Estradiol and Grip Strength in Midlife Women: An Early Cross-Sectional Signal

Estrogen gets filed under “reproductive hormone” in most people’s mental model and stops there. A new analysis of U.S. national health data suggests that’s too narrow a box — for women in midlife, circulating estradiol tracks with grip strength, a simple measure of muscle function that is often used to gauge frailty risk.^[1]

What the data showed

Researchers analyzed data from 1,350 adults aged 40-59 (693 of them women) in the NHANES 2013-2014 national health survey, measuring handgrip strength (HGS) with a dynamometer and appendicular lean soft tissue — essentially, the lean muscle mass in your arms and legs — with a DEXA scan. They then looked at how each person’s estradiol level and testosterone-to-estradiol (T/E) ratio related to those two muscle measures.

First the caveat: most of the hormone-and-strength associations in this study were largely attenuated once the researchers adjusted for other factors. Before adjustment, higher estradiol in women was linked to higher grip strength, and a higher T/E ratio was linked to lower grip strength. After adjustment, women in the lowest estradiol category had about 2.4 times the odds of falling into the “low grip strength” category compared with women in the higher category (odds ratio 2.44, 95% CI 1.01 to 5.88). That is a borderline estimate: the interval only just excludes 1, and the moderate-estradiol group’s result (odds ratio 2.27, 95% CI 0.98 to 5.26) was not statistically significant. In men, higher estradiol tracked with more lean muscle mass in the limbs, and a higher T/E ratio tracked with lower grip strength and lean mass — though these associations shrank substantially once the researchers adjusted for other factors, and in women, the estradiol-strength link weakened further after also accounting for sex hormone-binding globulin (SHBG), a protein that controls how much hormone is actually available to tissue.

The honest caveat

This is a snapshot, not a before-and-after. The study is cross-sectional — everyone was measured once, not tracked over time — so it can show that lower estradiol and weaker grip strength travel together, not that one directly causes the other. The authors themselves are careful to frame this as a signal worth following up with longitudinal research, not a settled mechanism. Most of the associations in men, and the T/E ratio findings in both sexes, didn’t hold up once other variables were accounted for. The estradiol-to-grip-strength link in women was the only result that was significant in the primary adjusted model, but it is a borderline estimate and it weakened after accounting for SHBG.

What this means for you

If you’re a woman moving through perimenopause or menopause and noticing your strength isn’t where it used to be, this study is an early signal worth following, but it cannot tell us why. It measured estradiol at a single time point in people aged 40 to 59, so it did not track any decline, and the abstract reports no analysis of menopausal stage. It cannot show that falling estradiol is a contributor to weaker strength. The three suggestions below are ours, not conclusions of the study.

• Get a grip-strength baseline. A hand dynamometer reading is quick and is offered at many physical therapy or sports medicine offices, and grip strength is commonly used as a marker of overall muscle function.
• Don’t skip resistance training through the menopause transition. This study did not test resistance training, and most of its hormone-and-strength links weakened after adjustment, so this is our suggestion rather than a finding: strength work is a sensible habit at any stage, including through the menopause transition, not a time to scale back.
• Bring hormone-and-strength changes to your doctor as one conversation, not two. If you’re discussing menopause symptoms, ask specifically whether declining strength or grip weakness has come up. Please do not start, stop, or change any hormone treatment based on this study; that decision belongs with you and your doctor.

The science here is still early: most of these links weakened after adjustment, and the one that held up in women was a borderline estimate. Whether estradiol has anything to do with muscle strength in midlife is a question for longitudinal studies, not something this snapshot can answer.

References

1. Prokopidis K, Boccardi V, Cacciatore S, et al. “Sex-specific associations of serum estradiol and the testosterone-to-estradiol ratio with handgrip strength and appendicular lean soft tissue in US adults aged 40-59 years.” Experimental Gerontology, 2026;224:113273. Finding used: in 1,350 NHANES 2013-2014 participants aged 40-59, women with lower estradiol had significantly higher odds of low handgrip strength (OR 2.44, 95% CI 1.01-5.88; a borderline estimate, attenuated after additional adjustment for SHBG) in the primary adjusted model, while most other hormone-muscle associations in men and for the testosterone-to-estradiol ratio were attenuated after multivariable adjustment. DOI: 10.1016/j.exger.2026.113273. Source: PubMed 42570737. ↑︎

Kurt Greiner

Kurt is a digital strategist and IT professional blending emerging technology with practical application to help businesses and individuals streamline their digital presence. His current work focuses on the intersection of intentional living and technological resilience, exploring how individuals can leverage modern tools to navigate the second half of life with purpose.