Testosterone Replacement Therapy for Men: TRT and Cholesterol

ARV BUTTAR, NP SHARES HER EXPERTISE AND KNOWLEDGE ABOUT THE CONNECTION BETWEEN TRT AND CHOLESTEROL.

The purpose of this post is to review the current research linking testosterone therapy to reduced fat mass, increased
lean body mass, positive changes to body composition and weight loss.
Testosterone can influence the amount and type of cholesterol your body produces.

TESTOSTERONE AND CHOLESTEROL
Understanding how testosterone and cholesterol relate to each other is an area of current research with potential
implications for maintaining good health.
There are two main types of cholesterol:
• LDL cholesterol is the type that builds up in your blood vessels, causing heart problems. It’s often called “bad”
or “Lousy” cholesterol.
• HDL cholesterol is known as “good” or “Happy” cholesterol because it carries LDL cholesterol back to your liver,
where it’s broken down and removed from your body.
Researchers continue to work on better understanding the role of Testosterone on types of cholesterol and heart
disease. Lower endogenous testosterone levels (ie naturally made by the body) are associated with a cholesterol profile
that promotes the formation of fatty plaques in the arteries1.
On the flip side, there is a positive relationship between HDL (the good cholesterol) and higher endogenous testosterone
levels, as seen in multiple studies:
THE TROMSO STUDY³
1274 men without known cardiovascular disease participated.
• Testosterone levels positively associated with good HDL levels.
• Increase in triglycerides was found in men with Testosterone levels below the 50th percentile range.
• Triglycerides did not change in men with testosterone levels above the 50th percentile.
• Men with bad cholesterol profiles had significantly lower levels of testosterone

THE TURKU MALE AGING STUDY
1619 men aged 40 to 69-year symptoms of low testosterone were assessed.
• Higher testosterone levels correlated directly with higher HDL-cholesterol levels
• Lower testosterone levels were associated with higher total cholesterol, triglycerides, and body mass index.
• Lower testosterone levels did not associate with higher LDL levels.

THE RANCHO BERNARDO STUDY
391 men aged 30-79 years were examined
HDL-C levels correlated positively with higher testosterone levels while higher very low-density lipoprotein
cholesterol levels correlated with lower testosterone levels independently of age, body mass index, physical exercise,
smoking, and alcohol intake.

HDL-C levels were 12% higher and VLDL-C levels were 40% lower in men with the highest testosterone levels compared to men with testosterone levels in the bottom 25%.
****Elevated levels of VLDL are associated with increased risk of atherosclerosis (ie plaque buildup around your arteries)

MULTIPLE RISK FACTOR INTERVENTION TRIAL
66 men aged 41-61 years monitored over 13 years.
A decrease in testosterone levels was associated with an increase in triglycerides and a decrease in HDL levels.

TESTOSTERONE REPLACEMENT THERAPY AND CHOLESTEROL LEVELS

Although there is a positive association between endogenous Testosterone and HDL levels, studies of Testosterone
treatment in testosterone deficient men have shown that:
TRT lowers HDL. But, bear in mind this is associated with also lowering of total cholesterol and LDL
concentrations
It is the lowering of HDL that has sounded off alarm bells in regards to Testosterone therapy and cardiovascular events.
Where the problem arises is that large decreases in HDL levels have been predominantly seen with supraphysiologic (very
high) doses of testosterone administered to young men and the use of anabolic steroids among athletes9-10.
This is why it needs to be emphasized that testosterone replacement therapy should only be given to bring levels
back to optimal levels within the range of what is considered normal. Not to supraphysiologic levels.
Normalization of Testosterone levels with TRT cream has not shown to affect HDL levels11.

CONCLUSION

It’s important to understand that there may be a connection between TRT and cholesterol. Before deciding on utilizing
testosterone therapy, considering its risks and benefits should be your main priority.
Following the advice of your doctor or nurse practitioner about having a lifestyle that is heart-healthy (daily exercise, no
smoking, less alcohol and junk food, low sodium diet etc), will help you keep your blood pressure, cholesterol, as well as
your other manageable risk factors be under control.
Assuming that both testosterone and cholesterol may be connected with each other, stay proactive and constantly keep
the levels of your cholesterol in its safe range.

REFERENCES

1. An update on testosterone, HDL and cardiovascular risk in men. Thirumalai, A., Rubinow, KB, Page, ST. Clinic Lipidol. 2015. 10(3): 251–258.
2. Relationship of sex hormones to lipids and lipoproteins in nondiabetic men. Haffner SM, Mykkänen L, Valdez RA, Katz MS. J Clin Endocrinol Metab. 1993 Dec;
77(6):1610-5.
3. Low serum testosterone in men is inversely associated with non-fasting serum triglycerides: the Tromsø study. Agledahl I, Skjaerpe PA, Hansen JB, Svartberg J. Nutr
Metab Cardiovasc Dis. 2008 May; 18(4):256-62.
4. Endogenous testosterone and serum lipids in middle-aged men. Mäkinen JI, Perheentupa A, Irjala K, Pöllänen P, Mäkinen J, Huhtaniemi I, Raitakari OT.
Atherosclerosis. 2008 Apr; 197(2):688-93.
5. Endogenous sex hormones, high density lipoprotein cholesterol, and other lipoprotein fractions in men. Khaw KT, Barrett-Connor E. Arterioscler Thromb. 1991
May-Jun; 11(3):489-94.
6. Longitudinal relation between endogenous testosterone and cardiovascular disease risk factors in middle-aged men. A 13-year follow-up of former Multiple Risk
Factor Intervention Trial participants. Zmuda JM, Cauley JA, Kriska A, Glynn NW, Gutai JP, Kuller LH. Am J Epidemiol. 1997 Oct 15; 146(8):609-17.
7. Intramuscular testosterone esters and plasma lipids in hypogonadal men: a meta-analysis. Whitsel EA, Boyko EJ, Matsumoto AM, Anawalt BD, Siscovick DS. Am J
Med. 2001 Sep; 111(4):261-9.
8. Effects of testosterone on body composition, bone metabolism and serum lipid profile in middle-aged men: a meta-analysis. Isidori AM, Giannetta E, Greco EA,
Gianfrilli D, Bonifacio V, Isidori A, Lenzi A, Fabbri A. Clin Endocrinol (Oxf). 2005 Sep; 63(3):280-93.
9. Cardiovascular issues in hypogonadism and testosterone therapy. Shabsigh R, Katz M, Yan G, Makhsida N. Am J Cardiol. 2005 Dec 26; 96(12B):67M-72M.
10. Androgen abuse in athletes: detection and consequences. Basaria S. J Clin Endocrinol Metab. 2010 Apr; 95(4):1533-43.
11. Rubinow KB, Vaisar T, Tang C, Matsumoto AM, Heinecke JW, Page ST. Testosteronereplacement in hypogonadal men alters the HDL proteome but not HDL
cholesterol efflux capacity. J. Lipid Res. 2012;53(7):1376–1383.

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