Female Athlete Health, RED-S and the Research Gap in Women’s Sport with Dr Kate Ackerman

Female Athlete Health, RED-S and the Research Gap in Women’s Sport with Dr Kate Ackerman

Female athlete health is often discussed in extremes: either physiology is underplayed, or every difference gets turned into a rule. This conversation sits in the middle, where evidence, clinical context and nuance matter. In this episode of Stronger With Time, Tony speaks with Dr Kathryn “Kate” Ackerman, a former elite rower, sports medicine physician, endocrinologist and leading researcher in female athlete health. Kate’s work sits at the intersection of sport, medicine, endocrinology and performance. She explains how her own experience as an athlete shaped her career, why the data gap in female athletes still matters, and how better research can improve both health and performance. Tony and Kate discuss RED-S, low energy availability, menstrual dysfunction, bone stress injuries, fueling, carbohydrate availability, hormone therapy, menopause, and how to think about female athlete health without turning every difference into a rule. They also explore the nuance often missing from online discussions: not every calorie deficit is RED-S, not every female athlete needs a bespoke training plan based on physiology alone, and the goal is not to create fear, but to understand what the evidence can and cannot tell us. In this episode, they cover: * The evolution from the Female Athlete Triad to RED-S * What low energy availability means, and when it becomes a problem * Why RED-S requires clinical nuance, not just symptom counting * Screening tools, clinical markers and medical context * Bone stress injuries, DEXA, HR-pQCT and delayed bone recovery * Transdermal estrogen, oral contraceptives and bone health in amenorrheic athletes * Adolescent athletes, loading, fueling, calcium, vitamin D and stress injury risk * Carbohydrate availability, meal timing and recovery * Menopause, HRT and the gaps still left in women’s health research * Why female physiology matters, without turning everything into a sex-specific rule This conversation is for coaches, clinicians, female athletes, parents of young athletes, and active women who want a clearer, evidence-informed understanding of female athlete health. Resources: WHSP Institute: https://whspinstitute.org/ [https://whspinstitute.org/?utm_source=chatgpt.com]WHSP Medical: https://www.whspmedical.com/ [https://www.whspmedical.com/]Dr Kate Ackerman bio: https://www.whspmedical.com/dr-kate-ackerman [https://www.whspmedical.com/dr-kate-ackerman?utm_source=chatgpt.com]IOC REDs CAT2 / BJSM article: https://bjsm.bmj.com/content/57/17/1068 [https://bjsm.bmj.com/content/57/17/1068?utm_source=chatgpt.com]Dr Kate Ackerman Instagram: https://www.instagram.com/drkateackerman/ [https://www.instagram.com/drkateackerman/]WHSP Institute Instagram: https://www.instagram.com/whsp_institute/ [https://www.instagram.com/whsp_institute/?utm_source=chatgpt.com] Tony’s website: https://tonyboutagy.com/ [https://tonyboutagy.com/?utm_source=chatgpt.com]Tony Instagram: https://www.instagram.com/tonyboutagy/ [https://www.instagram.com/tonyboutagy/?utm_source=chatgpt.com] All content is for general educational purposes only and is not intended as medical advice.

