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E139
June 02, 2026
GLP-1s, Hormones, and Why You Can't Calorie-Count Your Way Out of Menopause with Dr. Michelle Gordon
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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.

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Chapters

00:00:00 – Why Midlife Weight Gain Is Predictable
00:03:15 – Why Dr. Michelle Gordon Left Surgery
00:05:00 – The Myth of “Calories In, Calories Out”
00:07:00 – Hormones, Brain Fog & Losing Your Edge
00:10:15 – Why Women Are Still Being Dismissed
00:13:20 – The Real Cause of Menopause Weight Gain
00:14:45 – Insulin Resistance & Belly Fat Explained
00:16:45 – Hunger Hormones, Satiety & Weight Regain
00:18:00 – What Bariatric Surgery Taught Us About Obesity
00:23:00 – Muscle Loss, Protein & Healthy Aging
00:24:30 – Sleep Deprivation, Cravings & Metabolism
00:27:00 – Who Is a Good Candidate for GLP-1s?
00:31:00 – Tirzepatide vs. Semaglutide
00:35:45 – Protein, Fiber & Building a Sustainable Plan
00:39:00 – Hormone Therapy + GLP-1s
00:40:00 – Microdosing GLP-1s & Peptide Trends
00:46:00 – Labs, DEXA Scans & Measuring Progress
00:49:00 – GLP-1 Side Effects & Safety Considerations
00:53:00 – The Psychology of Weight Loss & Self-Concept
00:55:00 – Reaching Goal Weight & Building Muscle
00:56:00 – What If GLP-1s Aren't Working?
00:57:00 – The SELECT Trial & Heart Health Benefits
00:59:00 – Preserving Muscle and Bone While Losing Weight
01:02:00 – Brain Fog: Hormones, Thyroid & Obesity
01:04:00 – Retatrutide: The Next Generation of Weight-Loss Drugs
01:08:00 – The Future of Obesity Medicine for Women
01:12:00 – Final Advice for Women Struggling With Weight Gain 

About the guest

Dr. Michelle Gordon

Dr. Michelle Gordon is a board-certified obesity medicine physician (DABOM) and diplomate of the American College of Lifestyle Medicine (DACLM), with surgical fellowships from the American College of Surgeons (FACS) and the American College of Osteopathic Surgeons (FACOS). She runs Thrive Span Medical, a direct-pay practice specializing in midlife women's metabolic and hormonal health, with patients across 39 states and DC.

Her clinical work focuses on midlife women whose metabolic and hormonal symptoms have been dismissed as normal aging. When appropriate, she prescribes GLP-1 receptor agonists and hormone optimization, treating obesity as a chronic, relapsing disease.

She writes about the physiology of obesity, perimenopause, and metabolic dysfunction at drmichellegordon.substack.com. She lives in the Hudson Valley with her wife, also a physician, and two Newfoundlands.