(2):97-104.Garthe I, Raastad T, Refsnes PE, Sundgot-Borgen J. Effect of nutritional intervention on body composition and performance in elite athletes. Eur J Sport Sci. 2013;13(3):295-303. doi:10.1080/17461391.2011.643923Helms ER, Zinn C, Rowlands DS, Brown SR. A systematic review of dietary protein during caloric restriction in resistance trained lean athletes: a case for higher intakes. Int J Sport Nutr Exerc Metab. 2014;24(2):127-138. doi:10.1123/ijsnem.2013-0054Slater GJ, Dieter BP, Marsh DJ, Helms ER, Shaw G, Iraki J. Is an energy surplus required to maximize skeletal muscle hypertrophy associated with resistance training. Front Nutr. 2019;6:131. doi:10.3389/fnut.2019.00131Murphy C, Koehler K. Energy deficiency impairs resistance training gains in lean mass but not strength: a meta-analysis and meta-regression. Scand J Med Sci Sports. 2022;32(1):125-137. doi:10.1111/sms.14075Helms ER, Spence A, Sousa C, et al. Effect of small and large energy surpluses on strength, muscle, and skinfold thickness in resistance-trained individuals: a parallel groups design. Sports Med Open. 2023;9(1):102. doi:10.1186/s40798-023-00651-yMountjoy M, Ackerman KE, Bailey DM, et al. 2023 International Olympic Committee's (IOC) consensus statement on Relative Energy Deficiency in Sport (REDs). Br J Sports Med. 2023;57(17):1073-1097. doi:10.1136/bjsports-2023-106994Speakman JR, Hall KD. Models of body weight and fatness regulation. Philos Trans R Soc Lond B Biol Sci. 2023;378(1888):20220231. doi:10.1098/rstb.2022.0231Vargas-Molina S, García-Palumbo A, García-Sillero M, et al. Comparison of two nutritional protocols in body re-composition of resistance-trained participants. Eur J Appl Physiol. 2026;126(7):4019-4030. doi:10.1007/s00421-026-06209-6 Our Sponsors: * Check out Cometeer and use my code BBM for a great deal: https://www.cometeer.com * Check out FIGS and use my code FIGSRX 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 BBM for a great deal: https://www.quince.com * Check out Ten Thousand and use my code PODCAST15 for a great deal: https://www.tenthousand.cc Advertising Inquiries: https://redcircle.com/brands

    Do You Need a Calorie Surplus to Build Muscle? | Dr. Eric Helms

  7. Sep 4

    Is Obesity A Muscle Problem?

    Muscle is where most of the glucose goes, and muscle insulin resistance is the first thing that breaks on the road to type 2 diabetes. Both of those are true, and neither one means that building more muscle is the treatment for obesity. This episode works through what actually decides whether a tissue handles fuel well: not how much of it you have, but how fast it's moving fuel through. We go through the one-legged exercise studies, the 18,000-person analysis of what body composition actually predicts, the athlete's paradox, the energy cost of building a kilogram of muscle, the GLP-1 lean mass panic, and why sarcopenic obesity is named after the wrong organ. This is part two of a two-part series on storage capacity. Part one covered where body fat goes and what happens when the storage runs out.  