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Because the research is mixed and the long-term effects are still being studied, open communication between patients and doctors is critical. Blood pressure, blood sugar, smoking status, body weight, and family history all play big roles. For example, even if HDL falls slightly, overall heart risk may not rise if LDL remains stable and other risk factors are well controlled. The size and direction of these changes depend on the dose, the type of testosterone used (injection, gel, patch), and the health status of the individual. This combined approach gives a fuller picture of health and helps guide safe long-term treatment. When doctors monitor cholesterol during TRT, they usually check other labs at the same time. Continuous monitoring allows doctors to catch changes early and adjust therapy or recommend lifestyle changes if needed.
Like most hormones, testosterone is supplied to target tissues in the blood where much of it is transported bound to a specific plasma protein, sex hormone-binding globulin (SHBG). Like other steroid hormones, testosterone is derived from cholesterol (Figure 1). Lipophilic hormones (soluble in lipids but not in water), such as steroid hormones, including testosterone, are transported in water-based blood plasma through specific and non-specific proteins. In one experiment, subjects who interacted with handguns showed higher testosterone levels and aggression than those who interacted with toys. The masculinization of the brain is not just mediated by testosterone levels at the adult stage, but also testosterone exposure in the womb. The same research found fathers (outside competitive environments) had the lowest testosterone levels compared to other males. If a father's testosterone levels decrease in response to hearing their baby cry, it is an indication of empathizing with the baby.
The reflexive testosterone increases in male mice is related to the male's initial level of sexual arousal. Every mammalian species examined demonstrated a marked increase in a male's testosterone level upon encountering a novel female. Studies conducted in rats have indicated that their degree of sexual arousal is sensitive to reductions in testosterone. Sexual arousal and masturbation in women produce small increases in testosterone concentrations. Testosterone levels follow a circadian rhythm that peaks early each day, regardless of sexual activity.
Testosterone therapy is a treatment that is becoming more common, especially for men who have low testosterone either from aging or from medical conditions. Eating a balanced diet low in saturated fat, exercising regularly, avoiding smoking, and maintaining a healthy weight all reduce cholesterol and heart risk. These shifts may not be dangerous by themselves, but when combined with other risks—such as high blood pressure, diabetes, or smoking—they can contribute to long-term heart disease. Studies show that testosterone therapy may lower HDL cholesterol in some men. For this reason, doctors recommend regular blood tests to track cholesterol while someone is taking testosterone. Testosterone replacement therapy (TRT) can change levels of LDL ("bad" cholesterol), HDL ("good" cholesterol), and triglycerides. Diet, exercise, body weight, smoking, alcohol use, sleep, and stress all interact with testosterone therapy.
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. For now, men on testosterone therapy should work closely with their healthcare provider, monitor their lipid panel regularly, and maintain a heart-healthy lifestyle. Instead, they consider the full lipid profile (LDL, HDL, triglycerides, and total cholesterol) together with blood pressure, blood sugar, and family history of heart disease. These mechanisms help explain why even medically supervised testosterone therapy often results in lower HDL levels. Many studies have looked at the effect of testosterone therapy on HDL cholesterol.
Testosterone can influence cholesterol levels, but the effects vary widely depending on the person’s overall health and if they’re taking medication to help normalize testosterone levels. Because cholesterol is a raw material for this hormone-making process, your body depends on it to maintain healthy testosterone levels. One study from 2021 showed that low testosterone levels can raise cardiovascular risk, and testosterone replacement therapy, which supplements those levels, can decrease the risk of cardiovascular disease. Some studies suggest that testosterone therapy could have a positive effect on cholesterol levels, while other studies suggest no effect. Many studies have looked at how testosterone therapy affects cholesterol levels, but results are not always the same. To understand how testosterone therapy may change cholesterol levels, we first need to look at how cholesterol works in the body and what role testosterone plays in regulating it. In these cases, doctors may recommend testosterone therapy to bring hormone levels back to a healthy range.
Prenatal androgens apparently influence interests and engagement in gendered activities and have moderate effects on spatial abilities. This period affects the femininization or masculinization of the fetus and can be a better predictor of feminine or masculine behaviours such as sex typed behaviour than an adult's own levels. Examples include genital virilisation such as midline fusion, phallic urethra, scrotal thinning and rugation, and phallic enlargement; although the role of testosterone is far smaller than that of dihydrotestosterone. The relative potency of these effects can depend on various factors and is a topic of ongoing research. Testosterone can be described as having anabolic and androgenic (virilising) effects, though these categorical descriptions are somewhat arbitrary, as there is a great deal of mutual overlap between them. In general, androgens such as testosterone promote protein synthesis and thus growth of tissues with androgen receptors. have been undertaken on the relationship between more general aggressive behavior, and feelings, and testosterone. On the other hand, elevated testosterone in men may increase their generosity, primarily to attract a potential mate.|HDL cholesterol ("good" cholesterol), LDL cholesterol ("bad" cholesterol), and other fats (like triglycerides) travel from your bloodstream to your liver. Exercise, a heart-healthy diet, weight management, and limiting alcohol can offset potential HDL reductions from TRT and support overall cardiovascular health. Some studies suggest that TRT can reduce LDL cholesterol slightly, especially in men with low baseline testosterone.}
The FDA still requires caution and careful prescribing but has acknowledged recent evidence showing no clear rise in cardiovascular risk for most patients. Results showed no significant increase in heart attacks, strokes, or deaths in the testosterone group compared to the placebo group. For example, observational studies that included thousands of men found no clear increase in heart attack or stroke rates among men on TRT. Another small trial in 2010 also showed more cardiovascular events in men receiving testosterone gel.