LDL Up on Lower Dose?

[adrenalytic]

Sup Over 40 bros.

Nearing 47 and going pretty strong. I just have a concern and confusion with my LDL being higher on lower amounts of gear and wondering if there are other things I should be looking into.

Stats:

Age: 46 (47 in 2 months)
Height: 5' 9"
Weight: 202
BF%: ~10%

Let me back up and give you my gear history, which is fairly short. I just started TRT++ on April 28th of this year. I began with 500 test only. LDL was 55 and HDL 76 prior to beginning. Pretty good, right? Four weeks later, pulled bloods, LDL had risen to 60, HDL dropped to 64. Still pretty good so I added primo at 500 mg.

Four weeks later, pulled more bloods. LDL = 72, HDL = 25. Not super alarming but obviously trending in the wrong direction. Continued blasting at this rate for 8 more weeks. Then dropped to a TRT+ cruise of 300 test 100 primo. There was a little anavar and proviron sprinkled in but only for short 2 week durations. Currently not using either.

I've been riding this dose for about 6 weeks now so I pulled new numbers yesterday. Results came back already and I'm shocked to see LDL has risen to 106 (HDL improved to 48 and trigs are somehow amazing at 34).

I guess I'm just confused how my LDL could have shot up when the only change was a decrease in doses? My food, sleep and training didn't change.

Also, I have an appointment with my Dr. this week. What are the guidelines for getting a script for Ezetimibe or Pitavastatin? If I am below that threshold, is it stupid to artificially raise my numbers just to qualify?

Appreciate any help!

My ancillaries:

Fasted AM (before cardio)​

• Yohimbine – fat mobilization for cardio
• Bronchaid
• Caffeine
• Taurine – electrolyte balance, CTS symptom relief
• NAC – liver enzyme support (ALT/AST)
• Methylene Blue – mitochondrial + cognitive boost
• TUDCA – bile flow, liver support
• Vitamin C (1,000 mg) – antioxidant, CRP reduction
• Niacin – HDL up, LDL down, lipoprotein particle size

AM With Breakfast (Post-Cardio Meal)

• Fish Oil (2g) – lowers triglycerides, supports HDL
• Vitamin D3 + K2 – bone, hormone, calcium balance
• Multivitamin – micronutrient coverage
• CoQ10 (100 mg) – mitochondrial + cardiovascular support
• Astaxanthin (4 mg) – skin + antioxidant protection

---

Afternoon With Meal

• Citrus Bergamot – LDL lowering, CRP reduction, endothelial support
• Turmeric – anti-inflammatory, joint + liver support
• DIM – estrogen metabolism, E2 balance
• Calcium D-Glucarate – phase II detox, estrogen clearance
• DHEA – supports downstream androgens, libido, mood
• Pregnenolone – cognitive support, hormone precursor
• Psyllium Husk (½ serving) – LDL improvement, glucose control, satiety

PM With Food or Before Bed​

• Fish Oil (2g 2nd dose) – triglycerides + inflammation overnight
• TUDCA (2nd dose) – liver enzyme support
• Niacin (2nd dose) – HDL boost, lipid maintenance
• Turmeric (2nd dose, if splitting) – sustained anti-inflammatory effect
• Vitamin C (1,000 mg) – antioxidant support
• Magnesium Glycinate – sleep, muscle relaxation, BP support
• Psyllium Husk (½ serving) – LDL reduction overnight, supports satiety

Pre-Workout (Not in Pill Box — powders/caps separate)

• Citrulline Malate – NO pump, endurance, nutrient delivery
• Creatine – strength, power, recovery
• Electrolytes – pump + cramp prevention

 

[dinfar1337]

i think you're a victim of cumulative effect

ldl is slower to normalize from previous cycles while hdl rebounds quicker.

the safe stuff labeled as the most safe like "primo, anavar" trash lipids.

if you keep doing what you're doing with the vigorous supplementation and good healthy lifestyle you'll see ldl will decrease and hdl will rise, but its gonna take longer than few weeks. maybe even upto 3-6 months of hard dedication and work will only be good enough to get back to where you used to be pre cycle.

sorry if i replied if im not over 40 but i thought i had some useful input.

take your health seriously run lower or drop primo completely next cycle, your age does sound serious to me and its maybe time to chill on lower trt+

 

[adrenalytic]

ldl is slower to normalize from previous cycles while hdl rebounds quicker.

