The Dr. Gabrielle Lyon Show

Most patients are told one thing before surgery: stop all supplements. Duke surgeon Dr. Rebecca Knackstedt says that advice is often wrong – and that what you do in the days before surgery changes how you heal. In this episode: how much protein to eat (no standard exists, and most women get half of what they need), why surgery is catabolic and muscle is your reserve, the night-before carb loading trick that reduces pain, and the 5 day window that lowers complications and even mortality.
Dr. Knackstedt is a plastic and reconstructive microsurgeon on faculty at Duke, an MD-PhD researcher and a certified functional medicine provider whose research focuses on surgical prehabilitation, preparing the body, mind and home before surgery the way we already do rehab after it. She and Dr. Lyon cover what prehab looks like for any operation, the labs she checks, which supplements to keep and which to stop (omega-3s do not increase bleeding), why bed rest is over, hormones after breast cancer, why mammograms still beat thermography, what chemo does to metabolism, and the questions to ask before you consent.
Connect with Dr. Knackstedt
Instagram → https://www.instagram.com/surgical_recovery/
Website → https://www.clararecovery.com/
Join the Menopause Challenge →
https://drgabriellelyon.com/menopause-challenge/
(Use Code: 25OFF for 25% off)

Sponsors
- Perfect Amino by BodyHealth, https://bit.ly/4wZgg6N, code LYON20 for 20% off your first order
- Timeline Mitopure → https://bit.ly/4x18cm5, for an extra 20% off
- Lola Blankets → lolablankets.com, code: DRLYON for 40% off select blankets (limited time)

Find Dr. Gabrielle Lyon at:
- Instagram: https://www.instagram.com/drgabriellelyon/
- TikTok: @drgabriellelyon
- Facebook: facebook.com/doctorgabriellelyon
- X: x.com/drgabriellelyon
- Apply to become a patient – https://drgabriellelyon.com/new-patient-inquiry/
- Weekly newsletter – https://institute-for-muscle-centric-medicine.ck.page
- Order my book – https://www.amazon.com/exec/obidos/ASIN/1668085623

Mentioned
- Dr. Jocelyn Wittstein on estrogen, joints and injury → https://youtu.be/ILyzNTjZTGI
- Menopause Is a Muscle Problem (solocast) → https://www.youtube.com/watch?v=OvK21cHM_RE
- 5 Protein Myths Your Doctor Is Still Repeating → https://youtu.be/cYtTRTwUzcs

Chapters:
00:00 Prehab saves lives and money — so why isn't it standard of care?
01:05 Meet Dr. Rebecca Knackstedt: Duke microsurgeon and functional medicine provider
05:35 The patient who changed everything — good surgery isn't enough
08:34 What prehab is, and the exercises to do before any surgery
12:14 Hormones after breast cancer, rising rates in young women, and real risk factors
18:42 Chemo, metabolic syndrome and why body composition matters
23:13 The end of bed rest, and the labs that matter before surgery
27:04 Mammograms vs. thermography, and absolute vs. relative risk
34:12 Protein before surgery: 2 g/kg, track 3 days, never under 100 g
38:43 Supplements to take — and why "stop all supplements" is wrong
44:40 Preparing the mind: anxiety, sleep, anesthesia depression, expectations
51:21 Red light, saunas, hyperbaric oxygen, wound vacs, scars and pain control
1:04:59 Surgery is catabolic: muscle as your glucose reserve
1:07:34 Carb loading, the 5-day window, probiotics and the surgery go-bag
1:14:15 Why prehab isn't standard of care yet — and why she's hopeful

Disclaimer: This podcast is for general informational purposes only and does not constitute medical advice or create a doctor–patient relationship. It is not a substitute for professional medical advice, diagnosis, or treatment. Do not disregard or delay seeking medical advice because of something you heard here.

Menopause is changing your body, but the part nobody talks about isn't hot flashes. It's muscle. Women lose lean mass fastest in perimenopause, the loss probably starts closer to 35, and no pill, patch or injection fixes it.

