From the Guidelines
Bempedoic acid does not appear to reduce testosterone levels in patients. Bempedoic acid is a medication used to lower LDL cholesterol by inhibiting ATP citrate lyase, an enzyme involved in cholesterol synthesis, as described in the 2022 ACC expert consensus decision pathway on the role of nonstatin therapies for LDL-cholesterol lowering in the management of atherosclerotic cardiovascular disease risk 1. Unlike statins, bempedoic acid works primarily in the liver rather than in muscle tissue, which gives it a different side effect profile.
Mechanism of Action
The mechanism of action of bempedoic acid involves the inhibition of ATP-citrate lyase, resulting in the up-regulation of the LDL receptor and improved clearance of LDL, with a subsequent reduction in blood LDL-C levels 1. This action is specific to the cholesterol synthesis pathway and does not directly involve the hypothalamic-pituitary-gonadal axis, which regulates testosterone production and metabolism.
Side Effects
The common side effects of bempedoic acid include upper respiratory tract infections, muscle spasms, hyperuricemia, back pain, abdominal pain, and elevated liver enzymes, as demonstrated in the CLEAR Tranquility and CLEAR Serenity trials 1. However, hormonal changes, including alterations in testosterone levels, are not among the recognized adverse effects of bempedoic acid.
Clinical Implications
Patients taking bempedoic acid for cholesterol management should not be concerned about testosterone reduction as a side effect. If concerns about medication effects on hormone levels arise, it is always best to discuss these with a healthcare provider who can monitor the specific situation and provide personalized advice. Given the current evidence, bempedoic acid can be considered a safe option for patients with hyperlipidemia without significant concerns regarding its impact on testosterone levels.
From the Research
Bempedoic Acid and Testosterone Levels
- There are no research papers provided that directly investigate the effect of bempedoic acid on testosterone levels 2, 3, 4, 5, 6.
- The studies available discuss the mechanism of action, pharmacokinetics, and efficacy of bempedoic acid in reducing cholesterol levels and its potential as an alternative to statins for patients with hypercholesterolemia or mixed dyslipidemia 2, 3, 4, 5, 6.
- No information is provided on the impact of bempedoic acid on testosterone levels, and therefore, it is not possible to determine whether bempedoic acid reduces testosterone levels based on the available evidence.
Available Evidence
- The provided studies focus on the effects of bempedoic acid on lipid parameters, such as low-density lipoprotein cholesterol (LDL-C), total cholesterol, and apolipoprotein B, as well as its safety profile and potential drug-drug interactions 2, 3, 4, 5, 6.
- The evidence suggests that bempedoic acid is effective in reducing LDL-C levels and has a favorable safety profile, but it does not address the question of its impact on testosterone levels 2, 3, 4, 5, 6.