Interesting. I was not aware of this.

sorry if i replied if im not over 40 but i thought i had some useful input.

All good. I wasn't sure where this kind of post belonged tbh so I just kinda dropped it here. Not necessarily just looking for over 40 input.

take your health seriously run lower or drop primo completely next cycle, your age does sound serious to me and its maybe time to chill on lower trt+

Always, my dude.

If the high LDL is a hold over from my previous blast it should likely continue dropping on my cruise dose, no? Reason I ask is because I feel great at this dose and all my other markers are well within range. I could see dropping the primo completely but I feel like my test dose is pretty moderate and I'm still able to grow on it. If I can get my LDL dialed in, is there really a reason to go lower? I might as well just PCT at that point and go back to natty haha.

 

[RockyP]

do you recall when your last dosage of Primo was? If it was less than 40 days ago that could be contributing to the dyslipidemia. It could even be a longer tail than that. Primo would clear in 40 - 50 days after the last shot, but the recovery of lipids would likely lag for a few more weeks at least.

Along the same lines, when the the anavar stop?

 

[dinfar1337]

If the high LDL is a hold over from my previous blast it should likely continue dropping on my cruise dose, no? Reason I ask is because I feel great at this dose and all my other markers are well within range. I could see dropping the primo completely but I feel like my test dose is pretty moderate and I'm still able to grow on it. If I can get my LDL dialed in, is there really a reason to go lower? I might as well just PCT at that point and go back to natty haha.

yes, your hdl rebounding and healthy trigs suggest you have very strong metabolic health still as a 47 year old your trigs beat mine and im 20 years younger than you.

if i were you i would stay on 300mg test 100mg primo to see if you can still handle the primo and then get a script for ezetimibe or pitavastatin like you originally planned and see if you can even go back to your older 500mg test 500mg primo blast if everything starts looking ok.

if it keeps getting worse drop primo completely. going on 500 ish test shouldn't be too bad for later cycles. but i think its just a bad mix of anavar and primo over a longer period of time accumlating ldl, its most likely your ldl will start dropping in the upcoming weeks/months.

you should be fine after a health phase in worst case scenario just give it some time. you spend 5 months wrecking your shit haha

 

[Ghoul]

Things have gotten pretty simple regarding lipids in the last few years, even if most primary care docs are way behind.

LDL, lower for longer is better. Period.

Just get LDL down, below 60 if at all possible, and nearly everything else will either fall into range or become much less significant as risk factors.

Pita 4mg + Eze = about a 60% reduction.

How to get it really depends on how cooperative / forward looking your doctor is.

Most will go by the guidelines, which are a bit behind the current understanding of what's ideal.

So first is establishing your "Risk" level,

What's your BP? Are you on meds for it?
Does your family have any history of heart attacks or stroke?
Do you have any other metabolic conditions like diabetes or chronic kidney disease?
Does your doc know about your gear use?

Both Eze and Pita are cheap generics, so unless you have absolutely bottom of the barrel trash insurance, both are fully covered. In fact, since you're over 40, Pita won't even require the usual drug co-pay and be $0.

There's a workaround that I find often makes getting your doc to cooperate much easier. Get a 90 day prescription for both via telehealth, then walk in with the bottles and explain you were concerned about your cardiovascular risk because a friend recently had a heart attack, so you had a consult with a telehealth cardiologist who prescribed Pita and eze, and that you've been taking those meds for a few weeks with no issue, would he please take over refills? I've never been turned down using this method.

 

[RockyP]

Things have gotten pretty simple regarding lipids in the last few years, even if most primary care docs are way behind.

LDL, lower for longer is better. Period.

Just get LDL down, below 60 if at all possible, and nearly everything else will either fall into range or become much less significant as risk factors.

Pita 4mg + Eze = about a 60% reduction.

How to get it really depends on how cooperative / forward looking your doctor is.

Most will go by the guidelines, which are a bit behind the current understanding of what's ideal.

So first is establishing your "Risk" level,

What's your BP? Are you on meds for it?
Does your family have any history of heart attacks or stroke?
Do you have any other metabolic conditions like diabetes or chronic kidney disease?
Does your doc know about your gear use?

