Cholesterol and Testosterone: How They Influence Each Other – and Where TRT Fits in

Published: 2025-05-21

Updated: 2025-05-22

4 mins

Hormones and lipids work together in intricate ways to support many of the body’s essential systems. Cholesterol (a type of lipids) isn’t just something to watch for on your blood test – it actually serves as a building block for hormone production. Testosterone is synthesized from cholesterol, making their connection more significant than many people realize. 

In this article, we’ll explore how cholesterol and testosterone influence one another and how testosterone replacement therapy (TRT) may help restore balance when testosterone levels are low. Whether you’re managing high cholesterol, navigating symptoms of low testosterone, or simply trying to better understand your health, the connection between these two substances matters.

What are Testosterone and Cholesterol?

Testosterone is the primary male sex hormone, though it’s present in all genders. In men, it's mainly produced in the testes, with smaller amounts coming from the adrenal glands. Testosterone plays a central role in sexual health and overall well-being – it supports libido, sperm production, muscle mass, bone density, and mood regulation. As levels decline due to certain medical conditions or aging, men may experience symptoms like fatigue, decreased strength, and reduced sex drive. 

Cholesterol, on the other hand, is a type of fat (lipid) that circulates in the bloodstream. It often gets a bad reputation, but cholesterol is vital to life. It's a structural component of every cell membrane and serves as a raw material for the body to produce vitamin D, bile acids, and hormones – including testosterone.

There are three types of cholesterol:

• LDL (low-density lipoprotein) is often labeled “bad” cholesterol because high levels can lead to plaque buildup in arteries.

• HDL (high-density lipoprotein) is known as “good” cholesterol because it helps remove excess LDL from the bloodstream.

• Total cholesterol refers to the combined levels of HDL, LDL, and other lipid components.

One key biological connection is that cholesterol is the precursor to testosterone production. Your body uses cholesterol to create pregnenolone, a hormone that kickstarts the process of making testosterone and other steroid hormones. Without enough cholesterol, testosterone synthesis can be disrupted – just one reason why these two substances are more connected than they may seem.

The Link Between Testosterone and Cholesterol

The connection between testosterone and cholesterol starts at the cellular level. Testosterone belongs to a class of hormones called steroids, all of which are synthesized from cholesterol. Inside the body, cholesterol is converted into pregnenolone. This hormone then serves as a building block for testosterone and other important hormones like cortisol and estrogen. 

Because cholesterol is a raw material for this hormone-making process, your body depends on it to maintain healthy testosterone levels. If cholesterol levels are too low – whether due to diet, medication, or underlying conditions – this can potentially limit the amount of testosterone your body is able to produce. While rare, extremely low cholesterol levels have been linked in some studies to hormone imbalances and reduced testosterone synthesis.

Cholesterol is essential for testosterone production, but having high cholesterol doesn’t necessarily translate to high testosterone. In fact, high cholesterol levels – particularly elevated LDL – are more often linked to metabolic dysfunction and hormonal imbalance. So while cholesterol is a necessary component in testosterone synthesis, balance is key. Too little can impair hormone production, and too much can lead to other health issues that may ultimately disrupt testosterone regulation.

Does Testosterone Increase 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. 

Some studies have found that testosterone replacement therapy may cause slight shifts in cholesterol levels. For example, injectable testosterone might slightly reduce HDL – the “good” cholesterol – in some men, while transdermal formulations (like gels or patches) tend to have a more neutral impact. In general, the effects on cholesterol are small and often within a clinically acceptable range, especially when TRT is monitored by a healthcare provider.

TRT has also shown improvements in metabolic health that indirectly benefit cholesterol levels for some men. By increasing lean muscle mass and reducing fat mass, testosterone therapy may help improve insulin sensitivity and decrease visceral fat – two factors strongly tied to poor lipid profiles. For men with low testosterone and metabolic syndrome, TRT has been shown in some studies to reduce triglycerides and improve overall cholesterol ratios.

In some cases, there may be a mild increase in LDL or decrease in HDL due to medications that support testosterone, but this isn’t universal – and it’s often offset by broader metabolic improvements.

For certain men, especially those with low T and excess abdominal fat, TRT may support better lipid balance as part of a comprehensive health plan.

Ultimately, the relationship between testosterone and cholesterol is highly individualized. Regular monitoring is essential to ensure that any changes in hormone levels are matched with appropriate cardiovascular risk management.

Low Testosterone and Cholesterol Problems

Low testosterone doesn’t just affect energy, mood, and libido – it may also have a significant impact on your cholesterol levels.

Several studies have found that low testosterone is associated with unfavorable lipid profiles, including elevated LDL (the “bad” cholesterol), lower HDL (the “good” cholesterol), and higher triglyceride levels. This pattern is often seen in men with hypogonadism – a condition where the body doesn’t produce enough testosterone.

The link between low testosterone and cholesterol problems becomes even clearer when looking at metabolic syndrome. This cluster of conditions – which includes abdominal obesity, insulin resistance, high blood pressure, and dyslipidemia (abnormal cholesterol levels) – is more common in men with low testosterone. In fact, low T may contribute to the development of metabolic syndrome by promoting fat accumulation, increasing insulin resistance, and altering the body’s ability to regulate lipids.

While the correlation is strong, especially in men with obesity or metabolic dysfunction, the research still stops short of confirming direct causation. It’s more accurate to say that low testosterone and high cholesterol often go hand in hand – and that treating conditions associated with low testosterone may help improve other components of metabolic health, including cholesterol levels in some individuals.

How TRT May Help Normalize the Balance

For men with conditions associated with low testosterone, TRT can be a valuable option for restoring hormone levels and improving quality of life. TRT is available in several forms – gels, injections, and patches – and works by supplementing the body’s natural testosterone to reach healthier, more functional levels.

One of the broader benefits of TRT, beyond libido and energy, is its potential to improve metabolic markers, including components of the lipid profile. Clinical research has shown that in men with low T, TRT can help:

• Lower triglycerides

• Reduce LDL cholesterol in some cases

• Support weight loss and reduce visceral fat

• Improve insulin sensitivity

That said, TRT is not a direct treatment for high cholesterol. Its effects on lipid health are most notable when testosterone deficiency is driving broader metabolic issues. For this reason, regular monitoring of cholesterol levels is essential during TRT. A healthcare provider can ensure that therapy is improving your health overall – and not unintentionally increasing cardiovascular risk.

If you’re feeling off – whether it’s low energy, reduced sex drive, mood changes, or other signs of hormonal imbalance – it could be time to take a closer look at your testosterone levels, too.

The Rex MD Testosterone Program may help you feel like yourself again. If you qualify, your provider will help you determine the best treatment for balancing your hormone levels.

To find out if the program is right for you, answer a few questions about your symptoms and medical history. Your provider will order lab work for you and determine if you’re eligible for treatment options based on your results. 

Then, you’ll be able to schedule a virtual call with your Rex MD-affiliated physician.

Get started today.