Testosterone (or Anastrozole?) Decreased my HDL: What Can I Do?

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Bishop

New Member
Everything so far has been going great since getting my dose dialed in for TRT. Turned out everything looks really good at 70mg every 4 days subcutaneous. No need for an AI and no HCT issues.

Only thing that bothers me is my HDL has dropped to 38. My total cholesterol looked really good at 110 but my doc says the HDL needs to be over 50 ideally.

Is there anything I can do to help this number besides good eating and exercise which I already do?
 
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Defy Medical TRT clinic doctor

Nelson Vergel

Founder, ExcelMale.com

WAYS TO INCREASE HDL:

  1. Decrease or stop anastrozole since it can reduce HDL
  2. NAC Benefits: HDL and More
  3. How to Increase Good Cholesterol (HDL)
  4. Effect of Diet on HDL
  5. Why does testosterone therapy decrease HDL cholesterol in some men?
 

KSPhD

Member
I think the HDL woes are overblown. If you are over 40 mg/dl you are likely just fine. Most people can get there easily eating well and moving more or participating in structured exercise. HDL boosting drug trials have all failed over the past decade as they don't impact mortality. The newest research out supports this trend.

http://www.onlinejacc.org/content/68/19/2073
 

Nelson Vergel

Founder, ExcelMale.com
The studies actually showed that HDL lower than 30 increased risk of death caused by cardiovascular disease and cancer. The higher HDL levels over 70 did not seem as protective as 40-70.

HDL mortality.jpg
 
Last edited:

KSPhD

Member
Full text for those who are interested. Nelson, there is a higher hazard ratio for those at the very bottom and those at the very top. But if you look at Table 2, there is a difference in incidence rates for men (comparing <30 and >51) of ~7 / 1000 person years. I don't think this is much to lose sleep over.
 

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Stop injectable T and go to a high concentration compounded cream 200mg/gm applied 2x per day. Any higher concentration causes crystallization. This is about 10x the concentration of commercially available T. The injectable T does decrease your HDL but the the transdermal T increases your HDLs. This has to do with the injectable
passing through the liver to have the non bioidentical component (cypionate etc..) removed. It causes a advers effect on your lipid profile. If you want to improve your lipid profile find a well trained physician in your area that can do this. Injectable T also causes a roller coaster effect that the transdermal cream does not. My patients T levels are maintained at a constant level day to day without the high to lows seen with injectables.
HRT is not just knowing about the different types of hormones, but also the different effects based on mechanism of delivery as well as the appropriate dosages to achieve the desired effect.
 
The injectable T does decrease your HDL but the the transdermal T increases your HDLs

Testosterone replacement in hypogonadal men alters the HDL proteome but not HDL cholesterol efflux capacity

Effect of testosterone replacement therapy on lipids and lipoproteins in hypogonadal and elderly men. - PubMed - NCBI

I'm sorry, but evidence doesn't support this.

This has to do with the injectable
passing through the liver to have the non bioidentical component (cypionate etc..) removed.

Alternative routes of administration like suppository, intravenous, intramuscular, inhalational aerosol, transdermal and sublingual avoid the first-pass effect because they allow drugs to be absorbed directly into the systemic circulation.

First pass effect - Wikipedia

Are you telling me you believe parenteral administration of a drug undergoes first pass metabolism?

You also believe that esters are cleaved hepatically?

Critical Factors Influencing the In Vivo Performance of Long-acting Lipophilic Solutions—Impact on In Vitro Release Method Design
 

Nelson Vergel

Founder, ExcelMale.com
The HDL decrease happens in all TRT options but is dose-dependent. No HDL drop happens in doses equivalent to 100 - 150 mg per week of injectable testosterone.

Low HDL in combination with decreased Lipoprotein A (along with increased hematocrit) can substantially increase cardiovascular risks in high dose T or anabolic steroid users.


Am J Cardiol. 1996 Jun 1;77(14):1244-7.

Testosterone decreases lipoprotein(a) in men.

Zmunda JM1, Thompson PD, Dickenson R, Bausserman LL.


Abstract
We administered testosterone, with or without the aromatase inhibitor testolactone, to determine the effects of testosterone and its aromatization to estradiol on Lp(a) levels in normal men. Average Lp (a) values decreased by 37% during testosterone alone and by 28% when testosterone and testolactone were combined, suggesting that testosterone reduces Lp(a) in men primarily by an androgenic effect and not by its conversion to estradiol.

