HDL Cholesterol

High-density lipoprotein, or "good"cholesterol

21/22Providers

Lipid Panel / CCategory

Men:>40 mg/dL, WomeReference

Widely Available

21 of 22 providers

Reference Range

Men:>40 mg/dL, Women:>50 mg/dL, Optimal:>60 mg/dL

What is HDL Cholesterol?

HDL Cholesterol (High-Density Lipoprotein Cholesterol) is often called "good cholesterol"because it transports cholesterol from peripheral tissues back to the liver for excretion—a process called reverse cholesterol transport. HDL particles also have anti-inflammatory, antioxidant, and anti-thrombotic properties that protect against atherosclerosis.

Normal HDL is >40 mg/dL in men and >50 mg/dL in women, with >60 mg/dL considered protective. Historically, HDL was thought to be causally protective—the higher the better. However, recent trials show raising HDL with medications (niacin, CETP inhibitors) does not reduce cardiovascular events, questioning HDL's causal role. The relationship may be more complex:HDL is a marker of metabolic health rather than a therapeutic target.

HDL functionality matters more than quantity. Dysfunctional HDL (from inflammation, diabetes, smoking) may paradoxically promote atherosclerosis despite normal or high levels. This explains why some people with high HDL still have heart disease, and why raising HDL with drugs failed to reduce events. HDL cholesterol efflux capacity (ability to remove cholesterol from macrophages) is a better predictor of cardiovascular risk than HDL level, though not widely available clinically.

Why HDL Is a Health Marker, Not a Treatment Target

Reverse cholesterol transport:HDL removes cholesterol from arterial plaques and transports to liver for excretion
Anti-inflammatory:HDL reduces inflammation in artery walls, inhibiting atherosclerosis progression
Marker of health:High HDL reflects healthy lifestyle (exercise, lean body mass, Mediterranean diet) and absence of metabolic syndrome
Not a treatment target:Raising HDL with medications doesn't reduce cardiovascular events. Focus on LDL lowering instead
Gender difference:Women naturally have higher HDL (+10 mg/dL) than men due to estrogen. Same protective effect
Very low HDL (<20 mg/dL):Associated with 2-3x higher cardiovascular risk and often indicates severe metabolic dysfunction

Optimal vs Standard Ranges

Range Type	Level	Significance
Protective	>60 mg/dL	Associated with reduced cardiovascular risk. Each 1 mg/dL increase in HDL correlates with 2-3% lower cardiovascular risk in observational studies. Reflects healthy lifestyle:regular exercise, lean body mass, Mediterranean diet, no smoking.
Adequate	40-60 mg/dL (men), 50-60 mg/dL (women)	Acceptable range but not optimal. Consider lifestyle interventions to raise HDL:aerobic exercise (most effective, raises HDL 3-9%), weight loss, smoking cessation, moderate alcohol (1-2 drinks daily raises HDL 3-5 mg/dL but also increases triglycerides).
Low (Increased CV Risk)	<40 mg/dL (men), <50 mg/dL (women)	Low HDL increases cardiovascular risk 50-100%. Often part of metabolic syndrome with high triglycerides, abdominal obesity, insulin resistance. Focus on weight loss, exercise, treating insulin resistance. Medications to raise HDL (niacin, fibrates) don't reduce cardiovascular events—focus on lowering LDL instead. If triglycerides >200 mg/dL, fibrate may help both.
Very Low (High Risk)	<20 mg/dL	Very high cardiovascular risk (2-3x normal). Indicates severe metabolic dysfunction, often with diabetes, obesity, severe hypertriglyceridemia (>500 mg/dL). Requires aggressive lifestyle modification and LDL lowering. Check for tangier disease (genetic HDL deficiency) if HDL <10 mg/dL.

Standard lab range: Men:>40 mg/dL, Women:>50 mg/dL, Optimal:>60 mg/dL

How to Optimize HDL Cholesterol

1. Exercise - Most Effective HDL Intervention

Aerobic exercise:150-300 min/week moderate to vigorous intensity. Raises HDL 3-9 mg/dL (5-15%). Running, cycling, swimming most effective

High-intensity interval training:May increase HDL more than moderate intensity. 20-30 min sessions 2-3x/week

Resistance training:Weight lifting 2-3x/week modestly raises HDL, especially combined with aerobic exercise

Duration matters:HDL increase proportional to exercise duration. Need consistent 3-4 months to see maximal HDL rise

Mechanism:Exercise increases lipoprotein lipase and hepatic lipase, enzymes that remodel lipoproteins and raise HDL

2. Weight Loss and Body Composition

Weight loss:Each 6 lbs lost raises HDL ~1 mg/dL. Effect most pronounced if overweight/obese

Visceral fat reduction:Abdominal fat lowers HDL more than subcutaneous fat. Measure waist circumference—target <40"men, <35"women

Build muscle mass:Higher lean body mass associated with higher HDL. Resistance training helps

Avoid crash dieting:Severe caloric restriction transiently lowers HDL. Gradual weight loss (1-2 lbs/week) preferred

