Elevated Lipids - Advice Needed

I got my lipid panel results:

Cholesterol, total: 218
triglycerides: 153
HDL: 39
VLDL: 31
LDL: 148

All other tests were normal. All of the above were out of range except VLDL. 51 years old. 245 pounds. 25% body fat (guesstimate). Mother died of heart disease at age 49. Should I get on cholesterol medication? Which medicine does not interfere with TRT? Testosterone, HCG, & Anastrozole.

What would you do?

I have been getting similar results, low 200's, for last 8 years.

Thanks.
 
Before I offer any thoughts, may I ask if you have any blood sugar issues? Diabetes, pre-diabetes, insulin resistance? Would you be good enough to add the reference ranges to your test results? Many thanks.
 

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