Why Should I Care About High Cholesterol in Men?
High cholesterol, also called hypercholesterolemia, puts men at higher risk for heart attacks, strokes, and peripheral artery disease. For many men, the risk of high cholesterol starts in their 20s and goes up with age.
High cholesterol tends to run in families, so genes play a role. But a variety of lifestyle factors -- including diet, activity, and weight -- also affect cholesterol levels. The only way to know how high your cholesterol levels are is to get a blood test. Everyone over 20 should get a cholesterol test at least once every five years. If your numbers are high or you have other risk factors for heart disease, your doctor may recommend the test more often.
What Is High Cholesterol?
Cholesterol is a waxy, fat-like substance made in the liver and other cells. It’s also found in certain foods, such as dairy products, eggs, and meat.
Your body needs some cholesterol to make hormones, vitamin D, and the bile acids that help you digest fat. But the body needs only a limited amount of cholesterol. When there’s too much, health problems, such as heart disease, may develop.
There are different kinds of cholesterol, and if there’s too much of certain kinds in your blood, a fatty deposit called plaque can build up on the walls of your arteries. It’s like rust on the inside of a pipe. This plaque buildup can block blood flow to the heart muscle, reducing its oxygen supply. If levels of blood and oxygen to the heart drop far enough, you may start feeling chest pain or find yourself short of breath.
A heart attack happens when the plaque completely blocks a blood vessel feeding a section of the heart muscle. If the plaque blocks a blood vessel going to your brain, you can have a stroke.
The cholesterol that blocks arteries is called low-density lipoprotein (LDL). Your doctor might call this "bad" cholesterol. Another kind of cholesterol called high-density lipoprotein (HDL) is known as good cholesterol because it helps remove LDL from the blood and from the body. For good health, you want to keep the LDL levels down and the HDL levels up. If this balance isn’t maintained, especially if it’s reversed, you are said to have high cholesterol.
What Are the Risk Factors for Having High Cholesterol?
Your risk of having high cholesterol goes up if:
- Your diet is high in saturated fat. These fats, found in meat and full-fat dairy products, raise LDL cholesterol. Dietary cholesterol, found in eggs and organ meats, can also raise blood cholesterol levels, but not as much as saturated fat does.
- You eat foods with artificial trans fats. These are human-made fats found in partially hydrogenated oils. They raise LDL cholesterol and lower HDL cholesterol, exactly the wrong combination. While essentially banned by FDA, these fats remain in some processed foods in small, but still harmful, amounts.
- You eat processed foods or foods high in carbohydrates. These types of foods have also been shown to increase LDL cholesterol.
- You are overweight or have obesity. Extra weight increases LDL and lowers HDL.
- You don’t get much exercise. Studies show that frequent exercise can boost HDL, the good cholesterol. Lack of exercise can lead to weight gain.
What’s the Link Between Testosterone and High Cholesterol?
Testosterone is an important hormone for men. It helps control growth and development and is linked to sex drive, muscle, and bone mass. Researchers are studying the ways it might be linked with cholesterol and heart disease..
Some of the research is about whether men with low testosterone levels see changes in their cholesterol and other heart risks when they take testosterone supplements.
For example, an analysis of 35 previous studies, published in 2022, found that men taking the supplements saw small declines in their overall cholesterol levels, which could be a benefit. But they also saw small declines in their good HDL cholesterol, which could be a risk. The bigger takeaway from the study was that overall risk for heart attacks, strokes, and other bad heart outcomes was the same whether men took testosterone or not. But the researchers cautioned that the studies didn't last long enough to show long-term risks or benefits.
Another study, published in 2024, looked at a different question: whether eating lots of high-cholesterol foods, like eggs, or having high blood levels of cholesterol is linked with higher testosterone levels. Researchers are interested in that idea because testosterone is partly made from cholesterol. But the study, which included nearly 2,000 men ages 20-80, found no link.
How Does the Doctor Know I Have High Cholesterol?
There are two types of cholesterol tests. The simpler one measures total cholesterol levels in the blood. Most doctors use a more detailed lipoprotein analysis, which includes:
- Total cholesterol level
- LDL cholesterol level
- HDL cholesterol level
- Triglycerides (another fat in your blood that raises the risk of heart disease)
How Can I Prevent High Cholesterol?
Eat a healthier diet. To reduce your cholesterol, one of the most important changes to make is to cut back on the amount of saturated fat and trans fats in your diet. That means cutting back on meat and poultry -- either by eating smaller portions or eating them less often -- and choosing skim or low-fat dairy products. It also means eating less fried food, processed food, and foods high in sugar.
It is also important to increase the amount of soluble fiber you eat. This form of fiber, found in oatmeal, kidney beans, and apples, for example, helps remove LDL from the body.
Lose weight. If you are overweight or obese, losing even just a few pounds can help lower your cholesterol levels. There is no magical formula for weight loss, of course, but reducing portion sizes and cutting out things you can easily live without, such as beverages sweetened with sugar, are good places to start. The average American now gets more than 20% of calories from beverages. Switching to water can make a big difference in total calories.
Get regular exercise. As little as a brisk 30-minute walk most days raises HDL and may slightly lower LDL. Strength training, by lifting weights, using resistance bands, or doing moves like pushups, can help, too. Exercise is especially important if you have high triglyceride and LDL levels and more than your share of abdominal fat.
What Are the Treatments for High Cholesterol?
The first treatment of choice for high cholesterol is adopting a healthier lifestyle. In many men who have cholesterol in the borderline high category, healthier habits can bring the numbers down to normal. If lifestyle changes are not enough, a variety of cholesterol-lowering medications are available.
The leading choice is statin drugs, which are very effective at lowering LDL. They also help raise HDL levels and lower levels of harmful blood fats called triglycerides. In addition to lowering cholesterol levels, these drugs reduce the risk of stroke, heart attack, and death from cardiovascular disease. The medications are most effective when combined with a cholesterol-lowering diet.