Timestamps 0:00   The one-leg study, and the muscle-centric claim02:06   What obesity is, and the garage analogy05:06   How glucose gets into a muscle cell11:21   Insulin sensitivity improves without building muscle17:11   The best case for muscle-centric medicine21:13   What predicts falls and death: strength, not lean mass25:18   Separating muscle size from muscle function31:33   Liver fat: amount, type, and flux37:54   Should you build muscle first? The arithmetic42:37   Building muscle in a calorie deficit50:29   GLP-1s, DXA, and the lean mass panic58:23   Sarcopenic obesity, and why the name is wrong01:04:37 Why size still tells you something01:11:46 So what is obesity? Resources: Buy the book, Signal: https://www.barbellmedicine.com/shop/learning/signal/ New Barbell Medicine Hybrid 5K and 10K Run + Lift Programs Barbell Medicine coaching and templates: https://www.barbellmedicine.com 1.   Richter EA, Mikines KJ, Galbo H, Kiens B. Effect of exercise on insulin action in human skeletal muscle. J Appl Physiol (1985). 1989;66(2):876-885. doi:10.1152/jappl.1989.66.2.876. PMID: 2496078. https://doi.org/10.1152/jappl.1989.66.2.876 2.   Cawthon PM, Travison TG, Manini TM, et al. Establishing the link between lean mass and grip strength cut points with mobility disability and other health outcomes. J Gerontol A Biol Sci Med Sci. 2020;75(7):1317-1323. doi:10.1093/gerona/glz081. PMID: 30869772. https://doi.org/10.1093/gerona/glz081 3.   Bhasin S, Travison TG, Manini TM, et al. Sarcopenia definition: the position statements of the Sarcopenia Definition and Outcomes Consortium. J Am Geriatr Soc. 2020;68(7):1410-1418. doi:10.1111/jgs.16372. PMID: 32150289. https://doi.org/10.1111/jgs.16372 4.   Elgaddal N, Kramarow EA, Reuben C. Physical activity among adults aged 18 and over: United States, 2020. NCHS Data Brief No. 443. Hyattsville, MD: National Center for Health Statistics; 2022. PMID: 36043905. https://www.cdc.gov/nchs/products/databriefs/db443.htm 5.   Whitfield GP, Carlson SA, Ussery EN, Fulton JE, Galuska DA, Petersen R. Trends in meeting physical activity guidelines among urban and rural dwelling adults, United States, 2008-2017. MMWR Morb Mortal Wkly Rep. 2019;68(23):513-518. doi:10.15585/mmwr.mm6823a1. PMID: 31194722. https://doi.org/10.15585/mmwr.mm6823a1 6.   Wang T, Wang J, Hu X, Huang XJ, Chen GX. Current understanding of glucose transporter 4 expression and functional mechanisms. World J Biol Chem. 2020;11(3):76-98. doi:10.4331/wjbc.v11.i3.76. PMID: 33274014. https://doi.org/10.4331/wjbc.v11.i3.76 7.   DeFronzo RA, Tripathy D. Skeletal muscle insulin resistance is the primary defect in type 2 diabetes. Diabetes Care. 2009;32(Suppl 2):S157-S163. doi:10.2337/dc09-S302. PMID: 19875544. https://doi.org/10.2337/dc09-S302 8.   Richter EA, Hargreaves M. Exercise, GLUT4, and skeletal muscle glucose uptake. Physiol Rev. 2013;93(3):993-1017. doi:10.1152/physrev.00038.2012. PMID: 23899560. https://doi.org/10.1152/physrev.00038.2012 9.   Petersen KF, Dufour S, Savage DB, et al. The role of skeletal muscle insulin resistance in the pathogenesis of the metabolic syndrome. Proc Natl Acad Sci U S A. 2007;104(31):12587-12594. doi:10.1073/pnas.0705408104. PMID: 17640906. https://doi.org/10.1073/pnas.0705408104 10. Rabøl R, Petersen KF, Dufour S, Flannery C, Shulman GI. Reversal of muscle insulin resistance with exercise reduces postprandial hepatic de novo lipogenesis in insulin resistant individuals. Proc Natl Acad Sci U S A. 2011;108(33):13705-13709. doi:10.1073/pnas.1110105108. PMID: 21808028. https://doi.org/10.1073/pnas.1110105108 11. Perseghin G, Price TB, Petersen KF, et al. Increased glucose transport-phosphorylation and muscle glycogen synthesis after exercise training in insulin-resistant subjects. N Engl J Med. 1996;335(18):1357-1362. doi:10.1056/NEJM199610313351804. PMID: 8857019. https://doi.org/10.1056/NEJM199610313351804 12. Mikines KJ, Sonne B, Farrell PA, Tronier B, Galbo H. Effect of physical exercise on sensitivity and responsiveness to insulin in humans. Am J Physiol. 