Did you know your body uses cholesterol to make testosterone?

Based on this, you might assume that more cholesterol means more testosterone. But that’s not the case. In fact, raised total cholesterol often appears alongside lower testosterone. The reason for this is that both conditions often share the same cause, including obesity and metabolic syndrome [1].

TRT can shift your cholesterol results, but not predictably. Here’s what the evidence shows and what to do about it.

The cholesterol-testosterone connection
Does eating cholesterol increase testosterone?
Does low testosterone raise cholesterol?
Does TRT affect cholesterol?
Can you start TRT with raised cholesterol?
How to lower cholesterol on TRT
Do statins lower testosterone?
What cholesterol results should you monitor on TRT?

How are cholesterol and testosterone connected?

Cholesterol is a waxy substance found in every cell in your body. It gets a bad rep, but the truth is, you couldn’t live without it. It helps build the membranes around your cells and is used to make vitamin D, bile acids for digestion, and hormones like oestrogen and testosterone [2]. Your body makes the cholesterol it needs, and you also get some from animal foods like eggs, meat, and dairy.

In the testicles, specialised cells called Leydig cells convert cholesterol into testosterone through a series of steps. Signals from the brain tell them when to get to work [3].

Having more cholesterol in your blood doesn’t speed up this process. The signals from the brain and the ability of the testicles to respond (as well as your general health and genetics) are largely what determine your testosterone levels. A cholesterol test can’t tell you how much testosterone you’re making.

Does eating more cholesterol increase testosterone?

Once you know cholesterol is used to make testosterone, eating more of it might sound like an easy way to boost your levels, but that’s not how it works. Your body already makes its own supply. Eating more cholesterol doesn’t give your testicles extra fuel to make more testosterone [3].

If you’re trying to improve your testosterone naturally, weight, sleep, and activity are more useful places to focus. Our guide to increasing testosterone naturally explains where to start.

Does low testosterone raise cholesterol?

Low testosterone and unhealthy blood fat levels often appear together. In men carrying excess weight around their middle, a common pattern is raised triglycerides (bad ‘fat’) and low HDL (‘good’) cholesterol [4].

One reason is that the same health problems, like obesity, can affect both. Carrying excess weight can lead to lower testosterone levels by affecting brain signalling. Fat tissue also contains an enzyme called aromatase, which actively converts testosterone to oestrogen. Obesity simultaneously changes how the body handles blood fats, which can lead to raised cholesterol levels [5].

Some research also suggests that low testosterone may reduce the liver's ability to clear LDL (‘bad’) cholesterol from the blood [6].

However, in any case, it’s difficult to prove that low testosterone has caused raised cholesterol, or that increasing testosterone will improve it. Raised cholesterol still needs assessing in its own right, looking at diet, family history, exercise, and in some cases, medication.

Does TRT raise or lower cholesterol?

TRT can have a small effect on cholesterol, but the changes aren’t entirely consistent. Across clinical trials, total cholesterol tends to fall slightly, while changes in LDL (‘bad’) cholesterol are usually small. HDL (‘good’) cholesterol can also fall slightly.[1,7]

In one pooled study of 5,601 men, men taking TRT saw a small decrease in total cholesterol (0.15 mmol/L) and HDL cholesterol (0.06 mmol/L). However, changes in LDL were small and not significant (0.03 mmol/L) [7].

TRT can also change body composition. In men with low testosterone, treatment can reduce body fat and increase muscle mass, although it doesn’t reliably cause weight loss [8]. These changes could have wider metabolic benefits, but there’s limited evidence that they translate into meaningful reductions in cholesterol.

In summary, TRT shouldn't be prescribed to lower cholesterol. Any improvement is a possible bonus, not a substitute for treating cholesterol directly.

Can you start TRT with high cholesterol?

Usually, yes. Having raised cholesterol doesn’t rule out TRT, but it should be part of your assessment with a plan to manage it alongside treatment.

If your cholesterol is markedly high, or close relatives had heart disease young, your GP may look for an inherited cause [9]. You may need lifestyle changes, medication, or both.

For the wider picture, read our guide on TRT and heart health.

How to lower cholesterol on TRT

Being on TRT doesn’t change how you should manage cholesterol. Eating a cholesterol-healthy diet and getting enough exercise remain the most effective natural ways to keep your cholesterol levels healthy [10].

Reduce your intake of trans and saturated fats – Butter, cream, sausages, bacon, pastries, and biscuits can add a lot of saturated fat to your diet. Switching to olive oil, leaner meats (like fish or skinless chicken breasts), and nuts are healthier alternatives.
Add more fibre – Oats, beans, lentils, fruit, and vegetables are good choices. Soluble fibre helps reduce the reabsorption of bile acids in the gut, so your body uses more cholesterol to replace them.
Keep active – Aim for at least 150 minutes of moderate activity a week [11]. Brisk walking, swimming, and cycling all count.
Stop smoking – If you smoke, cutting down or ideally stopping can significantly improve your heart health.
Reduce alcohol intake – Reducing alcohol to less than 14 units a week can help protect your heart and improve your triglyceride levels [12].
Consider medication when it’s needed – Sometimes lifestyle changes aren’t enough, especially if you have a genetic predisposition to raised cholesterol. Your GP may recommend a statin to lower cholesterol and reduce your overall risk of heart disease and stroke.

If your cholesterol worsens on TRT, speak to your prescriber. They can review your hormones, dose, and wider health.

Do statins lower testosterone?

Statins reduce the amount of cholesterol your body makes, so it’s understandable to wonder whether they also affect testosterone.

A 2024 review found a small average fall in total testosterone after statin treatment. The fall was about 0.46 nmol/L, with average levels remaining within the normal range. It’s a very small reduction and unlikely to be clinically meaningful [13].

What cholesterol results should you monitor on TRT?

Ideally, you should monitor the full panel, including total cholesterol, HDL, LDL, non-HDL, and triglycerides. Having a test before treatment gives you a useful starting point for later comparisons. Current European guidance also recommends checking your lipid profile before TRT and monitoring it during treatment [1]. At Leger, we always check your cholesterol levels before starting TRT.

As a general guide, targets for healthy adults are [14]:

Total cholesterol less than 5 mmol/L
Non-HDL cholesterol less than 4 mmol/L
LDL cholesterol less than 3 mmol/L
HDL greater than 1 mmol/L

Your own personal targets may differ, particularly if you have a higher risk of heart disease or stroke. For example, people who already have cardiovascular disease are usually given lower LDL and non-HDL targets [14].

Looking after cholesterol and testosterone

Your body needs cholesterol to make testosterone, but that doesn’t make high blood cholesterol helpful. And although TRT may affect your cholesterol results, it won’t reliably correct an unhealthy balance.

If you’re starting treatment, have a plan for any raised cholesterol from the outset. If you’re already on TRT, use your earlier results to understand what’s changed and whether you’re heading towards your target.

Want to talk through TRT and your blood results? Get in touch with us.