Does TRT raise cholesterol?
Usually not. In studies, TRT cholesterol changes are small, usually a few mg/dL. Total cholesterol tends to fall a little, and so does HDL (“good” cholesterol).
LDL and triglycerides go different ways in different groups of men. What these small shifts mean for heart disease isn’t known. The AUA calls the evidence uncertain, with small drops in triglycerides and total cholesterol, if any.
Cholesterol is one of the extra tests in our guide to routine TRT labs. This page covers what the research shows and how to read your own panel.
What does a lipid panel measure?
A lipid panel is one blood test. It reports four or five numbers about the fats in your blood:
- Total cholesterol: all the cholesterol carried in your blood.
- LDL cholesterol: the type that builds up in artery walls. Many labs work it out from the other numbers instead of measuring it.
- HDL cholesterol: the type that carries cholesterol away to the liver, often called “good” cholesterol.
- Triglycerides: a different kind of fat, which rises after meals.
- Non-HDL cholesterol: total cholesterol minus HDL.
US labs report these in mg/dL. For men aged 20 and over, MedlinePlus lists these healthy levels: total cholesterol under 200, LDL under 100 and non-HDL under 130. HDL of 60 or more is best, and under 40 is low.
MedlinePlus adds that a healthy level for you depends on your age, family history and other risk factors. Your lab prints its own ranges next to each result.
What do studies show for cholesterol on testosterone?
The table puts the main studies side by side. The groups differ a lot. Some are older men, some have type 2 diabetes, and one is a clinic’s records, not a trial.
| Study | Who | Total cholesterol | LDL | HDL | Triglycerides |
|---|---|---|---|---|---|
| Review of injection studies | 19 studies, 272 men on injections | −14 mg/dL | −5 mg/dL | −4 mg/dL | −1 mg/dL (no clear change) |
| Testosterone Trials | 788 men 65+, gel vs placebo, 1 year | −6.1 mg/dL | −2.3 mg/dL | −2.0 mg/dL | No change |
| Review of 29 trials | 29 trials, 1,083 men | Fell | No change | Fell only where starting testosterone was higher | Not reported |
| Review of 51 studies | 51 studies | Not reported | Not reported | −0.49 mg/dL | Not reported |
| Review of 16 trials | 16 trials, 1,373 men | Fell | Not reported | Fell | Not reported |
| Review in type 2 diabetes | 7 trials, 612 men with type 2 diabetes | −6.44 mg/dL | Not consistent | Rose only in developing-country trials | −27.94 mg/dL |
| Review in diabetes or metabolic syndrome | 18 trials, 1,415 men with diabetes or metabolic syndrome | Not reported | Fell | Not reported | Fell |
| One clinic’s records | 178 men, gels, injections and pellets, 3 years | Brief changes | Brief changes | No significant change | Brief changes |
The pattern fits in one line: mixed, and mostly small. The authors of the injection review said the effect of these changes on heart risk is unknown. The 51-study review said its HDL finding had no known meaning for health.
What happens to HDL on TRT?
HDL is the number most often talked about in TRT forums, because it tends to dip. The review of injection studies found a small fall of about 4 mg/dL. There was a borderline hint that the fall was larger at lower doses.
In the Testosterone Trials, a year of gel lowered HDL by 2.0 mg/dL compared with placebo (a dummy treatment). One review of 29 trials found HDL fell only in studies where men started with higher testosterone. A study of one clinic’s past records found no real HDL change with gels, injections or pellets.
So a small HDL drop is common, but not universal. There’s no clear pattern by dose.
If your HDL falls after starting, raise it at your next visit. Your prescriber reads it next to your other heart risk factors, not on its own.
What happens to LDL and triglycerides on TRT?
These vary more. In older men on gel, LDL fell 2.3 mg/dL compared with placebo. That change just missed statistical significance, and triglycerides didn’t change.
In men with type 2 diabetes or metabolic syndrome, pooled trials found both LDL and triglycerides fell. Another review found triglycerides fell by about 28 mg/dL, but LDL didn’t improve in a steady way.
Part of the difference likely comes from the men studied. Men with diabetes often start with high triglycerides, so there’s more room for change.
Weight, diet, alcohol and other medicines also move these numbers. That makes it hard to credit or blame testosterone for any single result.
Does the type of testosterone change cholesterol?
No head-to-head trial settles it. The largest review of injections found small falls in total cholesterol, LDL and HDL. The main gel trial found smaller falls.
One clinic compared gels, injections and pellets over three years. It called the lipid effects variable and inconsistent.
The two studies differ in more than the product: different men, eras and doses. Choosing a product or schedule is your prescriber’s decision. To see how your schedule shapes testosterone between injections, try the level calculator.
Does low testosterone itself affect cholesterol?