1988;254(3 Pt 1):E248-E259. doi:10.1152/ajpendo.1988.254.3.E248. PMID: 3126668. https://doi.org/10.1152/ajpendo.1988.254.3.E248 13. Mikines KJ, Sonne B, Tronier B, Galbo H. Effects of acute exercise and detraining on insulin action in trained men. J Appl Physiol (1985). 1989;66(2):704-711. doi:10.1152/jappl.1989.66.2.704. PMID: 2496077. https://doi.org/10.1152/jappl.1989.66.2.704 14. Yu R, Duncombe SL, Nemoto Y, et al. Physical activity trajectories and mortality. Br J Sports Med. 2025;59(17):1228-1241. doi:10.1136/bjsports-2024-109122. PMID: 40639966. https://doi.org/10.1136/bjsports-2024-109122 15. Saint-Maurice PF, Coughlan D, Kelly SP, et al. Association of leisure-time physical activity across the adult life course with all-cause and cause-specific mortality. JAMA Netw Open. 2019;2(3):e190355. doi:10.1001/jamanetworkopen.2019.0355. PMID: 30848809. https://doi.org/10.1001/jamanetworkopen.2019.0355 16. Wang Y, Luo D, Liu J, Song Y, Jiang B, Jiang H. Low skeletal muscle mass index and all-cause mortality. PLoS One. 2023;18(6):e0286745. doi:10.1371/journal.pone.0286745. PMID: 37288745. https://doi.org/10.1371/journal.pone.0286745 17. Umpierre D, Ribeiro PAB, Kramer CK, et al. Physical activity advice only or structured exercise training and association with HbA1c levels in type 2 diabetes. JAMA. 2011;305(17):1790-1799. doi:10.1001/jama.2011.576. PMID: 21540423. https://doi.org/10.1001/jama.2011.576 18. Goodpaster BH, Carlson CL, Visser M, et al. Attenuation of skeletal muscle and strength in the elderly: the Health ABC Study. J Appl Physiol (1985). 2001;90(6):2157-2165. doi:10.1152/jappl.2001.90.6.2157. PMID: 11356778. https://doi.org/10.1152/jappl.2001.90.6.2157 19. Paquin J, Lagacé JC, Brochu M, Dionne IJ. Exercising for insulin sensitivity, is there a mechanistic relationship with quantitative changes in skeletal muscle mass? Front Physiol. 2021;12:656909. doi:10.3389/fphys.2021.656909. PMID: 34054574. https://doi.org/10.3389/fphys.2021.656909 20. Eriksson J, Taimela S, Eriksson K, Parviainen S, Peltonen J, Kujala U. Resistance training in the treatment of non-insulin-dependent diabetes mellitus. Int J Sports Med. 1997;18(4):242-246. doi:10.1055/s-2007-972627. PMID: 9231838. https://doi.org/10.1055/s-2007-972627 21. Cuff DJ, Meneilly GS, Martin A, Ignaszewski A, Tildesley HD, Frohlich JJ. Effective exercise modality to reduce insulin resistance in women with type 2 diabetes. Diabetes Care. 2003;26(11):2977-2982. doi:10.2337/diacare.26.11.2977. PMID: 14578226. https://doi.org/10.2337/diacare.26.11.2977 22. Bucci M, Huovinen V, Guzzardi MA, et al. Resistance training improves skeletal muscle insulin sensitivity in elderly offspring of overweight and obese mothers. Diabetologia. 2016;59(1):77-86. doi:10.1007/s00125-015-3780-8. PMID: 26486356. https://doi.org/10.1007/s00125-015-3780-8 23. Mavros Y, Kay S, Anderberg KA, et al. Changes in insulin resistance and HbA1c are related to exercise-mediated changes in body composition in older adults with type 2 diabetes: interim outcomes from the GREAT2DO trial. Diabetes Care. 2013;36(8):2372-2379. doi:10.2337/dc12-2196. PMID: 23474589. https://doi.org/10.2337/dc12-2196 24. Janssen I, Heymsfield SB, Wang ZM, Ross R. Skeletal muscle mass and distribution in 468 men and women aged 18-88 yr. J Appl Physiol (1985). 