Cholesterol and Testosterone: What's the Connection?

Key Takeaways:

• Cholesterol is a key building block for testosterone. Through a process called steroidogenesis, cholesterol sets the stage for testosterone creation in the Leydig cells found in the testes.

• Researchers are still trying to understand the link between cholesterol and testosterone. High LDL cholesterol and other cardiometabolic problems are linked to lower testosterone, while the impact of very low cholesterol is less clear and still being studied.

• What you eat, how much you move, how you manage stress, your sleep patterns, and even your drinking habits all play a role in maintaining healthy cholesterol and testosterone levels. 
  

Cholesterol often gets a bad reputation, but the story is more nuanced than “cholesterol = bad.”

Sure, too much LDL cholesterol in your blood can be harmful for your heart, but the cholesterol your body makes is essential for many normal functions. It’s actually the starting point for making testosterone, a sex hormone that helps support energy, muscle strength, and libido.

Understanding how cholesterol impacts testosterone production can help you make smarter lifestyle choices for your heart, hormones, and long-term health.

Without cholesterol, your body can’t make testosterone. Thankfully, your body produces all the cholesterol it needs, no matter what’s on your plate.

One study in about 750 white men found that those following plant-based diets had similar testosterone levels to omnivores, suggesting you don’t need dietary cholesterol to maintain healthy testosterone.

Cholesterol plays some crucial roles in your body. In addition to aiding in testosterone production, it also helps build and maintain the flexible, protective membranes around your cells. Plus, cholesterol is a key player in creating other important substances like:

• Cortisol 

• Aldosterone 

• Vitamin D

• Bile acids

Cholesterol is involved in testosterone production through a process called steroidogenesis, which translates to “creation of steroids.” 

First up, an enzyme cuts off part of a cholesterol molecule, turning it into pregnenolone. This compound is the starting point for nearly all steroid hormones, including testosterone. Next, pregnenolone undergoes a series of enzyme-driven reactions and modifications until it finally becomes testosterone.

At the cellular level, this process depends on Leydig cells having access to enough cholesterol to use as a starting material. How does cholesterol find its way into the special cells that manufacture testosterone (Leydig cells)? Leydig cells can draw cholesterol from several sources, including cholesterol they make themselves and cholesterol carried in the bloodstream by lipoproteins such as LDL-C and HDL-C. 

Recent research reveals that the link between circulating testosterone and cholesterol levels – both from what we eat and what our bodies produce — in men is more complex and requires further study.

But here’s what we can say so far. 

We’ve all heard LDL described as the “bad” cholesterol, the stuff that causes plaque buildup in the arteries, increasing the risk of coronary heart disease and strokes. 

But here’s something you probably haven’t heard: high LDL levels are also linked with factors—like oxidative stress and blood vessel damage—that may negatively affect testosterone production. 

Oxidative Stress

High LDL cholesterol is associated with oxidative stress. Animal and in vitro data suggest that oxidative stress can damage Leydig cells, impairing their ability to function properly, which may slow the conversion of cholesterol into testosterone.

Inflammation

Inflammation is your body’s natural response to injury or irritation. It’s helpful short-term, but when it sticks around, it causes problems. Persistently high LDL levels contribute to chronic low-grade inflammation in blood vessels and other tissues and may interfere with normal testosterone production.

Blood Vessel Damage

For your body to effectively make testosterone, it needs a steady supply of nutrients and oxygen. This all depends on healthy blood vessels. High cholesterol, along with chronic inflammation and oxidative stress, can harm blood vessels and make it harder for blood to flow freely. If blood flow to the testes is reduced, it can theoretically impair testicular function and contribute to lower testosterone levels.Damage to blood vessels from high cholesterol and inflammation is also a key contributor to erectile dysfunction (ED).

In theory, if Leydig cells don’t get enough cholesterol, they can’t make enough testosterone.

Low cholesterol levels (hypolipidemia) are much less common than high cholesterol. In rare cases, severe genetic conditions that dramatically lower cholesterol could theoretically affect testosterone, but this isn’t well studied.

