Elevation in lipid profile, a blood test for abnormalities in cholesterol and triglycerides, has been consistently shown to be linked with higher incidence of deaths related to heart disease, stroke, and other serious medical conditions. Interestingly, there is growing body of clinical evidence that supports the link between low testosterone levels and elevated cholesterol levels.
A study by Wickramatilake et al. found that low levels of total testosterone in men with coronary artery disease appeared together with an abnormal lipid profile.  Researchers found that men with abnormally low testosterone levels have higher low density lipoprotein (bad cholesterol). In addition to this, the subjects also have lower levels of high density lipoprotein (good cholesterol).
In a similar study, Bobjer et al. found a strong link between low testosterone levels and abnormal lipid profiles.  The researchers therefore concluded that medical management of patients with elevated cholesterol levels must include evaluation of testosterone levels.
On the other hand, several high quality studies have shown that higher blood testosterone levels are associated with higher high density lipoprotein concentrations. In particular, it was found that two genes involved in the production of high density lipoprotein are governed by testosterone, namely, hepatic lipase (HL) and scavenger receptor B1 (SR-B1).
Because of the strong link between testosterone and cholesterol levels, a number of clinical studies has been undertaken in order to assess the therapeutic benefits of testosterone in patients with abnormal lipid profiles. For instance, a study by Huisman et al. has shown that testosterone has a beneficial effect on cholesterol and triglycerides.  This study also reported lower incidence of atheroma (degeneration of the arterial walls caused by accumulated fatty deposits and scar tissue) among 536 males.
In another study, Han et al. evaluated the lipid profile changes with testosterone replacement therapy in the population with testosterone deficiency syndrome.  After 6 months of treatment, the study participants had significant reductions in total cholesterol and triglycerides compared to baseline values. The researchers therefore concluded that testosterone has the efficacy to reduce total cholesterol and triglycerides.
In hypogonadal and elderly men, Zgliczynski et al. found that intramuscular injections of testosterone enanthate 200 mg every second week was able to normalize testosterone levels as well as reduce low density lipoprotein cholesterol levels with no side effects on the prostate and other body systems.  In addition, the treatment also reduced total cholesterol levels after 6 months of treatment.
Finally, because abnormal cholesterol or triglyceride levels belong to the cluster of conditions in MetS, numerous clinical trials assessing the safety and efficacy of testosterone replacement therapy in patients with MetS have shown that the treatment can significantly improve lipid profiles without any adverse side effects. [500-503] Taken together, these results suggest that testosterone does have a therapeutic benefit in individuals suffering from abnormal lipid profiles.
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