Muscle strength and hormones

One of the longstanding rationales for testosterone supplementation is that it is believed to be essential for maintaining (or recovering) muscle mass and strength. It's also often been denied by the doctors of the "menopause only means hot flashes" school of thought that the sometimes crushing and always annoying fatigue and muscle weakness experienced by women post-oophorectomy has anything to do with their hormonal status.

But now, "Mechanisms Behind Estrogen's Beneficial Effect on Muscle Strength in Females" (free signup required to read) looks very closely into this situation from the standpoint of the physiology and reaches some conclusions that may surprise you.

Why is this important? Because physiology is difficult to write off to "oh, you're just not adjusting well to your surgery" or other blame-the-woman rejections.

This is an extremely well-written and readable report, even though the biochemistry of it may make your eyes glaze over at times. Still, it's worth it to understand their points—which you can do even if some of the terms may not mean much to you.

Basically, they are finding that the fundamental chemical responsiveness mechanism of muscle fibers is not only weakened (in strength) by estrogen deprivation but that estrogen restoration reverses this.

This linkage between fatigue/weakness and hormone levels is in keeping, of course, with women's experiential knowledge, but doctors are trained to reject this as "anecdotal" in favor of "evidence-based knowledge." Research is, by definition, evidence-based. That doesn't mean that your doctor won't reject any research that isn't covered in the headlines on CNN, but it's a step up the ladder.

And yes, much of what is being studied & reported in this particular article is rat-based. But in such fundamental processes, rat physiology is very much predictive of human function and it is extremely unlikely that a basic muscle fiber process would differ in humans: it's a whole different order of magnitude from the less-useful animal studies that purport to "prove" that some hormone variant "prevents" cancer. None of this is subjective: it's not anyone "feeling better" but rather specific measurable functions registering differently before and after addition of estrogen.

While the study conclusions note the pertinence expanding upon their findings might have for things like osteoporosis and, interestingly, cardiac muscle disease, we women in menopause are more likely to grasp the implications for simple daily wellbeing. Just as joint aches are well within documented effects of estrogen deficiency, so now we can point to estrogen when we are overwhelmed with weakness without having to reach first for such complex diagnoses as fibromyalgia.

But wait: what about testosterone? We've been over the interplay between these two hormones in metabolic interchangeability elsewhere and it's up to each woman to decide how and with what she chooses to supplement. What we feel this represents is solid, defensible support for the experience of muscle weakness in surgical menopause as being reversible with estrogen supplementation. For those women who feel their estrogen needs are already well met, fine: go on to consider testosterone. But for those women who count weakness in their unmet needs, this provides both solid validation of an association with their estrogen supplementation and supports a means of alleviating it, in a form that, shared with your doctor, might help educate him in this relationship.