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Cardiovascular

HDL Cholesterol: Normal Values and What a Low HDL Means

In men, HDL cholesterol is the value that responds most sharply to testosterone, and at the same time the value least is said about. The lower limit sits at 1.0 mmol/l, lower than in women, because men naturally have less HDL. What mainly pulls the value down is not your cholesterol intake but your waistline, your insulin sensitivity and the use of androgenic agents.

That last one is the pattern to recognise: a lipid profile in which everything looks normal, except an HDL that has halved and an LDL that has climbed. This page explains when your HDL is genuinely too low, what you can do about it that demonstrably works, and how quickly the value recovers when androgens are stopped.

Doctor's Assessment Included

When is this value abnormal?

Decision limits per result, in mmol/l
Result Value (mmol/l)
Higher risk < 1,04
Moderate risk 1,04–1,55
Low risk ≥ 1,55

Deze grenzen gelden voor iedereen; de NVKC maakt geen onderscheid tussen mannen en vrouwen. Het zijn risicogrenzen, geen normaalwaarden: een HDL onder 1,04 mmol/l gaat samen met een hoger risico op hart- en vaatziekten. Let op: hoger is niet onbeperkt beter. Bij zeer hoge HDL-waarden neemt de sterfte weer toe: bij mannen vanaf ongeveer 2,5 mmol/l en bij vrouwen pas vanaf ongeveer 3,5 mmol/l. De laagste sterfte werd gezien rond 1,9 mmol/l (mannen) en 2,4 mmol/l (vrouwen) (Madsen, Eur Heart J 2017). De NHG-Standaard CVRM stelt zelf geen streefwaarde voor HDL. Bespreek uw uitslag met uw huisarts.

Source: NVKC Reference population: Nederlandse volwassenen (NVKC, geen onderscheid man/vrouw)

Reference ranges may vary between laboratories. When you order a test, a BIG-registered doctor assesses your personal results in context. For treatment decisions, discuss your results with your GP.

HDL Cholesterol: what this test measures

The test reports the amount of cholesterol carried in the smallest and densest lipoproteins in your blood. Those particles remove cholesterol from your cells and from the artery wall and take it to the liver. What is not measured is how many of those particles you have and how effective they are. So the result describes the load and not the capacity.

For men, reading this value starts with the lower limit, and that sits at 1.0 mmol/l. For women it is 1.2. That difference arises at puberty and is hormonal: oestrogen raises HDL, while androgens lower it. Men therefore sit on average 0.2 to 0.3 mmol/l lower by nature. Your lower limit is more lenient than your partner's, but that does not make a value just above 1.0 comfortable: it only means the reference is calibrated on your physiology.

The hormonal mechanism behind that difference is exactly why this value is so sensitive in men. Androgens stimulate a liver enzyme that breaks HDL particles down faster. The more androgenic the agent and the higher the dose, the more firmly HDL drops. That holds to a lesser degree for your own testosterone, to a modest degree for prescribed testosterone therapy, and to a strong degree for synthetic androgens.

One relationship decides how you read the rest of your panel: HDL moves inversely with triglycerides. A transfer protein swaps cholesterol out of your HDL particles in exchange for triglycerides from the fat-rich particles, after which the HDL particle is cleared faster. In men with an increased waistline that is the most ordinary cause of a low HDL, and then the triglyceride value is the point of attack and not the HDL itself.

Fasting is not needed for HDL; the value barely shifts after a meal.

HDL Cholesterol: why this value matters

For men there are three things that make this value interesting, and none of them is the advice to eat fewer eggs.

Testosterone lowers HDL, including when it is prescribed. With testosterone replacement therapy at normal doses, HDL usually falls modestly. That is an expected effect and not in itself a reason to stop, but it does belong in the trade-off and it belongs to be followed. The fall is considerably stronger with synthetic, orally taken androgens, where HDL often roughly halves while LDL climbs at the same time. If you see that pattern in your results, it is recognisable and it deserves an open conversation with a doctor, including if you use those agents outside regular care. Your doctor can only think along about what they know.

It recovers, and that is good news. The unfavourable shift in your lipids is largely reversible. After androgenic agents are stopped, HDL usually creeps back towards your baseline over a few weeks to a few months, and LDL comes down with it. The longer and the higher-dosed the use has been, the slower that goes. If you want to follow that recovery, do not test again too quickly: give it at least eight to twelve weeks before having a second measurement, or you will be measuring noise.

