Testosterone Replacement Therapy and Lipid Profiles

Introduction to Testosterone Therapy

The American College of Physicians recommends considering the effects of testosterone replacement therapy on lipid profiles, with minimal to no negative effects on lipid parameters at physiologic levels 1
Testosterone replacement therapy at physiologic doses may reduce total cholesterol levels in hypogonadal men, with HDL cholesterol showing no change or minimal reduction, and LDL cholesterol levels typically remaining unchanged or reduced 1

Physiologic levels of testosterone have a neutral effect on lipid profiles, with some evidence suggesting it may even improve lipid parameters in men with hypogonadism, whereas supraphysiologic doses can significantly reduce HDL cholesterol and adversely affect overall lipid profile 1
The impact on lipid profiles appears dose-dependent, with physiologic doses showing minimal to no effects on lipid parameters, and only supraphysiologic doses associated with significant HDL reduction 1

Transdermal testosterone has minimal effects on lipid profiles, with a double-blind, placebo-controlled study showing no significant differences in serum lipids over 36 months 1
Injectable testosterone may have more variable effects on lipid profiles, with a higher risk of erythrocytosis compared to topical preparations, which could indirectly affect cardiovascular risk 1

The Endocrine Society recommends monitoring lipid profiles before and during testosterone therapy, and paying particular attention to hematocrit levels, as testosterone therapy can increase hematocrit, potentially increasing blood viscosity 1
Testosterone therapy can have beneficial effects on cardiovascular outcomes, with higher testosterone levels associated with better outcomes, such as improved angina-free exercise tolerance and increased mean coronary-artery diameter and blood flow 1
However, testosterone therapy can also increase the risk of erythrocytosis, particularly with injectable testosterone, which may aggravate vascular disease, particularly in elderly patients 1