In this solocast, Dr. Gabrielle Lyon explains what estrogen, testosterone and FSH actually do to your metabolism, why a 50-year-old body can still build muscle, and the training and protein protocol to start now.

Join the Menopause Challenge →
https://drgabriellelyon.com/menopause-challenge/
[Use Code 25OFF through Sept 27]

Thank you to our sponsors:
- Rula, therapy covered by insurance → rula.com/drlyon

Find Dr. Gabrielle Lyon at:
- Instagram: https://www.instagram.com/drgabriellelyon/
- TikTok: @drgabriellelyon
- Facebook: facebook.com/doctorgabriellelyon
- YouTube: youtube.com/@DrGabrielleLyon
- X (Twitter): x.com/drgabriellelyon
- Apply to become a patient – https://drgabriellelyon.com/new-patient-inquiry/
- Join my weekly newsletter – https://institute-for-muscle-centric-medicine.ck.page
- Pre-order my new book - https://www.amazon.com/exec/obidos/ASIN/1668085623

Chapters:
00:00 Menopause is changing your body — but it doesn't have to change your life
00:59 The suitcase story: today is about muscle, not hot flashes
01:47 Hormone therapy, yes or no? Why that's the wrong first question
03:36 What menopause is, when it arrives, and 40% of your life after it
04:37 When lean mass really starts to fall — and why testing misses it
06:46 Testosterone vs. estrogen: no two women go through it the same way
08:40 Anabolic resistance: why the muscle-building switch gets sticky
10:31 Estrogen, joints and injury risk (Dr. Jocelyn Wittstein)
13:27 Less muscle, nowhere to put carbs: the lean prediabetic patient
14:19 Falls, fractures, heart disease, and muscle as an early bone signal
16:14 Visceral fat, energy expenditure, fat oxidation and FSH
18:02 Test your blood — and pull the levers you control
19:00 The starting protocol: 2–3 days a week and the movements to keep
20:30 Menopause changes your body, not your life — the Menopause Challenge

Mentioned
- Dr. Jocelyn Wittstein on estrogen, joints and injury risk → https://youtu.be/ILyzNTjZTGI
- Juliet & Dr. Kelly Starrett on floor sitting and mobility → https://youtu.be/QOjzh-711Q0
- SWAN (Study of Women's Health Across the Nation)
- The Lancet Diabetes & Endocrinology review on lean mass and chronic disease
- ESCEO guidance on muscle and bone

Disclaimers: This episode includes paid sponsorships. The Dr. Gabrielle Lyon Podcast and YouTube are for general information purposes only and do not constitute the practice of medicine, nursing, or other professional health care services, including the giving of medical advice, and no doctor/patient relationship is formed. The use of information on this podcast, YouTube, or materials linked from this podcast or YouTube is at the user's own risk. The content of this podcast is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Users should not disregard or delay in obtaining medical advice for any medical condition they may have and should seek the assistance of their health care professional for any such conditions.

Your testosterone number matters at every age, but most men never learn what theirs should be. Mayo Clinic urologist Dr. Tobias Kohler explains why ~500 is the target, why 1,000 is already running hot, what 2,000+ does to the heart, and why a randomized trial found lifting without steroids beat steroids without lifting. Plus: the blood test that catches heart risk your cholesterol panel misses.

Dr. Kohler returns for his second appearance (his first, on erections, testosterone and muscle mass, is one of the most-watched episodes in the show's history). This time: why men's longevity is roughly 50 years behind women's; the Princeton IV consensus he co-chaired, which treats ED as one of the strongest predictors of a future heart attack and points young men toward a coronary calcium scan; the 0–12 ceramide blood test that changes with your behavior; how to get a testosterone baseline that actually means something; what redlining to 2,000–3,000 does to the heart, the set point and the skin; Peyronie's disease, Viagra vs. Cialis, the pills-to-implant ladder, sexual rehab after prostate surgery, and a patient who got stronger with zero testosterone.