Both Eze and Pita are cheap generics, so unless you have absolutely bottom of the barrel trash insurance, both are fully covered. In fact, since you're over 40, Pita won't even require the usual drug co-pay and be $0.

There's a workaround that I find often makes getting your doc to cooperate much easier. Get a 90 day prescription for both via telehealth, then walk in with the bottles and explain you were concerned about your cardiovascular risk because a friend recently had a heart attack, so you had a consult with a telehealth cardiologist who prescribed Pita and eze, and that you've been taking those meds for a few weeks with no issue, would he please take over refills? I've never been turned down using this method.

I have good insurance and Pita required a pre-auth. Doc is a nice guy and did it for me. But it does mean delays.

Divulging gear usage is tricky because it 100% moves us a few steps to the riskier end of the spectrum, but if it goes in your medical record it can have consequences for future health care bias and life insurance issues. And some docs will just dig their heels in and tell you to stop using gear.

What I have done is told my docs bout my PAST gear usage and the severe dyslipidemia that ensued from it. I told them about my family history and the whole area under the curve / total exposure to dyslipidemia and that I see myself as someone with a 60 pack year smoking history who quit 2 years ago, and I want to be as aggressive as possible. Still, they may "force" you to use rosuvastatin, which at 10 mg is likely to trounce your LDL (and insurance might make your doc "prove" that you failed a trial of rosuva or whatever statin is on their formulary). But over time the Pita is the way to go for various reasons (insulin sensitivity being the main one).

Separately, regarding primo - something I've finally realized for myself...

If you're going to run it, run it. Don't mess around with 100 mg, etc. Take whatever the full dosage is for you or don't run it at all. It's gonna fuck your HDL either way, might as well get something out of it. If you need E2 help for 300 mg test, add in 0.5 - 1 mg arimidex weekly.

 

[Ghoul]

You can establish whether you need Pre authorization or not with reasonable accuracy by going to ChatGPT with an inquiry worded like:

"Does (name of insurance plan) in (state) require a preauthorization for Pitavastatin in generic form."

If it does, follow up with "What are those requirements in detail?"

 

[dinfar1337]

You can establish whether you need Pre authorization or not with reasonable accuracy by going to ChatGPT with an inquiry worded like:

"Does (name of insurance plan) in (state) require a preauthorization for Pitavastatin in generic form."

If it does, follow up with "What are those requirements in detail?"

you guys are actually dealing with this bullshit, cant you just buy it cheap from indian pharma?

it sounds like such a hassle, i cant imagine going through all of that.

 

[adrenalytic]

do you recall when your last dosage of Primo was?

Do you mean my blast dose? Because I am still currently using 100 mg / week. My last blast dose was on 8/1.

Along the same lines, when the the anavar stop?

I used anavar from 5/30 and discontinued on 6/23 because I wanted to save it for my cut (which I'm on right now). A little longer than I remembered but there it is.

What's your BP?

Today it was 126/66 with resting heart rate of 74. I forgot to mention I'm on 4 mg of reta (raises resting HR). Also, using tadalafil 5 mg daily.

Are you on meds for it?

Just the tadalafil and daily fasted cardio. LISS 45 - 60 mins. 4% incline @ 4.2 mph 7 days a week.

Does your family have any history of heart attacks or stroke?

Yes, my father died of cardiac arrest. However this comes with a huge caveat in that he had an enlarged heart due to a child hood illness (rheumatic fever) so I don't believe genetically I have any predisposition. But the doc need not know this, right?

Do you have any other metabolic conditions like diabetes or chronic kidney disease?

No, but again, my father also suffered from type 2 diabetes as did his mother (unhealthy lifestyles, obesity, smoking, etc.) so there is probably a genetic component there.

Does your doc know about your gear use?

I will be establishing with a new GP this week but I have never mentioned it in the past to other docs. Only that I was interested in TRT due to "low T symptoms".

Get a 90 day prescription for both via telehealth

My limited experience with telehealth has not been great. I have seen them on occasions for other conditions (Gear/HGH induced CTS which I still struggle with even after discontinuing GH) and they were unwilling to prescribe anything or even order labs for me. Their answer was "stop working out for a couple weeks and see how you feel". Seriously? lol.

I live in NY and it is very difficult to navigate the healthcare system here as it is extremely governed/legislated to the point of nanny-statehood. Could you recommend any strategies?

