Introduction

High level female powerlifter with issues of a steady decline in performance in the gym and in competition. Problems with bodyweight creeping up and finding it harder to diet and lose weight without resulting in extreme diets (sub 1100 calories). Fatigue was constantly high, mood and motivation low and serious levels of brain fog. Lead a busy and non-stop lifestyle for 10+ years with managing horses at a yard first thing in the morning, high stress environment job and then training on top of it.

All these symptoms were starting to have a serious effect mentally as well with performance in their training declining, and high amounts of caffeine consumption just to get through the day. All time comp total was 452.5kg in the 67.5kg category as a natural, and gym totals were 192.5kg squat, 95kg bench and 195kg deadlift in 2021. Since then, comp totals had steadily declined with subsequent competition totals being 435kg, 420kg and 410kg.

So, there’s clearly various dysfunctions at play that certainly need addressing! Everything was applied at various steps over the course of 9-12 months, so it can be a slow process and not just throwing everything in at once.

At MST Systems, we’re committed to putting the athlete first and then the sport. If there’s underlying dysfunctions within the athlete, then they’re simply not going to be able to perform at their best, or feel their best and no training programme in the world is going to fix that, no matter how good it is.

As a disclaimer: This is published as information and entertainment purposes only. None of the below should be taken as medical advice and is not intended to replace the advice of a doctor or a qualified health professional on issues regarding your health.

Overstressed, Overthinking, Over-sympathetic

Stress is misunderstood a lot of the time. Acute levels of stress is good, it’s what helps us adapt. Chronic levels of unmanaged stress are what’s bad. People see stress as different buckets of “work stress”, “training stress” etc, but the body doesn’t differentiate it like that and sees it all as one big thing being applied to it.

Adjusted training frequency down to 3 days/week and adjusted training volume with training splits to not only allow the athlete to still progress, but more importantly have fun and enjoy their training! Reduces training stress as a whole too with the extra rest days, so week-to-week progress became more consistent.

Stress management practices and mindfulness techniques to balance work stress, and introduced ashwagandha and Rhodiola rosea to aid in stress whilst working and adjusted caffeine in-take to not be from upon waking, but holding off a couple of hours after waking to let natural waking rhythm and adenosine clearance take place instead of inhibiting it with caffeine, and having that energy crash mid-afternoon.

Better nutrition practices with high days and low days and refeed days to keep metabolic stress low from extreme dieting, via the help of a nutritionist who understands the relationship of nutrition and metabolic functioning.

Being in high levels of stress can lead to noradrenergic inhibition, where the feedback loop to stop you from getting overly sympathetic is inhibited, with side effects being fatigue/lack of energy, low mood, brain fog, decreased stress tolerance and impaired cognitive function.

So, to improve this inhibition we introduced Lion’s Mane and taking this in the morning as well, just to help with keeping more parasympathetic during the day and not burning out so quickly from high stress, but also to aid in some neurological dysfunctions too to boosting neurotransmitter signaling to improve memory, learning, recall and overall mood.

 

Brain Fog

So, another big symptom was brain fog and just generally being able to find that flow state, especially during training. Struggling to enunciate and recall short term memories and we approached this as an acetylcholine (ACh) debt-based problem. This ACh debt can also feed through into performance in the gym. It’s used throughout the body for arousal, attention, learning and memory formation, but also at neuromuscular junctions allows for skeletal muscle contractions, so it’s easy for high functioning athletes to burn through their ACh stores day to day.

First approach is supplemented Alpha-GPC. This is simply replacement therapy and is good to supplement on an “as needed” basis for bouts of brain fog.

But this brain fog was day-to-day, so we needed a more long term approach to fixing that so we introduced CDP Choline. Slightly different to how Alpha-GPC works, and is more of an enzymatic driver and that not only increases acetylcholine release, but also drives up dopaminergic cascades, serotonergic cascades and norepinephrine cascades (remember we mentioned that noradrenergic inhibition, that norepinephrine cascade is going to help address that).

Also added in a couple of ancillaries alongside it – Acetyl L-Carnitine and Huperzine A, which I’ve discussed in a nootropics post previously, just to aid in the production of ACh and inhibit the clearance of it.

