GLP-1s, Hormones, and Why You Can't Calorie-Count Your Way Out of Menopause with Dr. Michelle Gordon

In this episode of unPAUSED, Dr. Mary Claire Haver sits down with Dr. Michelle Gordon, a board certified obesity medicine physician and diplomate of the American College of Lifestyle Medicine, with surgical fellowships from the American College of Surgeons and the American College of Osteopathic Surgeons. Through her practice Thrive Span Medical, she works with midlife women across 39 states whose metabolic and hormonal symptoms have been dismissed as normal aging.

Dr. Gordon opens by dismantling the calories in, calories out framework, not as a vague wellness talking point but on a physiological level. She explains why biology determines the burn rate, why fat oxidation drops by 32% in perimenopause, why visceral fat accumulation accelerates when estrogen declines, and why insulin resistance and leptin resistance make it nearly impossible for midlife women to lose weight through willpower alone. She also covers how sleep deprivation compounds all of it, creating a cycle of cravings, brain fog, and weight gain that most women are navigating without any clinical support.

The conversation then moves into GLP-1 therapy, covering who is and is not a good candidate, the differences between semaglutide and tirzepatide and why women tend to tolerate tirzepatide better, how to dose safely and slowly, what informed consent should actually include, and why Dr. Gordon treats obesity as a chronic relapsing disease that requires long term management rather than a temporary fix. She also addresses weight regain after stopping GLP-1s, the SELECT trial and its cardiovascular findings, the anhedonia some patients experience on higher doses, and what the data actually shows about muscle loss.

Dr. Gordon and Dr. Haver also discuss the combination of GLP-1 therapy and hormone replacement therapy, including the studies showing women on HRT lose more weight on GLP-1s than on medication alone, and why the two together may represent the future of midlife metabolic care. They also cover protein intake, fiber, resistance training, and why these remain non-negotiable regardless of what medications a woman is taking.

Dr. Gordon closes the episode with a direct message to the women who have been dismissed, gaslit, and told to try harder: midlife weight gain is physiological and predictable, you are not broken, and help is available.

Guest links:

• Michelle E. Gordon, DO (LinkedIn)
  
• Dr. Michelle Gordon (Instagram)
  
• Dr. Gordon, Obesity Medicine (Substack)
  
• Dr. Michelle Gordon (Facebook)
  
• Dr. Michelle Gordon
  
• Dr. Michelle Gordon (TikTok)
  
• Dr. Michelle Gordon
  
• Dr. Michelle Gordon (YouTube)

Recommended Books:

• “The New Perimenopause: An Evidence-Based Guide to Surviving the Zone of Chaos and Feeling Like Yourself Again,” by Dr. Mary Claire Haver
  
• “The New Menopause,” by Dr. Mary Claire Haver
  
• "Weightless: A Doctor's Guide to GLP-1 Medications, Sustainable Weight Loss, and the Health You Deserve,” by Dr. Rocio Salas-Whalen

Articles:

• "Not feeling like myself" in perimenopause - what does it mean? Observations from the Women Living Better survey (Menopause)
  
• Surgical approach of weight regain after bariatric surgery (Digestive Medicine Research)
  
• OR09-08 Muscle Loss With Weight Loss Is Modulated by Age, Sex, and Protein Intake and May Affect Glucose Homeostasis in Adults With Obesity (Journal of the Endocrine Society)
  
• Tirzepatide for Obesity Treatment and Diabetes Prevention (New England Journal of Medicine)
  
• Once-Weekly Semaglutide in Adults with Overweight or Obesity (New England Journal of Medicine)
  
• Bone Health After Exercise Alone, GLP-1 Receptor Agonist Treatment, or Combination Treatment. A Secondary Analysis of a Randomized Clinical Trial (JAMA Network Open)
  
• Systematic review and meta-analysis of protein intake to support muscle mass and function in healthy adults (Journal of Cachexia, Sarcopenia and Muscle)
  
• Weight loss response to semaglutide in postmenopausal women with and without hormone therapy use (Menopause)
  
• Humoral immune response to COVID-19 vaccination in diabetes is age-dependent but independent of type of diabetes and glycaemic control: The prospective COVAC-DM cohort study (Diabetes, Obesity and Metabolism)
  
• Effect of Glucagon‐Like Peptide 1 Receptor Agonists on Patients With Rheumatoid Arthritis (ACR Open Rheumatology)
  
• Risk of Gastrointestinal Adverse Events Associated With Glucagon-Like Peptide-1 Receptor Agonists for Weight Loss (JAMA)
  
• Changes in Lean Mass, Absolute and Relative Muscle Strength, and Physical Performance After Gastric Bypass Surgery (Journal of Clinical Endocrinology and Metabolism)
  
• Obesity in the Elderly (EndoText)
  
• Semaglutide and Cardiovascular Outcomes in Obesity without Diabetes (New England Journal of Medicine)
  
• Weight regain and cardiometabolic effects after withdrawal of semaglutide: The STEP 1 trial extension (Diabetes, Obesity and Metabolism)

Other Resources:

• Tirzepatide reduced the risk of developing type 2 diabetes by 94% in adults with pre-diabetes and obesity or overweight (Eli Lilly News Release)
  
• People Who Don’t Lose Weight on Wegovy May Have Genetic Differences (Scientific American)
  
• Australian Longitudinal Study on Women’s Health (ALSWH)
  
• Women’s Health Initiative