Lower limit to LDL?

[lsutiger]

Is there a lower limit for one’s LDL cholesterol? Can it be too low? I’m seeing mixed answers depending on the doc I ask.

[AnUser]

If you get mixed answers from doctors, don’t be surprised to get the same from here. Make up your own mind based on the evidence.

It sounds to me you are starting to question the validity of low LDL cholesterol and health. That can happen if it increases. You just got off a statin? Just my thoughts.

I’m targeting 30-40 apoB if it is easy, below 60 otherwise.

[lsutiger]

Thanks for the reply.

I actually want to get LDL as low as possible given high Lpa. APOE is good.

[DeStrider]

I am interested in the exact same thing. I have not gotten a definitive answer, but the ‘feeling’ I have is you can probably go pretty low unlike blood sugar. But, I don’t have much evidence to support this and would change my opinion if presented with solid evidence.

[Alpha]

Doesn’t cholesterol serve as a precursor for testosterone, estrogen, and other necessary hormones?

In males, lower cholesterol correlates to lower testosterone.
Higher testosterone seems key to longevity and health-span.

Curious that the drug companies get everyone on statins and then manage to offset the affects of lowered testosterone by selling the same cohort Viagra.

We all need to finding the balance between all these variables.

[lsutiger]

Here are two articles I found that shed light on the “too low” of LDL question.

Safety and Efficacy of Extremely Low LDL-Cholesterol Levels and Its Prospects...

https://onlinelibrary.wiley.com/doi/full/10.1111/joim.12614

[scta123]

If you have low risk for ASCVD there is no need to go lower then 70 mg/dl I suppose. If you exercise, have low BP, low BS, low TG, reasonably healthy diet and you are not genetically predisposed to hypercholesterolemia there is no need to lower it beyond IMO. Cholesterol is also a precursor for many important steroid hormones as @Alpha pointed out that are important for longevity and health(span) too.

[AnUser]

It doesn’t really matter what I am about to tell you, because I can see the confirmation bias. It is an empirical claim you’re asking, namely how does affecting cholesterol levels effect testosterone levels. Very little, if you searched, not by an amount that will affect erectile function. Still within the wide normal range.

Most people on statins will naturally be on Viagra since the atheroschelosis has blocked more arteries than around the heart. Basically the people who aren’t on statins will prevent their T levels from reducing by 3.4% (The effect of statins on testosterone in men and women, a systematic review and meta-analysis of randomized controlled trials - PMC) but they will lose erectile function as atheroscherosis progresses and have a very high risk for heart disease, over time.

Steroid users you see in the gym take supra-physiological doses of testosterone, -3,4% relative to that is nothing and will have no effect.

[desertshores]

This is a very good video on the U-shaped curve paradox of low cholesterol and other U-shaped curve paradoxes by Gil Carvalho MD PhD

Cholesterol & Risk of Death | New Evidence Emerges

[dirk452]

Let me (36m) share my recent experiences related to LDL and testosterone…

Lp(a) and LDL Management

I recently found out my Lp(a) is elevated at 127 nmol/L (53 mg/dl). To address this, I started taking 5 mg Rosuvastatin and 10 mg Ezetimibe to lower my LDL.

Results After 6 Months:

• LDL: Dropped from 90 mg/dl to 44 mg/dl.
• Testosterone: Unfortunately, my total testosterone also dropped, going from 18.9 nmol/L (545 ng/dl) to 13.4 nmol/L (387 ng/dl).

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Testosterone and Health Concerns

During these six months, I wasn’t exactly taking great care of myself. I was experimenting with stimulants, Pregabalin, and Phenibut, which really strained my health. Way too little sleep. Definitely not a smart move if I care about longevity.

I also noticed erectile dysfunction, though I suspect that might be related to stimulant use. At some point, you can mess up your dopamine system enough to feel the consequences.

Another thing I learned: testosterone is made from cholesterol. Under stress, cholesterol gets redirected to make cortisol instead of testosterone. This might explain part of the drop in my levels.

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Questions About LDL, Statins and Testosterone

While LDL reduction sounds good, I’m wondering:

• How beneficial is it to lower LDL from 90 to 44?
• Should I stick with Ezetimibe only and stop Rosuvastatin?
• I’ve read that statins can affect brain cholesterol, but they might also improve the blood-brain barrier. So might Rosuvastatin be more protective than Ezetimibe?
• Is there any data on the relationship between lowering LDL to very low levels and its impact on testosterone? I wonder if pushing LDL too low could lead to a point where testosterone production becomes significantly impaired—beyond just a single-digit percentage decrease. The studies I’ve seen were conducted on people with hypercholesterolemia, meaning they initially had very high cholesterol levels. Even with statin treatment, these individuals wouldn’t typically reach the extremely low cholesterol ranges where there might be a bottleneck effect—too little cholesterol for adequate testosterone production. Is this assumption valid? Do you have any data or insights on this?

