Uploaded July 2026 | Updated September 2026, 2 weeks ago
DEXA says GLP-1 weight loss costs you muscle, but it can't tell muscle from water, glycogen, or the fat inside your liver and muscle. We break down what's really lost, why resistance training halves it, and whether creatine does anything here.
Chapters:
0:00 Why DEXA overstates muscle loss
2:10 What resistance training actually does
7:25 Does creatine help on a GLP-1?
Resources
barbellmedicine.com/blog/creatine-on-ozempic-does-it-prevent-muscle-loss
barbellmedicine.com/shop/subscriptions/plus-podcast-subscription
barbellmedicine.com/shop/subscriptions/barbell-medicine-premium
Signal book pre-order: barbellmedicine.com/shop/learning/signal
Enhanced Games results, AP News, 25 May 2026. apnews.com/article/enhanced-games-kerley-doping-ee1ad0ff82d30b3ff38728a35198fc83
Bhasin S, et al. Supraphysiologic testosterone and muscle size and strength. N Engl J Med. 1996. pubmed.ncbi.nlm.nih.gov/8637535
Warrier AA, et al. Performance-enhancing drugs in healthy athletes: an umbrella review. Sports Health. 2024. pubmed.ncbi.nlm.nih.gov/37688400
ACSM. Resistance Training Prescription... An Overview of Reviews. Med Sci Sports Exerc. 2026. acsm.org/resistance-training-guidelines-update-2026
Morton RW, et al. Neither load nor systemic hormones determine RT hypertrophy or strength in trained men. J Appl Physiol. 2016. pubmed.ncbi.nlm.nih.gov/27174923
Vieira AF, et al. Failure vs not to failure for strength, hypertrophy, power: meta-analysis. J Strength Cond Res. 2021. pubmed.ncbi.nlm.nih.gov/33555822
Refalo MC, et al. Proximity-to-failure and hypertrophy: meta-analysis. Sports Med. 2023. doi.org/10.1007/s40279-022-01784-y
Borde R, et al. Dose-response of resistance training in healthy old adults: meta-analysis. Sports Med. 2015. pubmed.ncbi.nlm.nih.gov/26420238
Cadore EL, et al. Sets to failure vs not in elderly men: randomized trial. Exp Gerontol. 2018. pubmed.ncbi.nlm.nih.gov/29577974
Helms ER, et al. Small vs large energy surplus in resistance-trained individuals. Sports Med Open. 2023. link.springer.com/article/10.1186/s40798-023-00651-y
Longland TM, et al. Higher protein during energy deficit with intense exercise. Am J Clin Nutr. 2016. pubmed.ncbi.nlm.nih.gov/26817506
STEP 1 body-composition substudy (semaglutide). J Endocr Soc. 2021. academic.oup.com/jes/article/5/Supplement_1/A16/6240360
SURMOUNT-1 body-composition substudy (tirzepatide). Diabetes Obes Metab. 2025. dom-pubs.onlinelibrary.wiley.com/doi/10.1111/dom.16275
Forbes SC, et al. Creatine and resistance training on lean tissue and strength in older adults: meta-analysis. Nutrients. 2021. ncbi.nlm.nih.gov/pmc/articles/PMC8229907
Ding P, et al. GLP-1 receptor agonists and risk of paralytic ileus: Mendelian randomization. medRxiv 2024 (preprint, not peer reviewed). doi.org/10.1101/2024.10.17.24315627
Pelland JC, et al. Resistance training dose response: volume and frequency meta-regressions. Sports Med. 2026. pubmed.ncbi.nlm.nih.gov/41343037
Schoenfeld BJ. Mechanisms of muscle hypertrophy. J Strength Cond Res. 2010. pubmed.ncbi.nlm.nih.gov/20847704
Nuell S, et al. Hamstring muscle volume and sprint performance. J Strength Cond Res. 2021. pubmed.ncbi.nlm.nih.gov/33555833
Sanchis-Moysi J, et al. Muscle hypertrophy in prepubescent tennis players (MRI). PLoS One. 2012. pubmed.ncbi.nlm.nih.gov/22428074
Wang R, et al. Variable-resistance vs constant-resistance training and maximum strength: meta-analysis. IJERPH. 2022. pmc.ncbi.nlm.nih.gov/articles/PMC9317775
Retraction notice, Soria-Gila MA, et al. Variable resistance training on maximal strength. J Strength Cond Res. 2018. pubmed.ncbi.nlm.nih.gov/30540286
Haugen ME, et al. Free-weight vs machine-based training: meta-analysis. BMC Sports Sci Med Rehabil. 2023. pubmed.ncbi.nlm.nih.gov/37582807
Aune D, et al. Fruit and vegetable intake and mortality: dose-response meta-analysis. Int J Epidemiol. 2017. doi.org/10.1093/ije/dyw319
Ding EL, et al. SHBG and risk of type 2 diabetes. N Engl J Med. 2009. nejm.org/doi/full/10.1056/NEJMoa0804381
Vermeulen A, et al. Estimation of free testosterone in serum. J Clin Endocrinol Metab. 1999. academic.oup.com/jcem/article/84/10/3666/2660660
Bhasin S, et al. Testosterone therapy in men with hypogonadism: Endocrine Society guideline. J Clin Endocrinol Metab. 2018. academic.oup.com/jcem/article/103/5/1715/4939465
Coleman KJ, et al. Initial validation of an exercise vital sign in EMRs. Med Sci Sports Exerc. 2012. pubmed.ncbi.nlm.nih.gov/22688832
Sallis JF, et al. Physical activity assessment, prescription and referral in US healthcare (It's Time to Move). Prog Cardiovasc Dis. 2021. pubmed.ncbi.nlm.nih.gov/33383058
DEXA says GLP-1 weight loss costs you muscle, but it can't tell muscle from water, glycogen, or the fat inside your liver and muscle. We break down what's really lost, why resistance training halves it, and whether creatine does anything here.
