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While TRT can change cholesterol levels—sometimes lowering HDL or affecting LDL—the actual impact on heart attacks and strokes is less clear and may be neutral. For other men, especially those with well-controlled risk factors, testosterone therapy may be reasonably safe under medical supervision. They also suggest monitoring cholesterol, blood pressure, and heart health regularly during treatment. Some even suggested the opposite—that men with low testosterone who received treatment had a lower risk of heart disease compared to those who stayed untreated. It has been substantiated that patients with hypercholesteremia suffer from higher cardiovascular risk. To achieve this, we adopted the methods of isotope tracing and fluorescence and identified attenuated cholesterol liver uptake as a pathogenic factor of hypercholesteremia in the state of testosterone deficiency both in animals and the cell line. However, previous studies of hypercholesteremia with testosterone deficiency remain superficial as most of them failed to identify the specific pathway of cholesterol metabolism in pathogenesis neither in vivo nor in vitro. Testosterone deficiency attenuated cholesterol liver uptake mediated by the PCSK9-LDLR pathway, in which AR and testosterone without transforming to DHT play important roles. In men with low testosterone levels, any possible cardiovascular advantage from testosterone supplementation should be considered a fringe benefit. Our data suggest that any androgenic effect on CVD risk is not mediated by an inhibitory effect of endogenous T on HDL-C levels. Very high levels are linked to heart disease, stroke, and inflammation of the pancreas (pancreatitis). While a drop in HDL may raise concerns, the overall impact on heart health depends on the broader risk profile of the individual. Other studies, however, suggest caution, especially in older men with preexisting heart disease. When it comes to TRT, HDL levels may go down, but this does not always lead to higher rates of heart attacks or strokes in studies. Two hundred and six men, 103 with angiographically proven CAD and 103 healthy men as a control group were studied. This is a case-control hospital-based study at Teaching Hospital, Karapitiya, Galle, Sri Lanka. A full metabolic work-up and serum testosterone level checks were performed. Men who took agents that influence serum lipid profiles within the previous 6 months were excluded. The Rancho Bernardo study also showed an inverse relationship between circulating T levels and plasma VLDL . A positive correlation exists between HDL-c and circulating T concentrations, as seen in multiple studies including the San Antonito Heart study , the Tromso study , the Turku Male Aging study , the Rancho Bernardo study , MRFIT and a study from Ghent, Belgium . In parallel to these clinical investigations, ongoing research efforts have been invested in better understanding the mechanisms by which T may influence cardiovascular health. Recently, larger cross-sectional studies have been undertaken to better define the cardiovascular effects of TRT. It is notable, however, that these community-dwelling participants had very significantly reduced mobility, a high prevalence of chronic disease, and that they received rather high doses of T in this study. In contrast, another recent meta-analysis that included the largest number of studies so far did not find any association between TRT and CVD risk. HDL cholesterol levels are often considered when looking at someone’s risk for heart disease. Some studies have found that testosterone replacement therapy may cause slight shifts in cholesterol levels. While rare, extremely low cholesterol levels have been linked in some studies to hormone imbalances and reduced testosterone synthesis. Because cholesterol is a raw material for this hormone-making process, your body depends on it to maintain healthy testosterone levels. Learn about getting your cholesterol checked and why it is important. Learn how to prevent, treat, and manage high cholesterol. You can't control some of these risk factors, such as your age or your family history. Millions of people in the United States have high cholesterol. Dietary cholesterol is found in animal foods, including meat, seafood, poultry, eggs, and dairy products. Some people may see improvements in their cholesterol profile, while others may experience negative changes. Testosterone therapy (TRT) does not affect everyone in the same way. Even though large trials are reassuring, not everyone faces the same level of risk. So why do some studies show possible harm while others show safety—or even benefit?
