8/27/26

Episode 33: Why Your Workouts Stopped Working (And What Actually Fixes It) with Dr. Carla DiGirolamo

Summary

You did the workout, you ate "clean,” and your body still isn't responding the way it used to. So what changed? In this episode, I sit down with Dr. Carla DiGirolamo, a double Board-Certified Obstetrician/Gynecologist and Reproductive Endocrinologist specializing in caring for active and high-performing women, to unpack what's really happening to active women's bodies in mid-life and beyond. 

We get into why hypothyroidism can be misdiagnosed because of chronic underfueling, what LEA and RED-S are (and why most doctors have never heard of them), hot takes on microdosing GLP-1s and muscle/bone loss for midlife women, and how HRT, testosterone therapy, and IUDs actually fit together. This isn't a decline — it's a detour, and it comes with a new playbook.

What You’ll Learn

  • Why recovery, hydration, and warm-up needs to shift with age — for men and women — and what to do about it

  • The real, most common driver of "low energy" in midlife women (hint: it's not your hormones, at least not first)

  • Why so much diagnosed "hypothyroidism" is actually chronic underfueling

  • What LEA (Low Energy Availability) and RED-S (Relative Energy Deficiency in Sport) are, and why most doctors have never heard of them

  • What the actual FDA data says about GLP-1s, muscle loss, and bone density — and why that matters more in perimenopause/menopause

  • How HRT, testosterone therapy, and IUDs fit together in a real hormone therapy plan

Chapters

  • 0:00 — Why "everything that used to work no longer does" in midlife training

  • 1:56 — Has the fitness playbook actually changed, or is this just aging?

  • 5:46 — Erin's mobility wake-up call after a year without yoga

  • 7:21 — Dr. Carla's CrossFit origin story and why women over 40 are its fastest-growing group

  • 12:37 — How CrossFit actually scales for every fitness level and age

  • 19:36 — The #1 hidden driver of low energy in midlife women

  • 23:02 — What's really behind stubborn belly fat in perimenopause

  • 28:29 — The thyroid misdiagnosis pattern tied to underfueling

  • 30:14 — LEA and RED-S, defined — and Erin's own 15-year PCOS misdiagnosis

  • 35:42 — GLP-1s: the promising research vs. the hype

  • 38:45 — What the FDA data shows about GLP-1s, muscle, and bone density risk

  • 42:56 — Choosing muscle and longevity over thinness — and the anger behind it

  • 48:15 — What hormone therapy actually does (and doesn't do)

  • 53:37 — Where IUDs fit into a hormone therapy plan

  • 55:41 — Testosterone therapy for women: dosing, delivery, and safety

  • 58:07 — Dr. Carla's closing advice: advocate for yourself

Resources

CONNECT WITH Dr. CARLA DIGIROLAMO