Common signs of low testosterone (hypogonadism) include:

• Less interest in sex (low libido)

• Erectile dysfunction

• Feeling tired all the time

• Losing muscle or strength

• Gaining more body fat

• Mood changes

• Finding it hard to focus (aka brain fog)

• Losing bone strength over time 

• Body hair loss

• Trouble sleeping

Many of these signs can mean different things. If you’re experiencing several of these symptoms, especially over time, it’s worth talking with your provider about whether checking your testosterone levels makes sense. For men, normal testosterone levels are usually between 300-1,000 ng/dL, but exact cutoffs vary by lab and clinical guidelines

Your everyday choices impact many things, including your cholesterol and testosterone production. Let’s dive into how your habits can play a role.

Nutrition

Here are some of the key nutrients involved in your body’s production of testosterone and cholesterol:

• Saturated and trans fats. Eating too many saturated and trans fats can raise LDL cholesterol and lower HDL. Diets high in these fats are linked with more inflammation, which may contribute to lower testosterone over time.

• Dietary cholesterol. Most people don’t need to worry too much about cholesterol in their food. But some people, called “hyper-responders,” might need to watch their intake. 

• Refined carbohydrates and sugars. A diet high in ultra-processed foods and saturated fat intake can lead to insulin resistance, high triglycerides, lower HDL cholesterol, and inflammation.

• Healthy fats. Foods like olive oil, avocados, nuts, seeds, and fatty fish (like salmon) can improve your lipid profile by lowering LDL and increasing HDL. Omega-3s in fish also fight inflammation, and some early research suggests they may also support healthy testosterone levels. 

• Fiber. Soluble fiber, like in oats, beans, apples, can help reduce LDL cholesterol by binding to it in the digestive tract. 

• Protein. Choose lean sources of protein like poultry, fish, and legumes. They can help you maintain muscle mass, which indirectly supports testosterone.

The takeaway? Emphasize whole, minimally processed foods and limit ultra-processed, high-fat foods, which are associated with worse cholesterol patterns and lower testosterone levels. 

Physical Activity

A combo of cardio and strength training is ideal for supporting a healthy lipid profile. Here’s what that might look like:

• Cardio. Aim for 150-300 minutes per week of moderate-intensity exercises, like running, swimming, or cycling.

• Strength training. Lift weights or do bodyweight exercises, like push-ups. Aim for at least two sessions a week. This may help stimulate testosterone production. 

Stress and Sleep

When you’re stressed, your body releases cortisol, the primary stress hormone, which can have negative effects on your testosterone production. Chronic stress can also raise your LDL and triglycerides, triggering inflammation. 

Did you know you make most of your testosterone in your sleep? When you don’t get enough sleep, your body struggles to adequately repair, recover, and maintain hormone balance. Studies also show that chronic sleep deprivation can lower testosterone levels. 

To keep your stress in check, try:

• Mindfulness exercises

• Meditation

• Breathing exercises

• Spending time in nature

• Journaling

As for sleep, aim for 7 to 9 hours a night. Make your bedroom cozy and avoid screens before bedtime. 

Alcohol Intake

Older research suggests a moderate amount (2 drinks per day for men) has a neutral or slightly positive effect on HDL cholesterol for some people. But newer studies question whether there’s any real overall health benefit from alcohol and the drawbacks of alcohol consumption outweigh the slight chance that it’ll benefit your cholesterol levels. Plus, there are plenty of healthy ways to boost HDL.

Chronic heavy alcohol usecan also damage your Leydig cells, impacting your body’s ability to make testosterone. 

One study found that heavy drinkers have 12 percent lower T levels compared to moderate or non-drinkers. Alcohol also increases the activity of the aromatase enzyme, which converts testosterone into estrogen. Plus, excessive alcohol intake can disrupt liver function, impacting cholesterol metabolism and contributing to fatty liver disease.

Certain medical conditions can impact healthy hormone balance, including:

• Metabolic syndrome (MetS). This is a cluster of conditions, including high blood pressure, high blood sugar, excess belly fat, high triglycerides, and/or low HDL, that can increase your risk of heart disease, stroke, and type 2 diabetes. Men with MetS often have low T levels because of chronic systemic inflammation and insulin resistance.