In this episode:
- Why ED is a blood-flow problem "until proven otherwise," and who needs a calcium score
- The ceramide test: what it measures and the score that sends you to a cardiologist
- Statins, LDL goals and testosterone
- Baseline T at 25, the ~500 target, why 1,000 runs hot
- The 1980s trial: exercise vs. high-dose testosterone vs. both
- Tolerance, the new set point, and the irreversible side effects
- Trading obesity for sarcopenia in the GLP-1 era
- Peyronie's disease: not cancer, not an STD
- Pills, shots and implants; what 90–95% satisfaction means
- Penile rehab after prostatectomy

About Dr. Tobias Kohler
Tobias S. Kohler, MD, MPH, is Professor of Urology at Mayo Clinic, a fellowship-trained andrologist with 25+ years of clinical and surgical experience and 250+ peer-reviewed publications. He co-chaired the Princeton IV Consensus Guidelines on ED and cardiovascular disease, co-founded the EROS penile implant registry, and co-edited Contemporary Treatment of Erectile Dysfunction (2nd ed.).

Dr. Kohler's first episode → https://youtu.be/__xtrUa3Dck
Clip: Why Every Man Should Prioritize Muscle Mass → https://youtu.be/PgBntuDnzTQ

Chapters:
00:00 Men are dying earlier — the penis is the check-engine light
02:01 Men's longevity is "50 years behind"
03:26 Boys stop seeing doctors — the Office of Men's Health
09:09 Princeton IV: ED predicts heart attacks; calcium scans; Cialis
10:46 The ceramide blood test your cholesterol panel can't replace
15:19 Ceramides, muscle, and knowing if your exercise works
20:51 Statins, testosterone, and your LDL goal
24:01 GLP-1s and "what's the risk of doing nothing?"
25:32 Testosterone: ~500 target, 1,000 too hot, 2,000+ and the heart
28:49 Check your T at 25 — but only if you feel good
29:19 Why steroids won't make you a pro athlete
31:52 Tolerance and the set point redlined men can't escape
35:18 The trial: lifting without steroids beat steroids without lifting
38:58 Steroid cocktails, arrhythmias, WrestleMania mortality
42:42 Irreversible side effects
45:45 Obesity to sarcopenia in the GLP-1 generation
47:51 Peyronie's disease explained
50:53 Viagra vs. Cialis
52:20 Penile implants: the knee-replacement analogy
54:17 Pills, injections, surgery: how long each works
57:15 Sexual rehab after prostatectomy
1:01:08 Fertility and the questions to ask before cancer treatment
1:03:20 The patient who got stronger with zero testosterone

Find Dr. Gabrielle Lyon at:
- Instagram: https://www.instagram.com/drgabriellelyon/
- TikTok: @drgabriellelyon
- Facebook: facebook.com/doctorgabriellelyon
- X: x.com/drgabriellelyon
- Apply to become a patient – https://drgabriellelyon.com/new-patient-inquiry/
- Weekly newsletter – https://institute-for-muscle-centric-medicine.ck.page
- Pre-order my new book – https://www.amazon.com/exec/obidos/ASIN/1668085623

Disclaimer: This podcast is for general informational purposes only and does not constitute medical advice or create a doctor–patient relationship. It is not a substitute for professional medical advice, diagnosis, or treatment. Do not disregard or delay seeking medical advice because of something you heard here.