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HDL Challenges

My HDL is low—it dropped from 37 mg/dl (March) to 32.8 mg/dl (September). I saw that Bryan Johnson’s HDL is 73, and I’m curious how to raise mine to something closer to that.

I’ve read that eating nuts can help, but if I buy them, I’ll binge on them like potato chips. Is there a systematic way to boost HDL?

Here’s what I’m already doing:

• 1 hour of cardio almost every day.
• 2x30-minute high-weight training sessions per week.
• A diet heavy in tofu, broccoli, cauliflower, and lentils (though I might need to diversify).
• A diet heavy in tofu, broccoli, cauliflower, and lentils (though I might need to diversify, but I get around 1.5g - 2g of protein per kg bodyweight). Also 4g of fish oil every day.
• 2 weeks ago I started enclomiphene which should raise testosterone. 6.25mg every 3 days. E3D (starting low intentionally). No effects noticed until now. Need to check blood values in a couple of weeks.

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Blood Value Table

Below is my table of blood values. Empty cells mean the measurements weren’t taken:

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Parameter	Value (27.03.24)	Evaluation (27.03.24)	Value (23.09.24)	Evaluation (23.09.24)	Reference Range	Reduction (%)
Apolipoprotein B	76 mg/dl	Normal	-	-	<100 mg/dl	-
Cholesterol	141 mg/dl	Normal	83.9 mg/dl	Low normal	<200 mg/dl	40.50% reduction
HDL Cholesterol	37 mg/dl	Low	32.8 mg/dl	Low	>45 mg/dl	11.35% reduction
LDL Cholesterol	89 mg/dl	Normal	44.6 mg/dl	Normal	<160 mg/dl	49.89% reduction
Non-HDL Cholesterol	105 mg/dl	Normal	51.1 mg/dl	Normal	<145 mg/dl	51.33% reduction
Triglycerides	60 mg/dl	Normal	33.7 mg/dl	Normal	<150 mg/dl	43.83% reduction
Lipoprotein (a)	127.3 nmol/L (53 mg/dl)	Elevated	105.12 nmol/L (43.8 mg/dl)	Elevated	<30.0 mg/dl	17.42% reduction
Testosterone	18.9 nmol/L (545 ng/dl)	Normal	13.4 nmol/L (387 ng/dl)	Low normal	12.0-30.0 nmol/L (240-870 ng/dl)	29.10% reduction
Free Testosterone	13.28 pg/ml	Normal	-	-	7.00-22.70 pg/ml	-

[AnUser]

Statins and ezetimibe shouldn’t really change testosterone levels, as the cholesterol for that is synthesized in the gonads and hasn’t anything to do with serum cholesterol. Most likely it wasn’t that, and a 100 ng/dl drop feels like it’s within the margin of error and lifestyle. In clinical trials statins lower testosterone by about 3-4% which isn’t clinically relevant.

@dirk452

How beneficial is it to lower LDL from 90 to 44?

Very beneficial if it’s apoB that decreases as you prevent atherosclerosis from developing, as long as you keep lower levels than your normal ones over decades.

@dirk452

I’ve read that statins can affect brain cholesterol, but they might also improve the blood-brain barrier. So might Rosuvastatin be more protective than Ezetimibe?

Rosuvastatin will get into and lower cholesterol in all tissues, so yes it might lower brain cholesterol enough. However, the link between brain cholesterol and cognition is very preliminary, based on association studies, but there’s a marker of suppressing cholesterol (desmosterol) too much, if you have one or two APOE4 allele’s Peter Attia targets 0.8 mg/L serum desomsterol or more, and for everyone else 1 mg/L. (Does low cholesterol cause cognitive impairment? Part II - Peter Attia). Too much suppression can mean using lower statin dose, or switching to a different drug, etc.

@dirk452

2 weeks ago I started enclomiphene which should raise testosterone. 6.25mg every 3 days. E3D (starting low intentionally). No effects noticed until now. Need to check blood values in a couple of weeks.

Your testosterone levels are normal at even 387 ng/dl and if you are asymptomatic doesn’t need to change and it might be something else.