However, doctors are still debating how serious this effect is. A drop in HDL is often seen in men taking testosterone, especially at higher doses. When combined with regular monitoring and healthy lifestyle habits, TRT can be used more safely. Monitoring helps catch changes early, so adjustments in therapy or lifestyle can be made as needed.
The relationship between testosterone and cholesterol is not simple. High-density lipoprotein cholesterol (HDL) is often called "good cholesterol" because it helps clear LDL from the bloodstream. Low-density lipoprotein cholesterol (LDL) is often called "bad cholesterol" because high levels can lead to a build-up of fatty plaques in arteries. It is a type of fat that the body needs for building hormones, vitamin D, and cell membranes.
High cholesterol also increases your risk for heart disease and stroke, two leading causes of death in the United States. Work with your health care team to prevent and manage high cholesterol by working toward optimal cholesterol levels. We present data on the link between testosterone levels and blood lipid levels in a sample of 293 men with Type 2 diabetes. Low HDL cholesterol (HDL-C) levels are now recognised as an independent cardiovascular risk factor and comprise part of the metabolic syndrome. Interest in testosterone as a potential treatment for cardiovascular disease continues to grow. Learn more about what to do if low testosterone levels are affecting how you manage your mental health.
In this section, we will go over why monitoring is needed, what the medical guidelines suggest, how often testing should happen, and which patients may need closer follow-up. On the other hand, men who combine therapy with weight loss strategies usually see the greatest benefits. Testosterone therapy sometimes helps reduce fat mass while increasing lean muscle, but the results are much stronger when paired with lifestyle changes. Being overweight or obese, especially carrying fat around the waist, is strongly linked to higher LDL and triglycerides, and lower HDL. On the other hand, diets rich in vegetables, fruits, whole grains, lean proteins, and healthy fats (like those from nuts, olive oil, or fatty fish) can lower LDL and raise HDL. A man who begins TRT with already high LDL or very low HDL may respond differently than someone with normal cholesterol. Men with these conditions tend to have higher triglycerides and lower HDL.
Testosterone therapy is a treatment that is becoming more common, especially for men who have low testosterone either from aging or from medical conditions. Eating a balanced diet low in saturated fat, exercising regularly, avoiding smoking, and maintaining a healthy weight all reduce cholesterol and heart risk. These shifts may not be dangerous by themselves, but when combined with other risks—such as high blood pressure, diabetes, or smoking—they can contribute to long-term heart disease. Studies show that testosterone therapy may lower HDL cholesterol in some men. For this reason, doctors recommend regular blood tests to track cholesterol while someone is taking testosterone. Testosterone replacement therapy (TRT) can change levels of LDL ("bad" cholesterol), HDL ("good" cholesterol), and triglycerides. Diet, exercise, body weight, smoking, alcohol use, sleep, and stress all interact with testosterone therapy.