Menopausal Hormone Therapy and Grip Strength After Age 60

On July 28, 2026, the Journal of Applied Physiology published an analysis that put a number on something women in midlife often ask about and rarely see measured. Using nationally representative US survey data, researchers at the University of Michigan found that older women with a history of menopausal hormone therapy use had hand grip strength 1.9 kg greater than women who reported no history of use. The gap was not fixed. It widened with age.

What the analysis actually did

The study, by Logue Cook and colleagues, pulled data from the National Health and Nutrition Examination Survey (NHANES) for 4,330 participants, 2,194 of them female. For each person the researchers had three things: hand grip strength measured with a dynamometer, blood concentrations of four sex hormones (total testosterone, bioavailable testosterone expressed as the free androgen index, estradiol, and bioavailable estradiol expressed as the free estradiol index), and, for women, self-reported history of menopausal hormone therapy use.

This is a snapshot design. Each participant was measured once. Nobody was followed over time, and nobody was assigned to take hormone therapy or not.

Within that design, three findings stood out:

• Older women with a history of hormone therapy use had grip strength 1.9 kg greater than women with no history of use (p<0.01).
• That advantage widened across the age range, from 2.4% at age 60 to 14.3% at age 80 and older.
• Men were 36% to 40% stronger than women throughout adulthood, which is the backdrop the female findings sit against.

Why grip strength is the marker they chose

Grip strength looks like a trivial thing to measure. It is not. In the PURE study, published in The Lancet in 2015, 139,691 adults across 17 countries were tested with a Jamar dynamometer and followed for a median of 4.0 years. Every 5 kg lower grip strength was associated with a 16% higher risk of death from any cause (hazard ratio 1.16, 95% CI 1.13 to 1.20) and a 17% higher risk of cardiovascular death. In that dataset, grip strength predicted all-cause and cardiovascular mortality better than systolic blood pressure did.

Worth noting for honesty: PURE found no significant association between grip strength and incident diabetes, hospital admission for pneumonia or COPD, injury from a fall, or fracture. It is a strong general marker, not a marker of everything.

Grip strength is also the clinical standard. The 2019 European consensus on sarcopenia (EWGSOP2) recommends grip strength measured with a calibrated handheld dynamometer as the primary clinical measure of muscle strength, and sets the threshold for low strength in women at less than 16 kg.

The hormone signal underneath

Beyond the therapy comparison, the analysis looked at whether hormone concentrations themselves tracked strength. In women, all four hormones correlated with grip strength, with estradiol (r=0.81) and bioavailable estradiol (r=0.82) the strongest. In the regression models, the free androgen index predicted strength in both women and men, while total testosterone did not. Estradiol and bioavailable estradiol were indicative of female strength specifically in later adulthood.

Why "bioavailable" keeps showing up

Bioavailable means the fraction of a hormone that is not bound to carrier proteins in the blood, the portion actually available to tissue. A total testosterone or total estradiol number tells you how much is circulating. It does not tell you how much is reaching muscle. The fact that the bioavailable measures predicted strength while total testosterone did not is the more interesting result here, and it is the reason a panel that reports only totals may not answer the question you are asking.

One caveat on those correlation numbers: the paper derived them from one-year age averages, so they describe how group trends move together across the lifespan, not how tightly a single woman's estradiol level would predict her own grip.

What earlier research had already shown

This is not the first look. A 2009 meta-analysis in The Journals of Gerontology pooled 23 studies comparing muscle strength in postmenopausal women who were and were not on estrogen-based hormone therapy. The pooled effect was small but statistically significant (overall effect size 0.23, p=0.003), which the authors translated to roughly 5% greater strength in women on hormone therapy.

The authors flagged real variation. Individual study effect sizes ranged from -0.56 to 1.25, and study quality ranged from 4 to 10 on the PEDro scale, with cross-sectional studies scoring lowest and randomized trials highest. So the direction has been consistent for years. The size of the effect has not been.

What this means if you are weighing hormone therapy

The honest version is narrower than the headline number.

An association is not a cause. Women who used hormone therapy and stayed on it may differ from women who did not in ways this design cannot separate out: access to care, income, baseline health, activity level. Any of those also moves grip strength.

The exposure was coarse. History of use was self-reported, with no accounting for dose, formulation, route, or how long anyone stayed on it. The 14.3% figure at age 80 and older comes from the oldest and smallest slice of the sample.

None of this establishes that starting hormone therapy will make a given person stronger, and the study's own authors frame it as a potential, not a demonstrated effect. Hormone therapy also carries risks that depend on your age, how long it has been since your final period, and your personal and family history. That balance is a conversation with a licensed provider, not something a survey analysis can settle.

What the analysis does add is a functional outcome to a discussion that usually stays on hot flashes, bone density, and mood and sleep. And it points at a number you can actually get measured: your grip, right now, against a threshold that has meaning.