Chapters:
0:00 Why DEXA overstates muscle loss
2:10 What resistance training actually does
7:25 Does creatine help on a GLP-1?
Resources
barbellmedicine.com/blog/creatine-on-ozempic-does-it-prevent-muscle-loss
barbellmedicine.com/shop/subscriptions/plus-podcast-subscription
barbellmedicine.com/shop/subscriptions/barbell-medicine-premium
Signal book pre-order: barbellmedicine.com/shop/learning/signal
Enhanced Games results, AP News, 25 May 2026. apnews.com/article/enhanced-games-kerley-doping-ee1ad0ff82d30b3ff38728a35198fc83
Bhasin S, et al. Supraphysiologic testosterone and muscle size and strength. N Engl J Med. 1996. pubmed.ncbi.nlm.nih.gov/8637535
Warrier AA, et al. Performance-enhancing drugs in healthy athletes: an umbrella review. Sports Health. 2024. pubmed.ncbi.nlm.nih.gov/37688400
ACSM. Resistance Training Prescription... An Overview of Reviews. Med Sci Sports Exerc. 2026. acsm.org/resistance-training-guidelines-update-2026
Morton RW, et al. Neither load nor systemic hormones determine RT hypertrophy or strength in trained men. J Appl Physiol. 2016. pubmed.ncbi.nlm.nih.gov/27174923
Vieira AF, et al. Failure vs not to failure for strength, hypertrophy, power: meta-analysis. J Strength Cond Res. 2021. pubmed.ncbi.nlm.nih.gov/33555822
Refalo MC, et al. Proximity-to-failure and hypertrophy: meta-analysis. Sports Med. 2023. doi.org/10.1007/s40279-022-01784-y
Borde R, et al. Dose-response of resistance training in healthy old adults: meta-analysis. Sports Med. 2015. pubmed.ncbi.nlm.nih.gov/26420238
Cadore EL, et al. Sets to failure vs not in elderly men: randomized trial. Exp Gerontol. 2018. pubmed.ncbi.nlm.nih.gov/29577974
Helms ER, et al. Small vs large energy surplus in resistance-trained individuals. Sports Med Open. 2023. link.springer.com/article/10.1186/s40798-023-00651-y
Longland TM, et al. Higher protein during energy deficit with intense exercise. Am J Clin Nutr. 2016. pubmed.ncbi.nlm.nih.gov/26817506
STEP 1 body-composition substudy (semaglutide). J Endocr Soc. 2021. academic.oup.com/jes/article/5/Supplement_1/A16/6240360
SURMOUNT-1 body-composition substudy (tirzepatide). Diabetes Obes Metab. 2025. dom-pubs.onlinelibrary.wiley.com/doi/10.1111/dom.16275
Forbes SC, et al. Creatine and resistance training on lean tissue and strength in older adults: meta-analysis. Nutrients. 2021. ncbi.nlm.nih.gov/pmc/articles/PMC8229907
Ding P, et al. GLP-1 receptor agonists and risk of paralytic ileus: Mendelian randomization. medRxiv 2024 (preprint, not peer reviewed). doi.org/10.1101/2024.10.17.24315627
Pelland JC, et al. Resistance training dose response: volume and frequency meta-regressions. Sports Med. 2026. pubmed.ncbi.nlm.nih.gov/41343037
Schoenfeld BJ. Mechanisms of muscle hypertrophy. J Strength Cond Res. 2010. pubmed.ncbi.nlm.nih.gov/20847704
Nuell S, et al. Hamstring muscle volume and sprint performance. J Strength Cond Res. 2021. pubmed.ncbi.nlm.nih.gov/33555833
Sanchis-Moysi J, et al. Muscle hypertrophy in prepubescent tennis players (MRI). PLoS One. 2012. pubmed.ncbi.nlm.nih.gov/22428074
Wang R, et al. Variable-resistance vs constant-resistance training and maximum strength: meta-analysis. IJERPH. 2022. pmc.ncbi.nlm.nih.gov/articles/PMC9317775
Retraction notice, Soria-Gila MA, et al. Variable resistance training on maximal strength. J Strength Cond Res. 2018. pubmed.ncbi.nlm.nih.gov/30540286
Haugen ME, et al. Free-weight vs machine-based training: meta-analysis. BMC Sports Sci Med Rehabil. 2023. pubmed.ncbi.nlm.nih.gov/37582807
Aune D, et al. Fruit and vegetable intake and mortality: dose-response meta-analysis. Int J Epidemiol. 2017. doi.org/10.1093/ije/dyw319
Ding EL, et al. SHBG and risk of type 2 diabetes. N Engl J Med. 2009. nejm.org/doi/full/10.1056/NEJMoa0804381
Vermeulen A, et al. Estimation of free testosterone in serum. J Clin Endocrinol Metab. 1999. academic.oup.com/jcem/article/84/10/3666/2660660
Bhasin S, et al. Testosterone therapy in men with hypogonadism: Endocrine Society guideline. J Clin Endocrinol Metab. 2018. academic.oup.com/jcem/article/103/5/1715/4939465
Coleman KJ, et al. Initial validation of an exercise vital sign in EMRs. Med Sci Sports Exerc. 2012. pubmed.ncbi.nlm.nih.gov/22688832
Sallis JF, et al. Physical activity assessment, prescription and referral in US healthcare (It's Time to Move). Prog Cardiovasc Dis. 2021. pubmed.ncbi.nlm.nih.gov/33383058