And raising it does not work the way you hope. This is the heart of the matter, and it is the honest version of the answer to the question of how you raise your HDL. Drugs that lifted HDL by tens of percent did not reduce the number of heart attacks, and people with an inherited variant for a higher HDL do not have a lower risk because of it. So HDL is not a target but a readout. What you read from it is your metabolic state, and in men with an increased waistline that is usually the real story.

What you do follow if you want to know your risk: LDL, non-HDL cholesterol and ApoB, the number of risk-carrying particles. In a man with a large waistline and raised triglycerides, the LDL can look normal while the ApoB is raised, and then the ApoB is the value that is right.

HDL Cholesterol: how to prepare

Nothing special is needed for these tests.

  1. No need to fast

    Good to know

    Eating beforehand makes little difference to these values. You can have breakfast.

  • Water is always fine. Drink as usual beforehand, it makes the draw easier.
  • Take your usual medication, unless your own doctor told you otherwise.

HDL Cholesterol: when is testing worthwhile?

HDL belongs in a full lipid profile, together with total cholesterol, LDL and triglycerides. Drawn on its own the result cannot be interpreted.

Fasting is not needed for the HDL itself, but it is if you want the complete picture: a non-fasting triglyceride value inflates the calculated LDL. Postpone testing until a few weeks after an infection, an operation or a hospital admission, because the whole profile dips temporarily then.

For men there are two moments when this test genuinely delivers something. The first is before starting testosterone therapy: a baseline makes every later measurement interpretable, and without that baseline nobody knows whether a low HDL comes from the treatment or was already there. The second is a few months after a change, whether that is the start of therapy, the stopping of androgenic agents, or a serious change in weight and training.

If you use testosterone or other androgenic agents, HDL belongs among the values followed with some regularity, together with LDL, ApoB, haematocrit and total testosterone. Always tell your doctor what you use and in which form; oral and injectable give a completely different lipid picture.

The table below summarises what your HDL does in different situations.

SituationWhat HDL doesHow to read it
Lower limit, men1.0 mmol/lfor a woman it is 1.2
Testosterone therapy, usual dosingfalls modestlyexpected; follow it, do not stop on your own initiative
Synthetic oral androgensfalls sharply, LDL risesthe most striking pattern in men's blood work
A few weeks to months after stoppingcreeps back towards baselinewait 8 to 12 weeks before repeating
Increased waistlinefallsthe most ordinary cause, independent of hormones
Raised triglyceridesfallstreat the triglycerides, not the HDL
Endurance training over monthsrises slightlyreal but small, order of 0.05 to 0.1 mmol/l
Alcoholrisesa favourable-looking number without health gain

Always have an abnormal result repeated before basing a decision on it.

HDL Cholesterol: symptoms of a high or low value

Low Levels

A low HDL causes no symptoms. It costs you no strength, no libido and no energy, and there is no symptom that would lead you to this value. You find it only in a blood result.

That is exactly why the pattern around it counts. In men a low HDL almost always runs together with an increased waistline, raised triglycerides and a fasting glucose on the high side. That combination is a metabolic signal, and it is that combination you can do something about, not the HDL number.

The second cause is hormonal. Androgenic agents lower HDL, and synthetic, orally taken variants do so most strongly. An HDL that has halved while your LDL has climbed fits that use and not your diet. That is no reason for embarrassment, but it is a reason to mention it to a doctor, because without that information your result will be interpreted wrongly.

For men the lower limit sits at 1.0 mmol/l. A value of 0.9 is therefore low, while 1.1 falls within the reference range and would be too low in a woman. Discuss a low result with a doctor, together with your triglycerides, your LDL and your other risk factors. A low HDL does not make a diagnosis on its own and says nothing about the state of your arteries.

High Levels

A high HDL causes no symptoms either, and in men it occurs less often than in women, simply because you have no oestrogen pushing the value up.

If your HDL is clearly raised, there are three ordinary explanations. The first is alcohol, and in men that is the most common. The second is an inherited variant in the transfer protein that pulls cholesterol out of HDL particles, which leaves the cholesterol sitting in your HDL. The third is the use of an oestrogen-like agent, for example alongside androgenic agents to damp down side effects. None of those three is a sign of a well-running metabolism.