2000;89(1):81-88. doi:10.1152/jappl.2000.89.1.81. PMID: 10904038. https://doi.org/10.1152/jappl.2000.89.1.81 25. Orwoll ES, Peters KE, Hellerstein M, Cummings SR, Evans WJ, Cawthon PM. The importance of muscle versus fat mass in sarcopenic obesity: a re-evaluation using D3-creatine muscle mass versus DXA lean mass measurements. J Gerontol A Biol Sci Med Sci. 2020;75(7):1362-1368. doi:10.1093/gerona/glaa064. PMID: 32232396. https://doi.org/10.1093/gerona/glaa064 26. Holten MK, Zacho M, Gaster M, Juel C, Wojtaszewski JFP, Dela F. Strength training increases insulin-mediated glucose uptake, GLUT4 content, and insulin signaling in skeletal muscle in patients with type 2 diabetes. Diabetes. 2004;53(2):294-305. doi:10.2337/diabetes.53.2.294. PMID: 14747278. https://doi.org/10.2337/diabetes.53.2.294 27. Manca A, Dragone D, Dvir Z, Deriu F. Cross-education of muscular strength following unilateral resistance training: a meta-analysis. Eur J Appl Physiol. 2017;117(11):2335-2354. doi:10.1007/s00421-017-3720-z. PMID: 28936703. https://doi.org/10.1007/s00421-017-3720-z 28. Bilet L, Phielix E, van de Weijer T, et al. One-leg inactivity induces a reduction in mitochondrial oxidative capacity, intramyocellular lipid accumulation and reduced insulin signalling upon lipid infusion. Diabetologia. 2020;63(6):1211-1222. doi:10.1007/s00125-020-05128-1. PMID: 32185462. https://doi.org/10.1007/s00125-020-05128-1 29. Lee J, Kim D, Kim C. Resistance training for glycemic control, muscular strength, and lean body mass in old type 2 diabetic patients: a meta-analysis. Diabetes Ther. 2017;8(3):459-473. doi:10.1007/s13300-017-0258-3. PMID: 28382531. https://doi.org/10.1007/s13300-017-0258-3 30. Goodpaster

    Is Obesity A Muscle Problem?

  8. Aug 27

    Who Needs Testosterone, and Who's Not Getting It I Signal Episode 4

    Most men who start testosterone never needed it, and some who genuinely do never get treated. In the final episode of the Signal series, Dr. Jordan Feigenbaum and Dr. Austin Baraki work through who actually needs testosterone replacement, who got sold it, and what the evidence says about the risks that scared the field for a decade. We cover the blinded trial where men couldn't tell real testosterone from placebo, what the heart and prostate data actually show now that we have the trials, what testosterone does to fertility, and the framework we use to decide. We also close the story of Mark, the patient whose lab result started the series. This is educational content, not medical advice. Talk to your physician about your personal situation. Here we cover the real diagnosis of testosterone deficiency, primary versus secondary low testosterone, how the system both over- and under-prescribes, the SHBG trap that makes a normal level look low, the gray-zone crossover study, what replacement should actually target, why most men quit within a year, testosterone as a male contraceptive, the TRAVERSE cardiovascular results, the saturation model and prostate safety, the blood side effect worth monitoring, and when not to start at all. Timestamps: 00:00 The study almost nobody mentions 01:31 Who this episode is for 03:35 What a real testosterone diagnosis requires 07:18 Primary vs secondary low testosterone 10:12 How testosterone gets over-prescribed 11:35 The SHBG trap: when a low number misleads 18:10 Would GLP-1 plus testosterone work better? 