_______________________________________________


Lipoprotein (a) and cholesterol in bodybuilders using anabolic androgenic steroids

We examined the influence of self-administered anabolic androgenic steroids (AAS) on the lipogram of male bodybuilders. Serum lipoprotein (a) (Lp(a)), total cholesterol, low-density lipoprotein cholesterol (LDL-C), and high-density lipoprotein cholesterol (HDL-C) levels were measured in 10 experimental and 8 control male competitive bodybuilders. The proportion of subjects with serum Lp(a) levels above 30 mg.dl-1 was significantly lower in the AAS group than the non-AAS group. HDL-C levels were significantly lower and LDL-C levels significantly higher in the AAS group than the non-AAS group. These data suggest that AAS in male bodybuilders have a beneficial effect on serum Lp(a) levels but reduce the HDL-C:LDL-C ratio.

Lipoprotein (a) and cholesterol in bodybuilders using anabolic androgenic steroids | Request PDF. Available from: Lipoprotein (a) and cholesterol in body builders using anabolic androgenic steroids | Request PDF [accessed Oct 07 2018].
 

xqfq

Active Member
The HDL decrease happens in all TRT options but is dose-dependent. No HDL drop happens in doses equivalent to 100 - 150 mg per week of injectable testosterone.

Low HDL in combination with decreased Lipoprotein A (along with increased hematocrit) can substantially increase cardiovascular risks in high dose T or anabolic steroid users.


Am J Cardiol. 1996 Jun 1;77(14):1244-7.

Testosterone decreases lipoprotein(a) in men.

Zmunda JM1, Thompson PD, Dickenson R, Bausserman LL.


Abstract
We administered testosterone, with or without the aromatase inhibitor testolactone, to determine the effects of testosterone and its aromatization to estradiol on Lp(a) levels in normal men. Average Lp (a) values decreased by 37% during testosterone alone and by 28% when testosterone and testolactone were combined, suggesting that testosterone reduces Lp(a) in men primarily by an androgenic effect and not by its conversion to estradiol.

_______________________________________________


Lipoprotein (a) and cholesterol in bodybuilders using anabolic androgenic steroids

We examined the influence of self-administered anabolic androgenic steroids (AAS) on the lipogram of male bodybuilders. Serum lipoprotein (a) (Lp(a)), total cholesterol, low-density lipoprotein cholesterol (LDL-C), and high-density lipoprotein cholesterol (HDL-C) levels were measured in 10 experimental and 8 control male competitive bodybuilders. The proportion of subjects with serum Lp(a) levels above 30 mg.dl-1 was significantly lower in the AAS group than the non-AAS group. HDL-C levels were significantly lower and LDL-C levels significantly higher in the AAS group than the non-AAS group. These data suggest that AAS in male bodybuilders have a beneficial effect on serum Lp(a) levels but reduce the HDL-C:LDL-C ratio.

Lipoprotein (a) and cholesterol in bodybuilders using anabolic androgenic steroids | Request PDF. Available from: Lipoprotein (a) and cholesterol in body builders using anabolic androgenic steroids | Request PDF [accessed Oct 07 2018].

As a note of clarification, Lipoprotein (a) (aka Lp(a)) is a "bad guy." People with elevated Lp(a) levels, which are almost entirely genetic, face substantially increased risk of CVD. There aren't yet great drugs to lower Lp(a):

Lipoprotein (a), an independent cardiovascular risk marker

This article on The Biggest Loser host Bob Haper's unexpected heart attack highlights the need to screen for Lp(a):

The Harmful Blood Particle You've Never Heard Of - Cleveland HeartLab, Inc.

Anabolic steroids are one of the substances known to decrease Lp(a) levels, oddly enough. But this particular decrease is (IMO) unlikely to confer CVD risk, as higher levels are worse for you.
 

Larry B

New Member
Great info! I'll be busy reading it. Do you feel .31 ml of testosterone Monday and Thursday and .5 mg of anastrozole once a week is too much? Could this be causing my low HDL? If so, what amount of each should I take to increase my HDL? My estradiol is 32.2 which is near the high end of normal.
 
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