Short answer: It can change cholesterol, mostly by small amounts, and the sources do not all point the same way. A 2001 review of 19 studies of testosterone injections found small drops in total cholesterol (14 mg/dL), LDL (5 mg/dL) and HDL, the "good" cholesterol (4 mg/dL). The Kyzatrex label also reports drops, while the older injection labels say cholesterol may rise. Current labels ask for periodic lipid checks, especially after starting.
Most current testosterone labels have a short warning called Lipid Changes. It says changes in the blood lipid profile may require a change in cholesterol medicine or stopping testosterone, and asks for a lipid check periodically, particularly after starting. The details differ by product:
| Label | What it says |
|---|---|
| Kyzatrex (capsule) | In trials, total cholesterol, LDL, HDL and triglycerides all went down (section 5.12) |
| Jatenzo (capsule) | HDL decreased was reported in 5 of 166 men (3.0%) in a 4-month study (section 6.1) |
| AndroGel 1.62% (gel) | High blood lipids were reported in 2% or fewer, more often than on placebo; post-approval reports include high cholesterol and HDL changes |
| Depo-Testosterone (cypionate) | Serum cholesterol may increase during androgen therapy (Precautions) |
| Testosterone enanthate (generic) | Lists increased serum cholesterol; asks for repeated cholesterol tests and caution after a heart attack or with coronary artery disease |
A 2001 meta-analysis pooled 19 studies, published from 1987 to 1999, of 272 men with low testosterone treated with testosterone ester injections. On average the men got 179 mg every 16 days for about 6 months. Compared with their own starting values, the pooled changes were:
| Lipid | Average change | 95% range |
|---|---|---|
| Total cholesterol | −14 mg/dL | −17 to −11 |
| LDL | −5 mg/dL | −8 to −1 |
| HDL | −4 mg/dL | −5 to −2 |
| Triglycerides | −1 mg/dL | −6 to +4 (no clear change) |
The HDL drop tended to be larger at lower doses, though that link was just short of statistical significance. The authors wrote that the overall effect of these changes on heart risk was unknown. The studies were small and had no placebo groups, and they did not cover gels or capsules.
A small drop in HDL is the change people most often ask about, because low HDL is linked with heart disease. None of the sources here show that the testosterone-related drop raises heart events. In the TRAVERSE trial, reported in the current labels, heart attack, stroke and heart death were similar on testosterone gel and placebo (7% vs 7.3%).
That does not settle every case. The enanthate label still asks for caution in people with a past heart attack or coronary artery disease. See TRT and blood pressure for the other heart-related warning on every label.
A lipid panel before starting gives a baseline to compare against. The labels put the next check in the months after starting, and say the prescriber may adjust a statin or other cholesterol medicine, or stop testosterone, if the numbers move.
Dose Track keeps the start date and each dose change in one log, so the timing of a lipid panel can be matched to where someone was in treatment.
Read more on Dose Track: Lipid panel · Cholesterol · Kyzatrex side effects · Depo-Testosterone side effects