It’s Not the Cholesterol, It’s the Inflammation: The Truth About TRT and Heart Health

 Let’s clear the smoke and slice through the fear-mongering: testosterone use and cholesterol. You’ve heard it all before—“TRT raises your cholesterol, you’re going to clog your arteries and die.” But here’s the truth no one’s telling you: elevated cholesterol doesn’t automatically equal arterial plaque or an increased risk of heart attack and stroke. 

That narrative is outdated, oversimplified, and missing the bigger, more dangerous picture—inflammation.

Testosterone—whether you’re on TRT or running a blast—can indeed increase LDL cholesterol and sometimes drop HDL. But multiple studies, like the 2018 meta-analysis in the Journal of Clinical Lipidology, show that while testosterone can tweak your cholesterol profile, it doesn’t inherently drive a rise in cardiovascular events. 

Why? 

Because cholesterol alone isn’t the villain. It’s more like a firefighter showing up at the scene of a blaze—it’s there because damage exists, not because it caused it.

Here’s where the real threat lies: chronic inflammation. When your endothelium (the lining of your blood vessels) is damaged—through poor diet, smoking, obesity, or even overtraining—your body kicks up inflammation as a repair response. That’s when LDL cholesterol can get trapped and oxidized, starting the plaque-building process. But the real trigger is the inflammatory environment, not the mere presence of cholesterol.

 In fact, studies like the CANTOS trial (2017) proved that reducing inflammation (without altering cholesterol) significantly lowered heart attack risk. Boom—proof that it’s inflammation, not cholesterol alone, that’s the killer.

Now enter the blood-thinner peddlers—the guys hyping up fish oils, aspirin protocols, and “vascular support” supplements. Sure, these have a place, and yes, reducing blood viscosity can ease the workload on your heart and reduce clot risk. But let’s be honest: thinning your blood isn’t a cure-all if you’re walking around with systemic inflammation burning through your arteries. You’re slapping a Band-Aid on a gaping wound and calling it good. 

It’s not just about keeping your blood thin—it’s about keeping your whole vascular system healthy.

If you’re serious about protecting your heart while on testosterone, your real checklist should look like this:

• Control systemic inflammation. That means clean up your diet (whole foods, anti-inflammatory staples like greens and omega-3s), get your sleep locked in, and manage oxidative stress.
• Monitor markers like CRP (C-reactive protein), homocysteine, and fibrinogen, not just cholesterol.
• And yes, keep an eye on hematocrit and blood pressure, but know that blood thickness is only part of the equation.

In summary? 

Testosterone gets a bad rap because it moves numbers on a blood test, but the science tells us those numbers alone don’t tell the full cardiovascular story. 

The real enemy is unchecked inflammation and endothelial damage, and if you’re not addressing that, no amount of blood thinning is going to save you. 

Stay sharp, stay skeptical, and don’t fall for half-truths dressed up as health advice.