 

Strength Performance

So, the next big one to address is gym performance. Bloods were taken at the start of this year, and sex hormones such as estrogen and progesterone were perfectly fine, with a regular, healthy menstrual cycle – which is one of the key areas to look at for overall female health and no signs of early menopause. Testosterone had completely flatlined (0.008nmol/l). We tried to address this with the holistic approach to stress and diet as mentioned above, but little impact was seen.

TRT wasn’t a first choice, and after many discussions with health professionals and helping the client understand possible routes to go, and understanding the risks of TRT in females, it was an informed decision and consent by the client to go this route. The therapeutic dose of TRT brought baseline levels of testosterone up to address underlying metabolic, physiologic and neurologic dysfunctions associated with low testosterone.

We also introduced some peptide therapy with the use of MOTS-C to help with the protection against oxidative stress, improve cellular stress response and improve mitochondrial function as a whole.

We also timed some Alpha-GPC around pre-workout time as well just to help top up those ACh stores to assist with performance in the gym.

 

Results

The first competition in July 2023 since starting this regimen resulted in a comp total of a comfortable 445kg total, extremely close to the comp total in 2021. The first competition wasn’t about setting new PBs and overshooting numbers, but just finding our rhythm again with comp prep and competing. We didn’t want to throw a huge amount of stress into the mix too fast and too soon, so a conservative total was taken, that we can then continue to build on through training for next year.

Training in the off-season has been a lot more consistent since then. Energy levels and motivation after work are greatly improved and continue to improve, not coming home and just feeling drained, but being able to come into the gym and be motivated for the workout. The adjustment to training frequency and volume will be helping a lot with recovery too, so more consistent gains are being made in terms of strength and in a fantastic position for next year’s competition season.

The nutrition side of things has mainly been stuck to the calorie high/low days and bodyweight has also started to be more consistent and responsive to lower calorie days too. Bodyweight in general is in a much better place and the client feels better that there’s more noticeable results. Even if the scale weight isn’t moving as much as they’d like, coming into the gym and being able to buckle their belt up a notch down is a huge win.

This is all still very much a work in progress as we monitor progression moving forward, as you can understand it’s a hugely complex approach and a slow approach is best, but everything is looking much more positive to what it was 12 months ago, and the client is performing and feeling the best they have in a long time.

The TRT isn’t being added in strictly as a performance enhancer either, but we’re fixing a problem with it which is the difference between HRT and simply using PEDs. TRT in females is massively more complex than in males and shouldn’t be taken lightly without full consent once the potential side effects are understood with harm reduction practices in place to try and mitigate any side effects as best as possible.

Further blood panels have seen improved blood markers as well with improved thyroid markers (thyroid wasn’t an issue to begin with, but thyroid function has improved through improving other areas of metabolic function), as well as sex hormones being in a healthy range (testosterone now at 1.7nmol/l) too with no disruption to the menstrual cycle. 

Summary

Address noradrenergic inhibition, reduce stress, combat fatigue, increase mental performance and resilience:

  • Lion’s Mane - 500mg
  • Ashwagandha - 600mg
  • Rhodiola rosea - 500mg
  • Adjusted caffeine intake

Address Brain fog, acetylcholine debt-based problems

  • Alpha-GPC - 300-600mg (split morning and pre-workout)
  • CDP Choline - 250mg
  • Acetyl L-Carnitine - 500mg

Hormonal imbalance and strength performance

  • TRT
  • MOTS-C - 200mcg away from training
  • Reduced training frequency from 4 days/week to 3 days/week with restructured volume within sessions to aid in recovery.

This may seem like a lot, but we've added things in from a holistic approach thinking "what's needed to help this issue". I've specifically left the TRT dosage out, as I don't people to read this and think "oh, she takes x mg/week, so I'll do the same". Everyone responds differently to dosages based on their own physiology and what might be one person's optimal dose isn't going to be someone else's. 

Female physiology is hugely complex, training programmes are only a part of what governs an athlete's success. Being able to identify dysfunctions that are acting as potential rate-limiting factors, we can then look at how we can fix those and then start thinking about how we can extract full nervous system potential.