Hypertrophy Research in Practice: What Matters for Muscle Growth

Hypertrophy advice can become confusing fast. Different studies, different coaches, different physiological models and different claims online can point to slightly different answers. Sets, reps, frequency, failure, soreness, exercise selection and periodisation are all debated, often with more certainty than the evidence allows. In this episode of Stronger With Time, Tony brings together close to four hours of conversations with leading hypertrophy researchers and turns them into a practical framework for coaches and serious lifters. Across the series, Tony explored muscle hypertrophy through three lenses: the history of strength and hypertrophy training with Professor William Kraemer, the molecular and mechanistic side of muscle growth with Professor Michael Roberts, and practical programming decisions with Dr Eric Helms. This episode is the synthesis. Tony distills the key takeaways into what current evidence suggests about how muscle grows, which variables deserve the most attention, and how that translates into real-world program design. In this episode, we discuss: * The three main worldviews coaches use to program hypertrophy * Why outcome-based research can be difficult to apply directly to long-term training * What muscle hypertrophy is, including radial and longitudinal growth * Why mechanical tension sits at the centre of current hypertrophy thinking * Where DOMS, “the burn” and acute hormonal spikes fit in * Minimalist vs maximalist approaches to training volume * Why no single exercise can train every fibre within a complex muscle group * Practical implications for pec, delt and glute exercise selection * Training frequency, weekly sets and proximity to failure * How to think about drop sets, supersets, rest intervals and rep ranges * Periodisation, fatigue management and training at longer muscle lengths Who this is for: * Coaches, PTs and S&C coaches programming hypertrophy for clients or athletes * Serious lifters who want their training aligned with current evidence, not trends * Practitioners who care about long-term strength, muscle and joint health * Gym owners who want clear hypertrophy principles their teams can apply consistently About Dr Tony Boutagy: Dr Tony Boutagy is an exercise scientist and strength coach with over 30 years of in-the-trenches experience. He is known for bridging hypertrophy and strength research with real-world programming for athletes, general population clients and serious lifters, with a focus on sustainable strength, hypertrophy and conditioning grounded in solid science. About Stronger With Time: Stronger With Time is Tony’s podcast on evidence-informed strength, hypertrophy and conditioning across the lifespan, helping coaches and lifters turn complex research into practical training decisions. Resources: Advanced Program MasteryTony’s course on long-term program design, periodisation and building training systems that get clients results across years, not weeks: https://tonyboutagy.com/advanced-program-mastery-course-page Fat Loss FundamentalsTony’s course on designing fat loss phases that preserve muscle, manage energy availability and produce results that hold: https://tonyboutagy.com/fat-loss-fundamentals-course-page Follow Tony on Instagram: @tonyboutagy All content is for general educational purposes only and is not intended as medical advice.

How to Program for Hypertrophy: Volume, Frequency & Exercise Selection (with Dr Eric Helms - Part 2)

Hypertrophy programming comes back to a few practical decisions: how close to failure, how much volume, how often, and how much variety. In this episode, I speak with Dr Eric Helms about how to make those decisions with better judgment, and where popular models claim more than the evidence supports. Dr Helms is a PhD researcher in strength and hypertrophy, a coach of physique and strength athletes, and a high-level natural bodybuilder. In Part 1, we discussed how to think about training advice when coaches, research, and physiology models do not point in the same direction. In this episode, we apply that thinking to programming. Some of what we discuss: * How close to failure you actually need to train, and when it matters more or less * Why “only the last 5 reps count” doesn’t hold up * Why estimating reps in reserve gets harder at higher reps * How much volume to use, and how frequency changes that decision * Why fatigue matters, but may be overweighted in programming decisions * Variety vs variation, and why hypertrophy may not need strength-style periodisation * Where drop sets, rest-pause, and myo-reps actually fit, as time-saving tools rather than superior methods Who this is for: Coaches programming hypertrophy for general population or athletes, and experienced lifters trying to make defensible decisions about failure, volume, frequency, and exercise selection without chasing every new trend. Guest and Resources Dr Eric Helms3D Muscle Journey: https://www.3dmusclejourney.com/about/ [https://www.3dmusclejourney.com/about/]The Muscle and Strength Pyramids: https://muscleandstrengthpyramids.com/ [https://muscleandstrengthpyramids.com/]Research profile: https://www.researchgate.net/profile/Eric-Helms-2 [https://www.researchgate.net/profile/Eric-Helms-2]MASS Research Review: https://massresearchreview.com/about-us-2/ [https://massresearchreview.com/about-us-2/] Host: Dr Tony Boutagy Exercise scientist and coach translating exercise science into practical training and programming decisions.Instagram: @tonyboutagyCourses, seminars, and resources: https://tonyboutagy.com/ [https://tonyboutagy.com/]

