By combining TRT with healthy lifestyle habits, patients reduce the risk that cholesterol changes will become harmful. For this reason, doctors recommend regular blood tests to track cholesterol while someone is taking testosterone. Doctors often recommend that men beginning testosterone therapy also receive counseling on diet, exercise, and other lifestyle factors. Testosterone therapy can change cholesterol levels in small ways, but lifestyle is what often makes the bigger difference.
Regular aerobic activity, such as brisk walking, jogging, swimming, or cycling, is known to lower triglycerides and improve HDL cholesterol. Exercise is another powerful lifestyle factor that works with testosterone therapy. When men start testosterone therapy, they often want to feel stronger, have more energy, or improve their quality of life. Diabetes and metabolic syndrome (a condition involving high blood pressure, high blood sugar, and abnormal cholesterol) often go hand in hand with low testosterone. However, in older adults, cholesterol and heart risk factors are already more complex. In men with true hypogonadism (a medical condition where the body does not make enough testosterone), TRT can help restore hormones to normal levels. While TRT can change cholesterol levels—sometimes lowering HDL or affecting LDL—the actual impact on heart attacks and strokes is less clear and may be neutral.
For this reason, regular monitoring of cholesterol levels is essential during TRT. In fact, low T may contribute to the development of metabolic syndrome by promoting fat accumulation, increasing insulin resistance, and altering the body’s ability to regulate lipids. The link between low testosterone and cholesterol problems becomes even clearer when looking at metabolic syndrome. This pattern is often seen in men with hypogonadism – a condition where the body doesn’t produce enough testosterone. Ultimately, the relationship between testosterone and cholesterol is highly individualized.
Some people who have a family history of high cholesterol can also be at risk for high cholesterol. If you are an adult or child, a total cholesterol above 200 mg/dL may be considered high.1 This condition is also called hyperlipidemia. (A cholesterol check is also called a lipid panel or lipid profile.) Learn more about preventing high cholesterol by making healthy eating choices.
Sufficient biobank samples for measurement of sex steroids were available for 6358 study participants. For testosterone and DHEA, medians and inter-decile ranges are reported as descriptive statistics. The assay limits of detection, limits of quantification, and within-run and between-run coefficients of variation are testosterone 35 pmol/L(1.01ng/dL), 0.09 nmol/L(2.59ng/dL), 2.0%, 3.9% to 6.5%, respectively and DHEA 0.07nmol/L (2.02ng/dL), 0.17 nmol/L (4.90 ng/dL), 32. Associations between hormones and lipids were examined using multilinear regression adjusted for potential confounders. Body fat oxidation is improved through the administration of transdermal testosterone in hypogonadal men.|Because younger men are usually healthier, their blood vessels are less likely to have plaque buildup or stiffening. In these younger men, therapy often improves overall metabolic health. Still, heart health should always be monitored closely, and treatment decisions should be individualized. The FDA still requires caution and careful prescribing but has acknowledged recent evidence showing no clear rise in cardiovascular risk for most patients. This trial is important because it was large, carefully designed, and focused on the very group most doctors worry about—older men with heart risk factors. Results showed no significant increase in heart attacks, strokes, or deaths in the testosterone group compared to the placebo group.|For most patients, regular monitoring and a healthy lifestyle are the best ways to balance the benefits of TRT with cholesterol-related risks. While a drop in HDL may raise concerns, the overall impact on heart health depends on the broader risk profile of the individual. When it comes to TRT, HDL levels may go down, but this does not always lead to higher rates of heart attacks or strokes in studies.|Many men who consider testosterone therapy are already older, and some may already have risk factors like obesity, high blood pressure, or diabetes. Some research shows that testosterone therapy can lower HDL, the "good" cholesterol, which may not be ideal because HDL helps protect the heart. We also take a closer look at effects of testosterone on lipids and HDL in particular, to see if this explains the cardiovascular effects seen in clinical studies. To the contrary, recent literature has raised concern for increased cardiovascular disease in certain groups of men receiving testosterone therapy. Ties between hypogonadism and cardiovascular disease are suggested by observational data, yet therapy with testosterone replacement has not been shown to mitigate that risk.|In the Study of Health in Pomerania, Haring et al. examined the relationship between T levels and lipids, both at baseline and prospectively over 5 years. The Rancho Bernardo study also showed an inverse relationship between circulating T levels and plasma VLDL . In parallel to these clinical investigations, ongoing research efforts have been invested in better understanding the mechanisms by which T may influence cardiovascular health. In a second study, Finkle et al. used a large healthcare database and also reported an association between T prescriptions and myocardial infarction in older men in the immediate 90-day postprescription period .