V low HDL - do I need to cruise

[Manualtrt]

Hi.

Just received my lipids back on a blast of test, npp, primo and var.

I am keen to get your advice on managing my HDL and whether I should return to a TRT dose? I was planning another 6 weeks currently 10 weeks in.

Very happy with my LDL, I’m taking 4mg pitavastatin, ezetimibe, bempodoic acid

Marker​	Your Value (SI)​	US Units​	US Value​	US Reference Range​
Total Cholesterol	2.3 mmol/L	mg/dL	89 mg/dL	< 200
HDL	0.74 mmol/L	mg/dL	29 mg/dL	> 40 (men)
LDL (calc)	1.2 mmol/L	mg/dL	46 mg/dL	< 100 optimal
Triglycerides	0.60 mmol/L	mg/dL	53 mg/dL	< 150
Non-HDL	1.6 mmol/L	mg/dL	62 mg/dL	< 130
Chol/HDL Ratio	3.1	ratio	3.1	< 5

 

[Geardad]

That’s not terribly low HDL. I’d carry on, especially with a 46 LDL

 

[BabaJagga]

0,74 is actually "high" in my book ..
just finish your blast.

 

[buck]

Hard to have good HDL levels with low cholesterol. As for what to do. Depends on how long it has been that way and how often you plan on doing such things in the future. Health is a long term thig not just 1 snapshot in time.

 

[Necessary Evil]

With Var and Primo in the mix your HDL was destined to crash since those DHT derivatives specifically the Anavar are notorious for hammering hepatic lipase activity. You simply cannot expect to maintain a healthy HDL reading while running those compounds so do not let that number scare you into dropping to TRT early especially since you are already ten weeks deep.

You are actually running a very sophisticated lipid management stack with the Pitavastatin Ezetimibe and Bempedoic Acid combination. That is basically the nuclear option for crushing LDL and if your ApoB is low then the low HDL becomes irrelevant. The protective mechanism of HDL is reverse cholesterol transport but if you have successfully nuked your LDL and ApoB there is nothing for the HDL to transport anyway so the risk is mitigated.

I would honestly just finish the last six weeks because you are already protecting yourself better than 99 percent of guys on this board with that ancillary stack. Just ride it out and let the lipids normalize when you cruise but right now you are chemically designed to have low HDL and that is fine given your low atherogenic burden.

 

[just some dude]

Hard to have good HDL levels with low cholesterol.

HDL and LDL cholesterol independently predict cardiovascular risk (published in The BMJ)


HDL and LDL cholesterol independently predict cardiovascular risk

• this study reanalyzed data from a large statin trial
• it found that higher HDL cholesterol was associated with lower cardiovascular events even when LDL cholesterol was low
• the relationship between HDL and risk persisted across LDL levels

• because HDL and LDL are different particles with different roles
• LDL
  • delivers cholesterol to tissues
  • excess LDL → penetrates arterial wall → oxidation → foam cells → plaque
• 
  
• HDL
  • participates in reverse cholesterol transport
  • helps remove cholesterol from macrophages in plaques
  • has antioxidant and anti-inflammatory effects
• 
  
• they are regulated differently:
  • LDL mainly reflects apoB particle number + hepatic production + clearance
  • HDL reflects apoA-I production, triglycerides, insulin sensitivity, and genetics
• 
  
• you can lower LDL (diet, statins, ezetimibe, PCSK9 inhibitors)
  while HDL stays high due to:
  • genetics
  • low triglycerides
  • high exercise volume
  • low insulin resistance
• 
  
• mechanistically:
  lowering LDL reduces cholesterol influx into artery walls
  high HDL may improve cholesterol efflux from artery walls
• that’s why they can be low and high independently — they are different lipoprotein systems, not opposites of each other.