How To Think About Training Advice (with Dr Eric Helms – Part 1)

If you coach or train seriously, you have probably had to weigh different sources of training advice against each other. A successful coach recommends one approach. A research paper seems to suggest another. A physiology-based explanation points somewhere else. In this episode, I speak with Dr Eric Helms about how to think through those conflicts without becoming dogmatic about any one source. Dr Helms is a PhD researcher in strength and hypertrophy, a coach of physique and strength athletes, and a high-level natural bodybuilder. Some of what we discuss: * Why success leaves clues, not answers * What we can and can’t learn from successful athletes and coaches * Why individual hypertrophy studies can seem to conflict * How to use reviews and position stands without outsourcing your judgement * When physiology-based explanations sound more certain than the evidence allows This is the first part of a longer conversation with Eric. The second part moves further into the practical programming questions. Guest and Resources Dr Eric Helms * 3D Muscle Journey: https://www.3dmusclejourney.com/about/ [https://www.3dmusclejourney.com/about/?utm_source=chatgpt.com] * The Muscle and Strength Pyramids: https://muscleandstrengthpyramids.com/ [https://muscleandstrengthpyramids.com/?utm_source=chatgpt.com] * Research profile: https://www.researchgate.net/profile/Eric-Helms-2 [https://www.researchgate.net/profile/Eric-Helms-2?utm_source=chatgpt.com] Resources mentioned: * Stark Center for Physical Culture and Sports: https://starkcenter.org/ [https://starkcenter.org/?utm_source=chatgpt.com] * Iron Game History journal: https://starkcenter.org/research/iron-game-history [https://starkcenter.org/research/iron-game-history?utm_source=chatgpt.com] Host: Dr Tony BoutagyExercise scientist and coach translating exercise science into practical training and programming decisions.Instagram: @tonyboutagyCourses, seminars, and resources: https://tonyboutagy.com/ [https://tonyboutagy.com/]

The Science of Muscle Growth - and What It Means in Practice, with Professor Michael Roberts

Every programme rests on some idea of what drives muscle growth. This episode looks at where the molecular and applied research supports that thinking - and where it does not. Professor Michael Roberts is a professor at Auburn University and one of the world's leading researchers on skeletal muscle hypertrophy, with a laboratory spanning cell culture, rodent models, and applied human research. In this episode, you will learn: * What is happening inside a muscle cell when it grows * Why mechanical tension appears to be central to hypertrophy * What the evidence shows about testosterone and the androgen receptor in muscle * Why women with much lower testosterone than men can still make similar relative gains with resistance training * Where the evidence lands on rep ranges and weekly set volume * Why drop sets are unlikely to add much once sufficient tension and volume are already in place * What sarcoplasmic hypertrophy is, and when it may occur * Why recent research suggests muscle fibres may grow by adding more myofibrils, not just by making existing ones bigger Key insight: Consistent mechanical tension, applied through a moderate rep range and sufficient weekly volume, appears to be a central driver of hypertrophy. The more complex the technique, the less likely it is to add much on top of that foundation. Resources & Links Dr. Tony Boutagy - https://tonyboutagy.com [https://tonyboutagy.com] Follow on Instagram - https://www.instagram.com/tonyboutagy/ [https://www.instagram.com/tonyboutagy/] Professor Michael Roberts - https://education.auburn.edu/directory/profile.php?id=mdr0024 [https://education.auburn.edu/directory/profile.php?id=mdr0024]Molecular and Applied Sciences Laboratory - https://education.auburn.edu/kinesiology/research/molecular-applied-sciences/index.php [https://education.auburn.edu/kinesiology/research/molecular-applied-sciences/index.php]Roberts Lab eLife paper on myofibril adaptations - https://elifesciences.org/articles/92674 [https://elifesciences.org/articles/92674]