If you're going to run it, run it. Don't mess around with 100 mg, etc. Take whatever the full dosage is for you or don't run it at all. It's gonna fuck your HDL either way

I use the 100 mg to maintain the vascular primo "look" and some E2 control but I'm willing to drop it if it makes sense to do so but my HDL isn't actually that bad right now (48). Based on reading @Ghoul 's past posts, HDL doesn't matter as much in the grand scheme. Better to focus on pushing LDL down.

If you need E2 help for 300 mg test, add in 0.5 - 1 mg arimidex weekly.

doesn't Adex also wreck lipids?

 

[adrenalytic]

you guys are actually dealing with this bullshit, cant you just buy it cheap from indian pharma?

it sounds like such a hassle, i cant imagine going through all of that.

Hey man, if I can get insurance to pay for pharma FDA approved meds then fuck out of pocket. But yea, worst case I can always buy Indian floor sweeps.

 

[RockyP]

Do you mean my blast dose? Because I am still currently using 100 mg / week. My last blast dose was on 8/1.



I used anavar from 5/30 and discontinued on 6/23 because I wanted to save it for my cut (which I'm on right now). A little longer than I remembered but there it is.



Today it was 126/66 with resting heart rate of 74. I forgot to mention I'm on 4 mg of reta (raises resting HR). Also, using tadalafil 5 mg daily.



Just the tadalafil and daily fasted cardio. LISS 45 - 60 mins. 4% incline @ 4.2 mph 7 days a week.



Yes, my father died of cardiac arrest. However this comes with a huge caveat in that he had an enlarged heard due to a child hood illness (rheumatic fever) so I don't believe genetically I have any predisposition. But the doc need not know this, right?



No, but again, my father also suffered from type 2 diabetes as did his mother (unhealthy lifestyles, obesity, smoking, etc.) so there is probably a genetic component there.



I will be establishing with a new GP this week but I have never mentioned it in the past to other docs. Only that I was interested in TRT due to "low T symptoms".



My limited experience with telehealth has not been great. I have seen them on occasions for other conditions (Gear/HGH induced CTS which I still struggle with even after discontinuing GH) and they were unwilling to prescribe anything or even order labs for me.

I live in NY and it is very difficult to navigate the healthcare system here as it is extremely governed/legislated to the point of nanny-statehood. Could you recommend any strategies?



I use the 100 mg to maintain the vascular primo "look" and some E2 control but I'm willing to drop it if it makes sense to do so but my HDL isn't actually that bad right now (48). Based on reading @Ghoul 's past posts, HDL doesn't matter as much in the grand scheme. Better to focus on pushing LDL down.



doesn't Adex also wreck lipids?

Adex can wreck lipids if it wrecks your E2 and seems to happen in a dose dependent manner. I have run Adex up to 1.5 mg weekly on higher dosages of test and lipids didn’t move (and that was pre statin). My HDL was 10% lower on 300 primo than it was on 1.5 mg Adex. But again, LDL control trumps all.

If you’re still on primo then that can explain this. That said, get the LDL under 60 and low HDL means much less.

 

[IndividualMan]

doesn't Adex also wreck lipids?

affects them negatively, yes. (E2 related probably)
wrecks them? no.
should you probably still use exemestane instead (assuming you don't have problems with it)? yes.

 

[adrenalytic]

Some interesting conclusions from ChatGPT:

​

• Total Cholesterol: 111 → 162 (up)
• HDL: 25 → 48 (huge recovery!)
• LDL: 72 → 106 (now slightly above reference)
• Triglycerides: 63 → 34 (cut nearly in half – excellent)
• LDL/HDL ratio: 2.9 → 2.2 (improved)

Interpretation:

• The most meaningful change here is HDL nearly doubled — likely due to citrus bergamot, niacin, and turmeric (all started in late June).
• LDL rose above reference but the overall atherogenic risk likely improved because your HDL:LDL ratio got better (2.2 is low-risk).
• Primo is typically lipid-friendly (doesn’t crash HDL like other DHT derivatives) — so this rebound is consistent with your compound choice.

