However, it is important to remember that all of these studies, regardless of findings, have methodological weaknesses that limit their interpretive value. The authors further suggested that the Xu meta-analysis may have noted an association because their definition of cardiovascular events was more inclusive than typical restriction to major adverse cardiovascular events. Rather than observational findings, interventional data are required to infer causality between androgen exposure and CVD risk in men. Given the absence of a clear, causal relationship, clinical use of TRT is predicated on the presence of hypogonadal symptoms rather than cardiometabolic disease. Since day-to-day variation of T concentrations in a given individual can be large , these single low measurements may not be as meaningful as multiple measurements over time. The inconsistency among the longitudinal data may in part be due to the design of such studies and the reliance on single, or even duplicate measures of serum T. Investigators found no differences in baseline circulating T levels, between the controls and those men who developed incident coronary events, over a decade of follow-up.
As testosterone replacement therapy (TRT) use increases, its role on cardiovascular health must be explored. Multiple risk factors for heart disease appear to be reduced by consuming fish or fish oil. Having documented that after a postmenopausal nadir, testosterone blood concentrations in women aged 70 years and older do not differ from premenopausal counterparts, we sought to understand the clinical significance of this observation. This is because testosterone blood concentrations decline by approximately 25% across the reproductive years, do not acutely change at menopause, but slowly decline to reach a nadir in women in the seventh decade of life.
For now, men on testosterone therapy should work closely with their healthcare provider, monitor their lipid panel regularly, and maintain a heart-healthy lifestyle. Many studies have looked at how testosterone therapy affects cholesterol levels, but results are not always the same. When patients ask if testosterone therapy "increases LDL," they are really asking whether TRT makes the blood more likely to cause cardiovascular disease. On the other hand, improvements in body fat, blood sugar control, and inflammation from testosterone therapy may reduce risks in other ways. Even small shifts in cholesterol caused by testosterone therapy may affect long-term heart health. To understand how testosterone therapy may change cholesterol levels, we first need to look at how cholesterol works in the body and what role testosterone plays in regulating it. Triglycerides are another kind of fat in the blood, and high levels of these can also raise the risk of heart disease.
Some studies show mild decreases in LDL cholesterol (the "bad" cholesterol) and neutral effects on triglycerides. Age, health status, and underlying medical conditions can change how testosterone influences cholesterol levels. For other men, especially those with well-controlled risk factors, testosterone therapy may be reasonably safe under medical supervision.
By understanding these mechanisms, patients and doctors can better predict what might happen during therapy and why close monitoring is important. Testosterone appears to lower HDL levels in some people, while its effect on LDL is less consistent. TRT can be delivered in several forms, such as injections, gels, patches, or pellets, and each method has unique advantages and risks. It is important to note that these benefits are best documented in men who truly have low testosterone due to medical causes.
It’s important to get enough omega-3s because the Western diet often replaces them with other fats, leading to potential health issues. Fish oil has better health benefits than plant-based sources of omega-3s. It contains omega-3 fatty acids, which have many health benefits.
Again, the key factor seems to be the steady hormone levels. This steady pattern seems to have less impact on how the liver makes or clears cholesterol. Studies suggest that gels and creams may have a milder effect on cholesterol compared to injections. The hormone is absorbed through the skin and slowly enters the bloodstream.
Furthermore, the actual exposure to T among the subjects is not clear, as the treatment group was categorized on the basis of a single-filled prescription, and post-treatment T levels were not measured nor was long-term use confirmed. All patients included in this retrospective analysis had low serum T concentrations and had undergone coronary angiography. In contrast to the cross-sectional studies mentioned above, these studies have attempted to analyze large populations of men who received exogenous T, presumably as TRT. Nonetheless, the results of the TOM trial provide important cautionary information regarding the potential for TRT to be harmful in at least some populations of older men and points to the need for larger studies. Importantly, the interpretive value of these randomized controlled trials remains limited, as these studies were not powered to look at CVD events as an outcome. Therefore, the higher rate of cardiovascular events noted in the TOM trial might be attributable to a poorer baseline cardiometabolic profile among the participants. In fact, a similar study of comparable size and design did not observe such an increase in CVD events among men randomized to the T arm .
A high TG to HDL-C ratio is also indicative of a greater proportion of small, dense pro-atherogenic LDL particles, even in healthy people without hyperlipidaemia50–52. In women suspected of having myocardial ischaemia, the ratio of TG to HDL-C has been identified as a strong, independent predictor of all-cause mortality and cardiovascular death. Indeed, an elevated TG/HDL-C ratio confers a significantly greater risk of CHD in women of all ages.

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