|Your body needs it to perform important jobs, such as making hormones and digesting fatty foods. Blood cholesterol is a waxy, fat-like substance made by your liver. The funders of this study had no role in the data collection, study design, analysis, preparation of the manuscript, and decision to publish. The cross-sectional design of our study allows us to report associations, but not causation. Therefore, our findings cannot be generalised to women with prior MACE or to women of other ethnicities. Physical activity may also impact lipid parameters, but was not included as a covariate in analyses.|Exclusion of women taking lipid lowering therapy, which although a strength, also limited the inclusion of women with more severe dyslipidaemia. Whether the associations between testosterone and each of HDL-C and TG are due to direct androgenic effects, or mediated via obligatory metabolism of testosterone to estradiol, or whether testosterone is a biomarker but not causative of a more favourable lipid profile, is uncertain. Following menopause testosterone is made from adrenal preandrogens in peripheral tissues, where it acts and blood levels primarily reflect spill-over of testosterone that has escaped metabolism in the cells in which it has been made, notably fat tissue. While the contribution of testosterone to the variation in lipids appears small, it needs to be considered in the context of testosterone physiology in postmenopausal women.|This study must be powered for CVD outcomes and, ideally, should examine TRT among a broad spectrum of hypogonadal men to stratify treatment effects by age and baseline health status, among other clinical variables. The inconsistent findings to date and lack of standardized approach to TRT administration in these studies mandate a large-scale randomized controlled trial to better define the cardiovascular effects of TRT. Interestingly, these authors reported that when T concentrations were tracked over time, a greater decline was evident among men with multiple CVD risk factors than men without risk factors, with T levels in some subjects reaching the hypogonadal range. These findings prompted a prospective look at the relationship between plasma T levels and dyslipidemia through longitudinal studies. A positive correlation exists between HDL-c and circulating T concentrations, as seen in multiple studies including the San Antonito Heart study , the Tromso study , the Turku Male Aging study , the Rancho Bernardo study , MRFIT and a study from Ghent, Belgium . The study endpoints include coronary artery plaque volume as measured by CT scan as well as serum lipids; thus, although resultant data merit interest, this study is underpowered to provide additional information regarding cardiovascular events.|Thus, despite numerous research efforts to date, the role of hypogonadism in the pathogenesis of CVD remains unclear, as does the cardiovascular risk profile of TRT. Continued research is critical to better elucidate both the effects of T on HDL composition and function and the utility of various HDL metrics in CVD risk prediction. The cholesterol efflux assay, for example, measures the capacity of serum HDL to efflux cholesterol from lipid-loaded macrophages and therefore is considered an index of HDL efficiency in the initial step in reverse cholesterol transport.}
Testosterone plays a central role in sexual health and overall well-being – it supports libido, sperm production, muscle mass, bone density, and mood regulation. Testosterone is synthesized from cholesterol, making their connection more significant than many people realize. The delivery method can influence lipid changes, but it’s not the only factor. The most consistent finding is a decrease in HDL, while LDL and triglyceride levels can change in different ways depending on the person and the treatment. Men who already have diabetes, obesity, or metabolic syndrome may have greater changes in their cholesterol and may need closer monitoring. What is clear is that cholesterol changes are only one piece of the puzzle. Injectable testosterone and transdermal patches often have a milder or more neutral effect.
The type of testosterone therapy does matter when it comes to cholesterol. However, for patients with already low HDL or high risk of heart disease, a doctor may prefer gels, patches, or pellets instead of injections. Lower HDL levels can reduce protection against heart disease. Doctors often check triglycerides along with cholesterol as part of a blood test called a lipid panel. Very high levels are linked to heart disease, stroke, and inflammation of the pancreas (pancreatitis).
After you eat, your body turns extra calories into triglycerides and stores them in fat cells. But there is another important fat in the blood called triglycerides. Testosterone therapy commonly lowers HDL ("good cholesterol"), though the size of the decrease varies. It is important to note that these effects can differ depending on dose, delivery method, and the patient’s health status. Unlike LDL ("bad" cholesterol), which can build up in blood vessels, HDL helps remove extra cholesterol from the blood and carries it back to the liver for disposal. Testosterone therapy does not appear to universally raise LDL cholesterol, but small increases are possible, especially with higher doses or injectable forms. The way testosterone is given may influence its effect on LDL cholesterol.
Because men with diabetes already face high risks of heart disease, doctors are extra cautious. The combination of obesity, low testosterone, and high cholesterol creates a cycle that increases heart risk. Older men are more likely to already have heart disease, diabetes, or high blood pressure.

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