Cholesterol concerns for bodybuilders

By Kim Crawford, M.D. Last updated: February 7, 2018
can be full of cholesterol

Cholesterol concerns and care of bodybuilders with info for all at the end!

Our understanding of cholesterol levels in bodybuilders is limited. The issue is with anabolic steroids and what I’ll do here is let you know the “best”,the “worst”, what to do to protect your heart from high cholesterol, the physiology of how placquing works and then some suggested regimen alterations. If you stop  reading, be sure to scroll to the end!

The reason we just don’t know a lot about lipids in bodybuilders is that the effects of anabolic steroids comes from a pretty small set of observations made in athletes taking these medications and from a small number of animal studies.

Retrospective (in hindsight) human studies in this area really suffer from important methodologic problems.

These problems include things like incomplete or inaccurate reporting on drug dosages by athletes, the contributions of the effects of other supplements or pharmaceuticals that the athletes may be taking; and the cardiovascular effects of an athlete’s training routine that may actually mimic some of the effects of steroids.

As a note here-I’m going to get into all the cardiovascular effects next week.

The vast majority of studies show that anabolic steroids have an undesirable (read-not GOOD)effect on the serum lipid profile.

These medications can lead to a 20%+ increase in the unhealthy, “bad”- cholesterol (LDL) and also a 20%+ decrease in the healthy, “good”- cholesterol (HDL).  Combining oral anabolics will inflate those numbers greatly. The exact mechanism for these changes has not been established although we’re pretty sure it’s all about how the liver metabolizes cholesterol. More to come on that in a moment.

These changes develop within weeks of starting to take anabolic steroids and can stick around for months after these products are stopped. This,indeed occurs despite a relatively short pharmacologic half-life measured in days.

Many studies suggest that the oral route of administration is worse in this regard than are injectables.

These unfavorable changes in the serum lipid profile are important because there is considerable evidence that high LDL and low HDL levels are associated with increased risk for coronary artery disease, heart attack, and stroke.

Now, this said, be aware that many doctors are not measuring lipids the correct way. Here is a one minute video I did explaining just what to ask for and then I’ll go into it more at the end when I tell you how to protect yourself and your heart, brain, and arteries.




How do hormones  affect blood lipids?

What is the connection between steroids and lipids? Since all hormones are produced from cholesterol, then taking steroids, it would follow, would shut down natural hormonal production.

That would then leave more cholesterol unused. However, the body can also reduce the production of cholesterol.

But it does indeed appear that certain steroid hormones have an effect on good and bad lipid levels.


And it appears to “happen” via some mechanism in the liver. Sorry but that’s the best explanation I have for now, but will keep you updated with new research. We do,however know which hormones have the greatest good and bad effects on lipids. First a word on dosing.

How dose the dose of steroids affect lipids?

  • Under the normal circumstances, meaning “no added hormones”,  the body limits the quantity of hormones the endocrine glands can secrete.
  • However, by taking steroids you can add as much hormones as you want. But this comes with a pricetag when it comes to lipids.
  • And we’re not even talking about liver and kidney here, just lipids.
  • Besides shutting down your own natural hormonal production, which usually means sterility for men,more steroids obviously have a greater effect on lipid  levels.
  • This is one of the reasons, why even non-bodybuilders on bioidentical hormones (BHRT) need blood testing, to make sure that their values are in the right range.


Hormones besides anabolics with effects on lipids:

According to majority of the studies, estrogen, testosterone, progesterone, and DHT appear to have the greatest effect on lipid levels.

Estrogen-namely estradiol in particular seems to be responsible for keeping good HDL- cholesterol elevated.

The downside to keeping an E2 level higher than 15-25 pg/ml is loss of libido, erectile issues and more importantly for health-a greater risk for benigh prostatic hypertrophy and prostate cancer.

If you are on anabolics and want to juggle this I would recommend seeing if a level of 35-as high as 50 can bring up your HDL,while keeping your PSA stable and your sex life decent-additions of cialis type drugs can not only help with E.D.-they can help stave off B.P.H.

DHT might raise total and LDL- cholesterol. The theory is that is “overpowers” estradiol. DHT or  Dihydrotestosterone has anti-estrogenic properties.

So, by reducing estrogen, HDL goes down or so some studies show.

However DHT as a byproduct of testosterone rarely has a noticeable effect on serum lipids in the general population but in the cycling phases of bodybuilding where testosterone dosing is high, we see an effect.

DHT or DHT-derived anabolics (much moreso) stimulate hepatic lipase. Hepatic lipase is responsible for clearance of HDL- cholesterol. That causes a decrease in HDL- cholesterol. Since HDL helps chomp out excess LDL cholesterol from the blood, reduction in HDL causes a rise in LDL? Make sense? Know this for when I talk about the anabolics and it will all come together.

Some guys do nothing, some take meds like propecia, and some have experimented with progesterone. The biggest effect with DHT is really the anabolics being derived from it-more in a moment.

A word about progesterone. This hormone is the precursor to both testosterone and estrogen and can be LOW and should be checked in bodybuilders, as supplementation will augment testosterone effects (so you need less)  and bring down DHT levels.