It seems to travel with it. The AUA pooled 21 studies and found that men with low testosterone had higher odds of dyslipidemia, which means abnormal blood fats. The AUA also asks clinicians to tell men that low testosterone is a risk factor for heart disease.
These links come from watching groups of men, not from trials. They don’t show that low testosterone causes high cholesterol, or that treatment fixes it. Weight, blood sugar and age affect both.
The AUA tells patients the evidence is unclear on whether testosterone therapy improves cholesterol.
Does TRT raise the risk of heart disease?
Cholesterol is only one piece of heart risk. So the best evidence comes from trials that counted heart events directly.
In the TRAVERSE trial, 5,246 men aged 45 to 80 got testosterone gel or placebo. All had heart disease or a high risk of it. A heart attack, stroke or death from heart or blood vessel disease happened in 7.0% on testosterone and 7.3% on placebo.
The same trial found more atrial fibrillation (an irregular heartbeat), acute kidney injury and pulmonary embolism (a blood clot in the lungs) on testosterone. It tested gel only.
A review of 35 trials also found no link between testosterone and heart or stroke events in the short to medium term. In that review, blood cholesterol and triglycerides were lower on testosterone.
One smaller study points the other way on an indirect measure. In 138 older men, a year of gel grew soft (noncalcified) plaque in the heart arteries on scans more than placebo did. No heart events happened in either group, and the authors said larger studies are needed to know what it means.
The AUA says no one can yet say for sure whether testosterone raises or lowers heart risk.
Do guidelines say to check cholesterol on TRT?
Not as a routine TRT test. The Endocrine Society’s monitoring plan covers testosterone, hematocrit and prostate checks. The AUA’s follow-up table has no lipid row.
The Endocrine Society guideline does note a significant but small fall in HDL on treatment.
Drug labels go further:
| Source | What it says about cholesterol |
|---|---|
| Endocrine Society guideline | Not part of its monitoring plan |
| AUA guideline | Effect uncertain; asks clinicians to assess heart risk factors, including cholesterol |
| AZMIRO cypionate label | Monitor the lipid profile periodically after starting |
| DEPO-Testosterone label | Serum cholesterol may increase during androgen therapy |
In practice, many prescribers include a lipid panel with yearly blood work. That’s more likely for men with other heart risk factors.
Our blood-work timing guide shows where it usually fits. Our guide to reading lab results explains ranges and flags.
How do you get comparable cholesterol results?
- Ask whether to fast. The 2018 US cholesterol guideline allows fasting or nonfasting tests. Some labs and prescribers still ask for 9 to 12 hours without food. Do the same every time.
- Use the same lab where you can. A calculated LDL and a directly measured one can differ.
- Note the day in your injection cycle. We found no study of whether lipids move within a cycle. Writing it down keeps your records comparable. The draw-date planner shows the draw windows from your schedule.
- Note changes in weight, diet, alcohol or medicines. Each one moves cholesterol more than most studies of testosterone did.
- Draw it with your other labs. Hematocrit and estradiol are often checked on the same day.
Why are anabolic steroid effects on HDL so different?
Many scary cholesterol stories come from people using steroids without a prescription. In one study, 19 men gave themselves several steroids at once. Their HDL fell by about 60%, from 1.08 to 0.43 mmol/L, and hadn’t recovered six weeks after stopping.
That’s a different exposure from prescribed replacement. In trials of prescribed testosterone, average HDL changes are a few mg/dL. So studies of “testosterone and cholesterol” need to be read with the dose and the product in mind.
What if your cholesterol changes after starting TRT?
Don’t stop or change your treatment because of one lipid panel. A single result can move with what you ate, how much you drank, a recent illness or a change of lab. So a repeat test often comes first.
If a change holds up, your prescriber looks at it next to everything else that drives heart risk. That includes your blood pressure, blood sugar, smoking, weight, family history and age.
The AUA asks clinicians to check those risk factors in every man with low testosterone. It says having them is not, on its own, a reason to avoid treatment. Whether anything needs to change is a decision for you and your prescriber.
Bring your earlier panels to that talk. A baseline from before TRT makes it much easier to tell if a number moved because of treatment or was already there.
What should you ask your prescriber about cholesterol on TRT?
- Do you want a lipid panel before I start, so we have a baseline?
- How often will you check it, given my other heart risk factors?
- Should I fast for it?
- Has anything changed since my last panel, and is it big enough to matter?
- Do my blood pressure, blood sugar or family history change how you read these numbers?
For the side effects you can feel, see our guide to TRT side effects.
How can you track your cholesterol on TRT?
A single lipid panel is a snapshot. Keep each panel with its date, lab, fasting status and the day in your injection cycle. That shows whether an HDL dip is a one-off or a trend.
TRTracker keeps your results next to your other markers, so the change since baseline is easy to see. For the full list of tests that come up on treatment, start with our TRT lab guide.