22:19 Why genuine deficiency gets under-treated 24:15 The cardiovascular scare and where it came from 34:11 The gray-zone study, in full 41:02 What TRT should actually target, and the "900" myth 47:38 Running TRT as a trial, and why 70% quit 52:36 Testosterone as a contraceptive: the fertility cost 57:19 Does TRT cause heart problems? The TRAVERSE trial 01:01:40 Testosterone and the prostate 01:09:13 The blood side effect worth watching 01:12:02 When not to start testosterone 01:14:26 Who actually benefits from TRT 01:18:28 The Signal framework, and what happened to Mark 01:21:14 Five things to take away 01:23:33 Our conflict of interest, and the bookResources: Buy the book, Signal: https://www.barbellmedicine.com/shop/learning/signal/ Part 1: Is the testosterone crisis real?Part 2: Is you testosterone actually low?Part 3: What's actually driving your testosterone down? New Barbell Medicine Hybrid 5K and 10K Run + Lift Programs Barbell Medicine coaching and templates: https://www.barbellmedicine.com Testosterone Action Plan: https://www.barbellmedicine.com/testosterone-action-plan/  Mulligan T, Frick MF, Zuraw QC, Stemhagen A, McWhirter C. Prevalence of hypogonadism in males aged at least 45 years: the HIM study. Int J Clin Pract. 2006;60(7):762-769. doi:10.1111/j.1742-1241.2006.00992.xBaillargeon J, Urban RJ, Ottenbacher KJ, Pierson KS, Goodwin JS. Trends in androgen prescribing in the United States, 2001-2011. JAMA Intern Med. 2013;173(15):1465-1466. doi:10.1001/jamainternmed.2013.6895Bhasin S, Brito JP, Cunningham GR, et al. Testosterone therapy in men with hypogonadism: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2018;103(5):1715-1744. doi:10.1210/jc.2018-00229Mulhall JP, Trost LW, Brannigan RE, et al. Evaluation and management of testosterone deficiency: AUA guideline. J Urol. 2018;200(2):423-432. doi:10.1016/j.juro.2018.03.115Corona G, Goulis DG, Huhtaniemi I, et al. European Academy of Andrology (EAA) and European Society of Endocrinology (ESE) recommendations on the diagnosis and management of male hypogonadism. Andrology. 2020;8(5):970-987. doi:10.1111/andr.12770Morgentaler A, Zitzmann M, Traish AM, et al. Commentary: who is a candidate for testosterone therapy? A synthesis of international expert opinions. J Sex Med. 2014;11(7):1636-1645. doi:10.1111/jsm.12546Mok SF, Fennell C, Savkovic S, et al. Testosterone for androgen deficiency-like symptoms in men without pathologic hypogonadism: a randomized, placebo-controlled cross-over with masked choice extension clinical trial. J Gerontol A Biol Sci Med Sci. 2020;75(9):1723-1731. doi:10.1093/gerona/glz195Clift AK, Johnson H, Huang DR, Morgentaler A. Real-world outcomes and safety of testosterone therapy: a longitudinal, retrospective cohort study of over 9,000 men. World J Mens Health. 2026;44(2):438-450. doi:10.5534/wjmh.250245Malik RD, Wang CE, Lapin B, Lakeman JC, Helfand BT. Characteristics of men undergoing testosterone replacement therapy and adherence to follow-up recommendations in a metropolitan multicenter health care system. Urology. 2015;85(6):1382-1388. doi:10.1016/j.urology.2015.01.027Donatucci C, Cui Z, Fang Y, Muram D. Long-term treatment patterns of testosterone replacement medications. J Sex Med. 2014;11(8):2092-2099. doi:10.1111/jsm.12608Saad F, Aversa A, Isidori AM, Zafalon L, Zitzmann M, Gooren L. Onset of effects of testosterone treatment and time span until maximum effects are achieved. Eur J Endocrinol. 2011;165(5):675-685. doi:10.1530/EJE-11-0221Ly LP, Liu PY, Handelsman DJ. Rates of suppression and recovery of human sperm output in testosterone-based hormonal contraceptive regimens. Hum Reprod. 