And orally, it helps with sleep. (Oral passes blood-brain barrier, cream doesn’t).

I’m talking about BI progesterone, NOT progestins which are actually carcinogenic.

The downside is that too much progesterone will negate the positve cardiac effects of estrogen. As you can see, a good doctor can guesstimate, check levels, adjust and get this “symphony” all in tune. A REALLY smart bodybuilder  could figure all this out for himself, but the vast majority of others benefit from guidance.

OK, now the part you want-the “rankings”:

Now remember I’m trying to be scientific here so cannot “rank” steroids that haven’t been studied. So here is what HAS been studied.

Testosterone based steroids don’t have a big effect on cholesterol levels, when used in “typical” or off-cycle doses.  Although high doses of testosterone (giving levels of 5000 ng/dL) by itself can raise LDL- cholesterol, its’ main effect is caused by it’s metabolites-estradiol and DHT.

DHT based steroids such as the very popular Anavar, Winstrol, and Masteron have shown to have the biggest effect, when it comes to lowering HDL and increasing LDL- cholesterol.

You can, in my opinion, extrapolate all of the results on the orals mentioned to all the DHT derived orals.

Amazingly enough the injectables have sparse studies but hormone experts like myself and many others agree IM anabolics in this category will drop the HDL and raise the LDL but not to the degree that orals do.

Don’t worry, I have the “fix” below.

Progesterone based steroids such as  Deca Durabolin  don’t seem to have as significant of an effect on lipid levels.

Well, it’s IM for one thing, studies have been done and it usually slightly reduces HDL without bumping up LDL.

If I were to name the SAFEST anabolic it would be deca. Great for joints too. (Yes I know it’s OUT if you’re competing). And yes I know about the original studies on deca but that was progestin not progesterone derived-quite a difference.

What about HGH?

Also, chemically similar to steroids, Human Growth Hormone seems to actually improve blood lipid profiles.This is likely due to it’s great ability to let users drop fat mass and gain lean body mass. The effects are augmented by acetyl-l-carnitine supplementation.

 How can we help the cholesterol “situation” here:

So let’s first clear up the LDL serum measurement issue. If you watched the youtube video above you know I advised that a serum LDL is antiquated and you must get an NMR lipoprotein profile. This test measures the size and density of LDL particles. Big or medium particles aren’t sticky. Small and dense (lots of) LDL particles,when “oxidized” will stick to coronary endothelium. So now what are the factors that influence whether or not the small dense particle stick?

Oxidative stress which is a topic I have covered over and over and is easily fixable and present in most mortals, let alone bodybuilders who have it big time due to high free radical generation during workouts.

Next, inflammation which again- caused by poor diets, overweight in the general population and the intense workouts and muscle tearing causes it for bodybuilders.

Then we have a really high incidence of high cortisol levels in bodybuilders due to several factors: stimulants, crazy-hard workouts=high physical stress.

Then we have high blood sugars which can be caused by high doses of HGH. And finally high T doses add into the mix. So what we want to do first is always create an environment where LDL particles just plain can’t stick. 

What about alternatives?

This is one of those places where I legally must tell you that I don’t condone the use of anabolics or anything not medically prescribed. Now with that out of the way, if you are seeing LFT’s doubling, HDL in the basement and LDL up in the sky AND GFR dropping you know you need to change up your routine,right? Please say right.

Ideas: HGH is safe in clinical studies up to an IGF-1 of 500 ng/mL-of course, no pre-existing cancers,cancer screening, watch for fluid retention, blood pressure elevations and carpal tunnel. This does not mean bodybuilders can put it that high-perhaps to 350 ng/ml and if you inch higher get echocardiograms. Meaning we don’t know where left ventricular thickening becomes “too much” such that you have heart failure.

Rarely do I see that bodybuilders push the HGH but instead they the pile on the orals. Think about it.

Next idea: Another little-used pretty much non-toxic injectable drug is IGF1LR3, legal in Europe.

This drug will not just hypertrophy muscles, it creates new muscle fibers-new sarcomeres-new muscle units by mostly lowering muscle unit degredation so you end up with more muscle TO WORK WITH.

This can be combined with HGH and it is being done in Europe with so far, no reports of issues.

Dosing starts at .1 mg sub-Q and If I were to advise I would go up .1 mg per week. IDK how high you can push this but be careful and watch your body and your numbers. Know that the new muscle you create doesn’t go away.  At the very least it would seem logical to me (and I can’t say whether or not I’ve seen it “in action” for legal reasons) that if you push the HGH up, add the IGF1LR3 +t he BCAA’s that you can drop off at least on most of the orals. Perhaps you can alternate cycles?

While you are doing this, you want to feed those muscle LOTS of bcaa  protein including supplements and the IGF1LR3 will work better. I would also suggest the one of  nitric oxide benefits (meaning benes of boosting) is holding down your blood pressure, another is preventing blood clots and the last one is that it amps up your workouts for MORE muscle and more fun during workouts.



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