Your testosterone number matters at every age, but most men never learn what theirs should be. Mayo Clinic urologist Dr. Tobias Kohler explains why ~500 is the target, why 1,000 is already running hot, what 2,000+ does to the heart, and why a randomized trial found lifting without steroids beat steroids without lifting. Plus: the blood test that catches heart risk your cholesterol panel misses.
Dr. Kohler returns for his second appearance (his first, on erections, testosterone and muscle mass, is one of the most-watched episodes in the show's history). This time: why men's longevity is roughly 50 years behind women's; the Princeton IV consensus he co-chaired, which treats ED as one of the strongest predictors of a future heart attack and points young men toward a coronary calcium scan; the 0–12 ceramide blood test that changes with your behavior; how to get a testosterone baseline that actually means something; what redlining to 2,000–3,000 does to the heart, the set point and the skin; Peyronie's disease, Viagra vs. Cialis, the pills-to-implant ladder, sexual rehab after prostate surgery, and a patient who got stronger with zero testosterone.

About Dr. Tobias Kohler
Tobias S. Kohler, MD, MPH, is Professor of Urology at Mayo Clinic, a fellowship-trained andrologist with 25+ years of clinical and surgical experience and 250+ peer-reviewed publications. He co-chaired the Princeton IV Consensus Guidelines on ED and cardiovascular disease, co-founded the EROS penile implant registry, and co-edited Contemporary Treatment of Erectile Dysfunction (2nd ed.).

🙌 Thank you to our sponsors:
Cozy Earth - Get 20% off at https://bit.ly/3RLZNEv
Egg Life - https://bit.ly/4yxBs5l
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📺 Watch the “Dr. Gabrielle Lyon Show” every Tuesday at 9AM EST:
YouTube: https://bit.ly/4boCFC3
Spotify: https://bit.ly/4cWTbLG

📱 Connect with Dr. Gabrielle Lyon:
Instagram: https://bit.ly/4uk9adc
TikTok: https://bit.ly/3OFK3kJ
X.com: https://bit.ly/4l3YlaX
Facebook: https://bit.ly/3MBrJso
LinkedIn: https://bit.ly/3N1nrdL
Website: https://bit.ly/3NdV2kT
Books: https://bit.ly/4r6ugZK
Newsletter: https://bit.ly/402QCAj

⏰Chapters
00:00 Men are dying earlier than women the penis is the check-engine light
03:26 Boys stop seeing doctors for 20 years the case for an Office of Men's Health
10:57 Princeton IV: ED predicts heart attacks, calcium scans, and Cialis
12:44 The ceramide blood test your cholesterol panel can't replace
20:37 Cardiac risk calculators, statins, and what your LDL should be
25:38 GLP-1s, fertility, and "what's the risk of doing nothing?"
29:05 Testosterone: the ~500 target, why 1,000 runs hot, what 2,000+ does to the heart
31:44 Check your testosterone at 25 and why steroids won't make you a pro
36:57 Tolerance and the new set point redlined men can't escape
38:13 The 1980s trial: lifting without steroids beat steroids without lifting
42:06 Steroid cocktails, arrhythmias, irreversible side effects, and the sarcopenia trade-off
53:04 Peyronie's disease and Viagra vs. Cialis
57:32 Penile implants: the knee-replacement analogy and the pills-to-surgery ladder
1:02:27 Sexual rehab after prostatectomy and the questions to ask before cancer treatment
1:07:55 Closing: be proactive and the patient who got stronger with zero testosterone

Disclaimer: This podcast is for general informational purposes only and does not constitute medical advice or create a doctor–patient relationship. It is not a substitute for professional medical advice, diagnosis, or treatment. Do not disregard or delay seeking medical advice because of something you heard here.

You say "steroids" and picture a baseball scandal, a jacked guy, a bad spray tan. But cortisol is a steroid. Estrogen is a steroid. The cream you put on poison ivy is a steroid. The word covering all of them is also covering testosterone therapy for women, and that collision is quietly costing women muscle and bone they don't have to lose.
In this solo episode, prompted by a magazine interview on steroid use in women, Dr. Gabrielle Lyon breaks down what these molecules actually are, what they do inside a cell, and why the line between medicine and misuse has nothing to do with the word "steroid."