Why LDL rose:

• Testosterone raises LDL in some people by increasing hepatic cholesterol output.
• Your LDL was unusually low at 72 in June (possibly too low for optimal steroid hormone synthesis).
• The rise could actually represent a more “normal” lipid profile in context of increased androgen exposure.
• If this bothers you, you could consider:
  
  • Adding Ezetimibe (10 mg/day, very well tolerated) – blocks cholesterol absorption without affecting HDL.
  • Continuing citrus bergamot and fish oil as you already are.

What particularly stands out to me is the comment on Primo being lipid-friendly (contrary to what people say here) and the remark about my LDL being "possibly too low for steroid hormone synthesis".

Is that a thing or just a ChatGPT hallucination?

 

[Ghoul]

Some interesting conclusions from ChatGPT:

​

• Total Cholesterol: 111 → 162 (up)
• HDL: 25 → 48 (huge recovery!)
• LDL: 72 → 106 (now slightly above reference)
• Triglycerides: 63 → 34 (cut nearly in half – excellent)
• LDL/HDL ratio: 2.9 → 2.2 (improved)

Interpretation:

• The most meaningful change here is HDL nearly doubled — likely due to citrus bergamot, niacin, and turmeric (all started in late June).
• LDL rose above reference but the overall atherogenic risk likely improved because your HDL:LDL ratio got better (2.2 is low-risk).
• Primo is typically lipid-friendly (doesn’t crash HDL like other DHT derivatives) — so this rebound is consistent with your compound choice.

Why LDL rose:

• Testosterone raises LDL in some people by increasing hepatic cholesterol output.
• Your LDL was unusually low at 72 in June (possibly too low for optimal steroid hormone synthesis).
• The rise could actually represent a more “normal” lipid profile in context of increased androgen exposure.
• If this bothers you, you could consider:
  
  • Adding Ezetimibe (10 mg/day, very well tolerated) – blocks cholesterol absorption without affecting HDL.
  • Continuing citrus bergamot and fish oil as you already are.

What particularly stands out to me is the comment on Primo being lipid-friendly (contrary to what people say here) and the remark about my LDL being "possibly too low for steroid hormone synthesis".

Is that a thing or just a ChatGPT hallucination?

Yes.

Ask:

"Isn't HDL/LDL ratio largely discredited as a therapeutic target and absolute LDL-C the primary indicator of cardiovascular risk?"

and see what it says.

Then follow with: "Regenerate previous analysis based on this revision regarding ratio"

 

[Ghoul]

also, for kicks try:

" Based on those levels, using the best current science rather than guidelines, would an AAS using bodybuilder lowering ldl using pitavastatin 4mg + ezetimibe see significant risk reduction over the long term? "

 

[buck]

Try running the same thing for a decent period of time as opposed to swinging the pendulum back and forth every few weeks with big changes.

 

[DinoBB76]

You've posted a lot of supplements (useful, okay, but not essential). I've controlled LDL with my diet. I challenge you to do 15-20 days with zero direct fat in your diet. Get blood tests and you'll see that you've lost 25-30 points of LDL. You can't do anything with AAS for HDL, it will necessarily drop. What you can do is keep LDL very low.

I've got 10-15 HDL and 35-40 LDL, triglycerides 40.

0 fat diet

 

[Ghoul]

You've posted a lot of supplements (useful, okay, but not essential). I've controlled LDL with my diet. I challenge you to do 15-20 days with zero direct fat in your diet. Get blood tests and you'll see that you've lost 25-30 points of LDL. You can't do anything with AAS for HDL, it will necessarily drop. What you can do is keep LDL very low.

I've got 10-15 HDL and 35-40 LDL, triglycerides 40.

0 fat diet

Regardless of diet, 35-40 LDL without pharmaceuticals suggests a PCSK9 loss of function or similar genetic mutation (conferring lifelong cardiovascular protection), or hyperthyroidism.

 

[dinfar1337]

Regardless of diet, 35-40 LDL without pharmaceuticals suggests a PCSK9 loss of function or similar genetic mutation (conferring lifelong cardiovascular protection), or hyperthyroidism.

can we talk about his hdl? its never worth it to sacrifice your hdl to get low ldl. unless your total cholesterol is sky high and you just need to bring it down as aggresively as you can.

at this point its like trying cut bodyfat and in doing so he has lost all muscle aswell, and after that is he is just deciding to stay in the cut forever with 0 dietary fats.