• Obesity. Carrying extra weight around your middle can increase the activity of something called aromatase, which can lead to insulin resistance, chronic low-grade inflammation, and poor lipid profiles. Higher body weight is also a risk factor for sleep apnea, and poor sleep directly lowers T production.

• Type 2 diabetes. A substantial proportion of men with type 2 diabetes also have low testosterone levels. Insulin resistance makes it hard for Leydig cells to function optimally. It’s also common for people with T2D to have dyslipidemia, or high triglycerides, and low HDL.

• Thyroid disorders. Underactive thyroid (hypothyroidism) slows metabolism and can encourage elevated LDL and triglycerides. It can also impact testosterone, leading to lower levels due to impaired testicular function. 

• Familial hypercholesterolemia. Some people inherit genetic mutations that lead to extremely high levels of LDL from birth, regardless of lifestyle. This can increase cardiovascular disease risk and impact metabolic health, which may indirectly influence testosterone production

Some medications can cause side effects that change how your body works. Here are a few examples of medications that can impact testosterone and cholesterol levels.

Testosterone Replacement Therapy (TRT)

TRT can be life-changing in a good way, but can also lead to a slight decrease in HDL. 

Testosterone therapy can also increase hematocrit (red blood cell count), which can thicken blood and may increase the risk of blood clots if levels get too high, which is why regular monitoring is importantIn some men with low T, TRT may reduce total cholesterol and LDL cholesterol while also lowering triglycerides. But, TRT can also lower HDL cholesterol in certain cases, which is not always ideal since HDL helps protect heart health. 

Other Medications

Other medications that can change your testosterone or cholesterol levels:

• Beta-blockers. These help with high blood pressure (hypertension) and heart issues. Some older beta-blockers might raise triglycerides and lower HDL cholesterol. 

• Statins. Healthcare providers prescribe these to lower high cholesterol. Some research suggests they might lower testosterone, but the evidence is mixed. 

• Diuretics (Thiazide). These help your body get rid of excess fluid and lower blood pressure, but they might slightly increase total cholesterol, LDL, and triglycerides. 

• Corticosteroids. Long-term use can raise blood sugar, lead to weight gain, and affect lipid profiles negatively. They can also lower testosterone by affecting how your body makes it. 

• Opioids. Chronic opioid use is a known cause of secondary hypogonadism. Long-term use can significantly suppress testosterone production by interfering with the brain's signals to the testes.

There’s a pretty important link between cholesterol and testosterone: cholesterol is the raw material for testosterone synthesis, and cholesterol imbalances often travel alongside hormone and metabolic issues Ultimately, more research is needed to understand just how much of an effect cholesterol has on testosterone production. 

So, how can you keep your cholesterol and testosterone levels in check? Eat nourishing foods, get regular exercise, control your stress levels, and grab adequate shut eye. It’s also important to work closely with your healthcare provider. Get annual checkups and mention when something feels off. 

We’ve compiled a list of answers to common questions about how testosterone and cholesterol are related in men’s health. 

How exactly does cholesterol become testosterone?

Cholesterol is converted into pregnenolone through enzyme activity. It then undergoes several steps to form testosterone in the Leydig cells, found in the testes.

Can high cholesterol cause low testosterone?

While the mechanism isn’t fully understood, high LDL cholesterol is linked with oxidative stress, inflammation, and blood vessel problems, which may, over time, impair Leydig cell function and contribute to lower testosterone 

What happens if my cholesterol is too low?

Extremely low cholesterol could impact testosterone production. However, in people whose LDL is lowered with medications low LDL levels have generally not been shown to cause major problems with testosterone.

Can improving my diet and exercise boost testosterone naturally?

Yes. A diet rich in unsaturated fats, fiber, and whole foods (paired with regular resistance and cardio training) supports healthy cholesterol balance and testosterone levels. Read our guide on natural ways to increase testosterone.

Do medications for cholesterol or other conditions affect testosterone?

Some medications, like statins or corticosteroids, can slightly alter testosterone levels, while others (such as opioids or beta-blockers) may impact hormone balance more significantly. Always discuss side effects with your healthcare provider.