In contrast, another recent meta-analysis that included the largest number of studies so far did not find any association between TRT and CVD risk. In aggregate, though there have been mixed results regarding the relationship between low endogenous T levels and incident CVD, these studies suggest that, if anything, higher T levels may be protective. An alternative approach, employed to examine the association between T levels over time and CVD, was a nested case–control study within the Baltimore Longitudinal Study of Aging and the Multiple Risk Factors Intervention Trial . 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. 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. Too little can impair hormone production, and too much can lead to other health issues that may ultimately disrupt testosterone regulation. Many other factors—like blood pressure, blood sugar control, body weight, and lifestyle—also matter. For example, studies often show that TRT lowers HDL ("good cholesterol") and sometimes increases LDL ("bad cholesterol"). Research has shown mixed results, and many factors—such as age, type of therapy, and preexisting health conditions—play a role. For patients and doctors, knowing these differences is important for choosing the right therapy and planning regular cholesterol monitoring. Injections are linked with bigger drops in HDL cholesterol, while gels, patches, and pellets seem to have gentler effects. Because cholesterol is also managed by the liver, there may be crossover effects. Giving testosterone in the form of injections, gels, patches, or pellets can often improve these symptoms. It plays a key role in sexual health, energy, muscle strength, bone density, and mood. It is a type of fat that the body needs for building hormones, vitamin D, and cell membranes. Some men may also receive it for age-related decline in testosterone or for certain medical conditions when a doctor believes it can improve quality of life. Hopefully, a randomized controlled trial, sufficiently powered to look at cardiovascular outcomes in a wide range of hypogonadal men receiving TRT, will be under way. However, this was a small study and there is a need to verify the findings and better understand the functional implications of the observed changes in HDL constituent proteins .. Associations between hormones and lipids were examined using multilinear regression adjusted for potential confounders. Body fat oxidation is improved through the administration of transdermal testosterone in hypogonadal men.|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. This made headlines and created fear that TRT could raise cardiovascular risk. Some of the first studies that got public attention suggested TRT might be harmful for the heart.} One of the most common concerns about testosterone therapy (TRT) is how it affects HDL cholesterol, often called the "good" cholesterol. These effects depend on whether the testosterone is natural or given as therapy, the dose and form used, and the person’s overall health. But cholesterol is carried in the blood by different particles, and the balance between these particles determines heart health. Each has its own benefits, drawbacks, and effects on cholesterol and heart health. Some men may prefer more frequent testing for peace of mind, even if their risk is low. 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. Testosterone therapy may affect those cholesterol levels, including higher HDL cholesterol levels. HDL cholesterol ("good" cholesterol), LDL cholesterol ("bad" cholesterol), and other fats (like triglycerides) travel from your bloodstream to your liver. If TRT significantly improves symptoms of low testosterone (like energy, mood, and muscle mass), doctors may continue therapy while managing cholesterol with lifestyle or medications. Physicians may combine TRT with statins or other lipid-lowering therapies to balance testosterone benefits with cardiovascular safety. 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. Since HDL helps remove cholesterol from arteries, this reduction may be a concern for cardiovascular risk.