Is creatine necessary?

It has the deepest evidence base of any supplement for lean-mass support and is well-tolerated in older adults. We treat it as default, not optional, in this stack.

Do women need a different protocol?

No. The same protein, resistance, and creatine evidence applies. Women historically under-dose all three; the protocol assumes the higher target intentionally.

What if I'm on a GLP-1?

Lean-mass preservation becomes critical, not optional. The protocol scales protein and resistance volume during active GLP-1 use to protect against the documented lean-mass loss.

Protocol

Sarcopenia and lean-mass preservation stack

Lean mass after 50, during GLP-1, and post-TRT - the protocol behind the slogans.

Duration: 16-24 weeks
Phases: 3
Updated: 2026-04-29

Start the assessment Compare lab packages

Medically reviewed byDr. Lena Okafor, MD

Medical Director - updated April 2026How we review

Best fit

Who this protocol is built for.

We screen eligibility before any prescription enters the conversation. Decline is treated as an outcome, not a failure.

Adults aged 50+ with declining grip strength or visible muscle atrophy
Members on GLP-1 therapy concerned about lean-mass loss
Anyone with a low DEXA-measured appendicular lean-mass index

Contraindications

Who should avoid this path.

These are hard stops. We route into a different protocol or refer out, rather than working around a contraindication.

End-stage renal disease where high protein intake is contraindicated
Untreated severe rheumatologic flare preventing resistance loading
Acute fracture or post-surgical recovery without rehab clearance

Execution

Phased protocol timeline.

Each phase has explicit entry criteria, actions, and exit conditions. The plan moves on data and tolerance, not a calendar.

Phase 01
Weeks 0-2
Measure and target
DEXA + grip + sit-to-stand are the three measures that correlate with sarcopenia outcomes. Without baselines, there is no protocol.
- Run DEXA for appendicular lean-mass index (ALM/height squared)
- Measure grip strength via dynamometer and 30-second sit-to-stand reps
- Set protein floor (1.6-2.0 g/kg lean mass) and creatine 5g daily
Phase 02
Weeks 3-12
Load and adapt
Resistance loading is the single most powerful lever. Protein and creatine support it; nothing replaces it.
- Build to 3-4 weekly resistance sessions with progressive overload
- Hit protein floor at every meal (target at least 0.4 g/kg per meal)
- Add 1-2 short Zone-2 or sled-push sessions for capacity
Phase 03
Weeks 13-24
Re-measure and adjust
Retest the same three measures and compound levers where response is slow.
- Re-DEXA at 16-24 weeks for ALM and visceral fat trends
- Recheck grip strength and 30-second sit-to-stand
- Layer creatine, vitamin D, and HMB if response is slow; consider hormone optimization workup if symptoms warrant

Stack components

What this protocol layers.

Prescription

Provider-selected and state-dependent.

Labs

Advanced

Supplements

Coaching

Resistance Training Progression
Protein Adherence At Every Meal
Recovery And Load Monitoring

Expected outcomes

What should improve.

Maintain or increase appendicular lean-mass index over 16-24 weeks
Grip strength gain of 5-10% in adherent members
Improved 30-second sit-to-stand reps and visceral fat trend

Risk picture

What we monitor closely.

Inadequate protein adherence undermining resistance gains
Joint or tendon flare-ups from rapid load progression
Plateau in older members without a compounding lever (creatine, HMB, hormone optimization)

Monitoring cadence

How we track progress.

Training adherence weekly
Grip strength and sit-to-stand monthly
DEXA scan at 16-24 weeks

Labs and availability

Run this protocol where service is live.

Check state availability

labs