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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.
For now, men on testosterone therapy should work closely with their healthcare provider, monitor their lipid panel regularly, and maintain a heart-healthy lifestyle. Many studies have looked at how testosterone therapy affects cholesterol levels, but results are not always the same. When patients ask if testosterone therapy "increases LDL," they are really asking whether TRT makes the blood more likely to cause cardiovascular disease. On the other hand, improvements in body fat, blood sugar control, and inflammation from testosterone therapy may reduce risks in other ways. Even small shifts in cholesterol caused by testosterone therapy may affect long-term heart health. To understand how testosterone therapy may change cholesterol levels, we first need to look at how cholesterol works in the body and what role testosterone plays in regulating it. Triglycerides are another kind of fat in the blood, and high levels of these can also raise the risk of heart disease.
Because high triglycerides are linked to heart disease, this may be a positive effect of testosterone. Even though testosterone therapy can shift cholesterol levels, lifestyle habits often have a stronger influence. Research shows that testosterone therapy can influence cholesterol, but the effects are not the same for every person. 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. Monitoring cholesterol during testosterone therapy is an important part of staying safe and healthy. Quitting smoking can raise HDL levels within weeks, which helps balance cholesterol changes from testosterone therapy.
It’s important to get enough omega-3s because the Western diet often replaces them with other fats, leading to potential health issues. Fish oil has better health benefits than plant-based sources of omega-3s. It contains omega-3 fatty acids, which have many health benefits.
For example, observational studies that included thousands of men found no clear increase in heart attack or stroke rates among men on TRT. Another small trial in 2010 also showed more cardiovascular events in men receiving testosterone gel. This made headlines and created fear that TRT could raise cardiovascular risk. Some of the first studies that got public attention suggested TRT might be harmful for the heart.
Several reviews have found that testosterone therapy tends to reduce total cholesterol and triglycerides slightly, but it may also lower protective HDL cholesterol. Doctors weigh both the direct effects on cholesterol and the indirect benefits when deciding if testosterone therapy is safe for a patient. For these conditions, testosterone therapy is considered a standard and accepted treatment because the hormone levels are truly low due to medical disease. In these cases, doctors may recommend testosterone therapy to bring hormone levels back to a healthy range.