2005;20(6):1733-1740. doi:10.1093/humrep/deh834Liu PY, Swerdloff RS, Christenson PD, Handelsman DJ, Wang C; Hormonal Male Contraception Summit Group. Rate, extent, and modifiers of spermatogenic recovery after hormonal male contraception: an integrated analysis. Lancet. 2006;367(9520):1412-1420. doi:10.1016/S0140-6736(06)68614-5Ko EY, Siddiqi K, Brannigan RE, Sabanegh ES Jr. Empirical medical therapy for idiopathic male infertility: a survey of the American Urological Association. J Urol. 2012;187(3):973-978. doi:10.1016/j.juro.2011.10.137Kohn TP, Louis MR, Pickett SM, et al. Age and duration of testosterone therapy predict time to return of sperm count after human chorionic gonadotropin therapy. Fertil Steril. 2017;107(2):351-357.e1. doi:10.1016/j.fertnstert.2016.10.004Wenker EP, Dupree JM, Langille GM, et al. The use of HCG-based combination therapy for recovery of spermatogenesis after testosterone use. J Sex Med. 2015;12(6):1334-1337. doi:10.1111/jsm.12890Basaria S, Coviello AD, Travison TG, et al. Adverse events associated with testosterone administration. N Engl J Med. 2010;363(2):109-122. doi:10.1056/NEJMoa1000485Vigen R, O’Donnell CI, Barón AE, et al. Association of testosterone therapy with mortality, myocardial infarction, and stroke in men with low testosterone levels. JAMA. 2013;310(17):1829-1836. doi:10.1001/jama.2013.280386Basaria S, Harman SM, Travison TG, et al. Effects of testosterone administration for 3 years on subclinical atherosclerosis progression in older men with low or low-normal testosterone levels: a randomized clinical trial. JAMA. 2015;314(6):570-581. doi:10.1001/jama.2015.8881Budoff MJ, Ellenberg SS, Lewis CE, et al. Testosterone treatment and coronary artery plaque volume in older men with low testosterone. JAMA. 2017;317(7):708-716. doi:10.1001/jama.2016.21043Lincoff AM, Bhasin S, Flevaris P, et al. Cardiovascular safety of testosterone-replacement therapy. N Engl J Med. 2023;389(2):107-117. doi:10.1056/NEJMoa2215025Huggins C, Hodges CV. Studies on prostatic cancer. I. The effect of castration, of estrogen and of androgen injection on serum phosphatases in metastatic carcinoma of the prostate. Cancer Res. 1941;1(4):293-297.Morgentaler A, Traish AM. Shifting the paradigm of testosterone and prostate cancer: the saturation model and the limits of androgen-dependent growth. Eur Urol. 2009;55(2):310-320. doi:10.1016/j.eururo.2008.09.024Khera M, Crawford D, Morales A, Salonia A, Morgentaler A. A new era of testosterone and prostate cancer: from physiology to clinical implications. Eur Urol. 2014;65(1):115-123. doi:10.1016/j.eururo.2013.08.015Bhasin S, Lincoff AM, Nissen SE, et al. Prostate safety events during testosterone replacement therapy in men with hypogonadism: a randomized clinical trial. JAMA Netw Open. 2023;6(12):e2348692. doi:10.1001/jamanetworkopen.2023.48692Snyder PJ, Bhasin S, Cunningham GR, et al. Effects of testosterone treatment in older men. N Engl J Med. 2016;374(7):611-624. doi:10.1056/NEJMoa1506119 Our Sponsors: * Check out Cometeer and use my code BBM for a great deal: https://www.cometeer.com * Check out FIGS and use my code FIGSRX 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 BBM for a great deal: https://www.quince.com * Check out Ten Thousand and use my code PODCAST15 for a great deal: https://www.tenthousand.cc Advertising Inquiries: https://redcircle.com/brands

    Who Needs Testosterone, and Who's Not Getting It I Signal Episode 4
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