From the Guidelines
Testosterone replacement therapy is not associated with a significant increase in the risk of hyperlipidemia, and its effects on lipid profiles are generally neutral or beneficial, as shown in the most recent and highest quality study 1.
Introduction to Testosterone and Lipid Profiles
Testosterone therapy can potentially affect lipid profiles, but the evidence suggests that this effect is minimal. Exogenous testosterone typically causes a decrease in HDL (good) cholesterol, but this decrease is often accompanied by a reduction in total cholesterol and LDL (bad) cholesterol. The relationship between testosterone and lipids stems from testosterone's role in lipid metabolism; it affects hepatic lipase activity and reverse cholesterol transport.
Management of Hyperlipidemia in Patients on Testosterone Replacement Therapy
For patients on testosterone replacement therapy (TRT) who develop hyperlipidemia, management should include both lifestyle modifications and possibly medication. Lifestyle changes should focus on:
- A heart-healthy diet low in saturated fats
- Regular exercise (150 minutes of moderate activity weekly)
- Weight management
- Smoking cessation
- Limiting alcohol consumption If lipid levels remain elevated despite lifestyle changes, statin therapy may be necessary, with medications like atorvastatin (10-80mg daily) or rosuvastatin (5-40mg daily) being common first-line options.
Monitoring Lipid Profiles in Patients on TRT
Patients on TRT should have lipid panels monitored before starting treatment, after 3 months, and then annually. This monitoring is crucial to assess the potential cardiovascular effects of TRT and to adjust treatment plans accordingly. The most recent study 1 provides evidence that the risk of adverse cardiovascular outcomes is low, but ongoing monitoring is still necessary to ensure the safety of patients on TRT.
Key Findings from Recent Studies
The study by 1 found that the pooled risk for adverse cardiovascular outcomes did not differ between groups, and the incidence of cardiovascular events was 2.3% in the testosterone group, compared with 1.5% in the placebo group. This study provides the most recent and highest quality evidence on the topic, and its findings should guide clinical practice. Overall, the evidence suggests that testosterone replacement therapy is safe and effective for managing hypogonadism symptoms, and its potential cardiovascular effects can be mitigated with careful monitoring and management of lipid profiles.
From the FDA Drug Label
Serum cholesterol may increase during androgen therapy.
- Testosterone therapy may be associated with an increase in serum cholesterol levels, which can contribute to hyperlipidemia.
- The FDA drug label recommends monitoring patients receiving long-term androgen administration, including checking hemoglobin and hematocrit levels, but does not provide specific guidance on managing hyperlipidemia.
- Based on the available information, it is recommended to monitor lipid profiles in patients receiving testosterone therapy, especially those with pre-existing hyperlipidemia 2.
From the Research
Testosterone and Hyperlipidemia
- The relationship between testosterone and lipid profiles has been investigated in several studies 3, 4, 5, 6, 7.
- A study published in 2021 found that testosterone levels were positively correlated with LDL-C levels in male hypercholesterolemic patients with diabetic retinopathy 3.
- Another study published in 2015 reviewed the current literature on the relationship between testosterone and cardiovascular disease, including the effects of testosterone on lipids and HDL 4.
- A 2015 article reviewed the extensive literature on testosterone and cardiovascular risks, and found that several dozen studies reported a beneficial effect of normal testosterone levels on cardiovascular risks and mortality 5.
- A 2019 review provided an overview of epidemiological data on the association between serum levels of endogenous testosterone and cardiovascular disease, and found that the cardiovascular safety of testosterone replacement therapy remains unclear 6.
- A 2025 article discussed the present and future considerations of testosterone therapy in older men, including its potential benefits and risks, and highlighted the need for high-quality evidence from randomized controlled trials 7.
Key Findings
- Testosterone levels are positively correlated with LDL-C levels in male hypercholesterolemic patients with diabetic retinopathy 3.
- Normal testosterone levels may have a beneficial effect on cardiovascular risks and mortality 5.
- The cardiovascular safety of testosterone replacement therapy remains unclear 6.
- Testosterone therapy may have benefits for older men, including improved sexual function, anaemia, and bone mineral density, but key questions remain regarding its safety and efficacy 7.
Lipid Profiles and Testosterone
- Testosterone levels were lowered in proportion with LDL-C lowering under statin therapy 3.
- Cortisol levels were not correlated with LDL-C levels 3.
- Testosterone therapy may have effects on lipids and HDL, but the relationship between testosterone and cardiovascular disease is complex and requires further study 4, 5, 6, 7.