At very high values, mortality in large population research climbs again: in men the most favourable point sat around 1.9 mmol/l and above roughly 3.0 mmol/l the risk rose. An HDL of 3.2 is therefore not a better result than an HDL of 1.7.

A strongly raised HDL is no cause for concern in itself, but it is a reason to discuss your result with a doctor, together with your alcohol use, every agent you use and the rest of your lipid profile.

HDL Cholesterol: what to do about an abnormal value

Male

If Low

Low HDL increases cardiovascular risk. Consider more exercise and healthy fats.

If High

High HDL is protective and beneficial for heart health.

HDL Cholesterol: lifestyle and this value

The question is almost always how to raise your HDL, so here is the honest answer: you can a little, it goes slowly, and it is not where the gain sits. Drugs that raised HDL substantially did not reduce the number of heart attacks. So treat this number as a gauge of your metabolic state and direct your effort at what improves that state.

What demonstrably works, in order of return for men:

  • Less visceral fat. In men this is by far the most important lever. Fat around the organs lowers HDL through reduced insulin sensitivity and raised triglycerides. Waistline says more here than weight.
  • Stopping smoking. Smoking lowers HDL and the value recovers after quitting. It is also the measure with the largest gain for your cardiovascular risk, regardless of what your HDL does.
  • Endurance training alongside your strength work. Aerobic exercise genuinely raises HDL, but modestly: roughly 0.05 to 0.1 mmol/l over months, with duration per session weighing more heavily than intensity. Strength training alone does little here.
  • Less alcohol and fewer fast carbohydrates. Both lower your triglycerides, and because HDL moves the other way, your HDL follows.
  • Sleep. Chronic sleep shortage and untreated sleep apnoea go together in research with a less favourable lipid profile. Snoring with daytime fatigue is, in men, a reason to have that looked into.

What not to do: drink alcohol in order to raise your HDL. The value does rise from it, but without any health gain.

And the most important one: never change anything yourself about prescribed testosterone therapy or about cholesterol-lowering medication on the strength of an HDL result. Discuss the result instead, mentioning everything you use.

HDL Cholesterol: frequently asked questions

What can I do about a low HDL?

In men, tackling abdominal fat and triglycerides delivers the most, followed by stopping smoking and regular endurance training alongside the strength work. Expect modest shifts over months, not weeks. The HDL number itself is not a treatment target: no drug has been shown to lower your risk by raising HDL. Discuss a persistently low value with a doctor.

Does testosterone therapy lower my HDL?

Usually yes, and modestly. Androgens speed up the breakdown of HDL particles in the liver, so a fall after starting therapy is an expected effect and not a sign that something is going wrong. With synthetic, orally taken androgens the fall is much larger. Have a baseline measured before starting, and never stop a prescribed treatment on your own initiative.

Does my HDL recover if I stop androgens?

Largely yes. The unfavourable shift in your lipids is substantially reversible: after stopping, HDL usually creeps back towards your baseline over a few weeks to a few months, and LDL comes down with it. The longer and higher-dosed the use was, the slower that goes. Wait eight to twelve weeks before testing again, or you will mostly be measuring noise.

My HDL is 0.95 mmol/l. Is that too low for a man?

That falls just below the lower limit of 1.0 mmol/l that applies to men. A slightly reduced HDL is not a disease and causes no symptoms, so panic is not called for. What counts is the pattern: have the value assessed alongside your triglycerides, your waistline, your fasting glucose and your LDL, and repeat the measurement before deducing anything from it.

Why is my HDL falling while I am losing weight and training?

That can be temporary. During active weight loss HDL often stays flat or dips slightly, and the value only comes up once your weight has been stable for a while. If you also use androgenic agents, that effect overrides anything training does. So do not assess your lipids in the middle of a cutting or building phase, but at a moment when your weight has been stable for several weeks.

Does poor sleep affect my HDL?

In research, chronic sleep shortage and untreated sleep apnoea go together with a less favourable lipid profile, including a lower HDL. That is an association and not a proven cause, but in men who snore and are tired during the day it is worth having sleep apnoea ruled out. That is a question for your GP, not something you can read from a blood value.

Should I have my HDL checked if I use testosterone?

Yes, and not only HDL. With the use of testosterone or other androgenic agents, HDL, LDL, ApoB and haematocrit belong to be followed with some regularity, alongside your testosterone value itself. Always tell your doctor which agents you use and in which route of administration, because oral and injectable give a completely different lipid picture.

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HDL Cholesterol

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