Study and References:
The Effects of Supraphysiologic Doses of Testosterone on Muscle Size and Strength in Normal Men (Bhasin et al., NEJM 1996) - https://pubmed.ncbi.nlm.nih.gov/8637535/
Testosterone Enhances Estradiol's Effects on Postmenopausal Bone Density and Sexuality (Davis et al., 1995) - https://pubmed.ncbi.nlm.nih.gov/7616872/
Global Consensus Position Statement on the Use of Testosterone Therapy for Women (2019) - https://pubmed.ncbi.nlm.nih.gov/31498...
ISSWSH Clinical Practice Guideline for the Use of Systemic Testosterone for HSDD in Women (2021) - https://pubmed.ncbi.nlm.nih.gov/33814...
The Global Epidemiology of Anabolic-Androgenic Steroid Use: A Meta-Analysis (Sagoe et al., 2014) - https://pubmed.ncbi.nlm.nih.gov/24582...
What Is the Prevalence of Anabolic-Androgenic Steroid Use Among Women? A Systematic Review (Piatkowski et al., Addiction, 2024) - https://onlinelibrary.wiley.com/doi/1... "
The Compounds for Females Are Really Commonly Faked!": Women's Challenges in Anabolic Steroid Acquisition (Piatkowski et al., Drug and Alcohol Review, 2024) - https://onlinelibrary.wiley.com/doi/1...

Explore More from Dr. Gabrielle Lyon:
Premium Podcast Subscription: Ad-free episodes, key takeaway summaries, exclusive Q&A, and behind-the-scenes content https://foreverstrong.supercast.com
Weekly newsletter: Recipes, podcast updates, and practical weekly insights https://drgabriellelyon.com/sign-up/
Apply to become a patient: Personalized care with Dr. Lyon's clinical team https://drgabriellelyon.com/new-patie...

📱 Connect with Dr. Gabrielle Lyon:
Instagram: https://bit.ly/4uk9adc
TikTok: https://bit.ly/3OFK3kJ
X.com: https://bit.ly/4l3YlaX
Facebook: https://bit.ly/3MBrJso
LinkedIn: https://bit.ly/3N1nrdL
Website: https://bit.ly/3NdV2kT
Books: https://bit.ly/4r6ugZK
Newsletter: https://bit.ly/402QCAj

📺 Watch the “Dr. Gabrielle Lyon Show” every Tuesday at 9AM EST:
YouTube: https://bit.ly/4boCFC3
Spotify: https://bit.ly/4cWTbLG
⏰ Chapters:
00:00 - Beginning
01:25 - Introduction: The Sister Who Says "Oh My Gosh, You're Taking Steroids" Why Medicine Needs a Shared Vocabulary
03:43 - What a Steroid Actually Is: Four Rings of Carbon
04:49 - Anabolic vs. Androgenic: Same Receptor, Different Effects
06:16 - A Brief History: From Wasting Disease to the Weight Room
08:59 - Restoring vs. Exceeding: Why the Range Is the Whole Game
11:38 - The Davis Trial: Testosterone, Bone Density, and Lean Mass
13:38 - Oral Compounds, the Liver, and Why Conversion Matters
14:20 - What Gets Sold Isn't What's Labeled: The Australian Drug-Checking Data
15:31 - The 1.6% vs. 4% Myth: Reading the Prevalence Data Correctly
18:33 - Why GLP-1s Are Pushing Women Toward Androgens
20:26 - Permanent Effects: Voice Changes and What the Literature Shows
21:33 - The Four Questions to Ask Before Any Androgen Conversation
24:25 - Closing: Entering the Sarcopenia Era
‼️ Disclaimer: The Dr. Gabrielle Lyon Podcast and YouTube are for general information purposes only and do not constitute the practice of medicine, nursing, or other professional health care services, including the giving of medical advice, and no doctor/patient relationship is formed. The use of information on this podcast, YouTube, or materials linked from this podcast or YouTube is at the user's own risk. The content of this podcast is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Users should not disregard or delay in obtaining medical advice for any medical condition they may have and should seek the assistance of their health care professional for any such conditions.