Maintain weight loss:HDL improvements sustained only if weight loss maintained

3. Dietary Strategies

Mediterranean diet:Olive oil, nuts, fish, vegetables. Raises HDL 3-5 mg/dL and improves HDL function

Omega-3 fatty acids:2-4g EPA+DHA daily. Modest HDL increase (2-3 mg/dL) but improves particle function

Monounsaturated fats:Olive oil, avocados, nuts. Replace saturated fats with MUFA to raise HDL

Avoid trans fats:Trans fats lower HDL. Eliminate partially hydrogenated oils

Moderate alcohol:1-2 drinks daily raises HDL 3-5 mg/dL. However, also raises triglycerides. Not recommended solely to raise HDL

Purple/blue foods:Anthocyanins in berries, red wine, purple vegetables may improve HDL function

4. Address Metabolic Dysfunction

Improve insulin sensitivity:Low HDL often reflects insulin resistance. Metformin 1000-2000 mg daily, weight loss, exercise improve insulin sensitivity and raise HDL

Treat diabetes:Optimal glycemic control (HbA1c <7%) improves HDL. GLP-1 agonists and SGLT2 inhibitors modestly increase HDL

Lower triglycerides:TG >150 mg/dL suppresses HDL. Reduce simple carbs, lose weight. If TG >200 mg/dL, fibrate therapy raises HDL 10-20%

Thyroid optimization:Hypothyroidism lowers HDL. Ensure TSH 0.5-2.5 mIU/L

Testosterone:Low testosterone in men associated with low HDL. Consider evaluation if HDL <35 mg/dL with low muscle mass

5. Lifestyle Factors

Smoking cessation:Quitting raises HDL 3-10 mg/dL within weeks. Smoking makes HDL dysfunctional even if level is normal

Adequate sleep:7-9 hours nightly. Sleep deprivation lowers HDL

Stress management:Chronic stress lowers HDL via cortisol. Meditation, mindfulness help

Medications that lower HDL:Beta-blockers, thiazide diuretics, anabolic steroids. Discuss alternatives with doctor if HDL low

Don't use niacin:Niacin raises HDL 15-35% but doesn't reduce cardiovascular events and causes flushing, hyperglycemia. No longer recommended for low HDL

Symptoms of Abnormal HDL Cholesterol

Low HDL Cholesterol

Low HDL itself causes no direct symptoms. Symptoms relate to associated conditions:
Metabolic syndrome:Abdominal obesity, fatigue, acanthosis nigricans (dark skin patches)
Diabetes:Polyuria, polydipsia, blurred vision if poor control
Coronary disease:Angina if low HDL contributed to atherosclerosis over years
Tangier disease:Orange tonsils, hepatosplenomegaly, neuropathy if genetic severe HDL deficiency (<10 mg/dL)

High HDL Cholesterol

Very high HDL (>100 mg/dL) is generally benign:
Usually reflects genetic variation (CETP deficiency)
No symptoms
Paradoxically, extremely high HDL (>90-100 mg/dL) may not be protective—U-shaped relationship in some studies

Causes of Abnormal HDL Cholesterol

Low Levels

Low HDL (<40 men, <50 women) causes:
Metabolic syndrome:Insulin resistance, abdominal obesity, hypertriglyceridemia (most common)
Sedentary lifestyle:Physical inactivity is primary modifiable cause
Smoking:Lowers HDL and impairs function
Obesity:Especially visceral adiposity
Diabetes:Poorly controlled diabetes lowers HDL
Hypertriglyceridemia:Inverse relationship—high TG lowers HDL via lipid exchange
Genetic:Familial low HDL, Tangier disease (homozygotes have HDL <5 mg/dL), LCAT deficiency
Medications:Beta-blockers, thiazide diuretics, anabolic steroids, progestins

High Levels

High HDL (>60 mg/dL) causes:
Exercise:Regular aerobic exercise is primary cause of elevated HDL
Leanness:Low body fat percentage
Genetics:CETP deficiency, cholesterol ester transfer protein variants
Moderate alcohol:1-2 drinks daily (not recommended to start drinking for HDL)
Estrogen:Women have higher HDL premenopause. Estrogen replacement therapy raises HDL
Medications:Fibrates, statins (modest 5-10% HDL increase)
Extreme HDL (>100 mg/dL):Usually genetic (CETP deficiency). May not be additionally protective

When to Retest

Routine screening:Check every 5 years age 20-39, every 1-2 years age 40+
After lifestyle changes:Retest HDL in 6-12 weeks after starting exercise program or losing weight. Expect 3-9 mg/dL increase with consistent exercise
If low HDL:Recheck annually. Focus on lifestyle (exercise, weight loss) and LDL lowering rather than HDL-targeted medications
On fibrate therapy:If fibrate prescribed for high triglycerides, recheck HDL in 6-12 weeks. Expect 10-20% increase
Post-cardiovascular event:Check HDL as part of lipid panel 4-6 weeks after event. Low HDL indicates need for aggressive LDL lowering
No need for frequent monitoring:Unlike LDL, HDL is not a treatment target. Once measured, annual checks sufficient unless lifestyle changes attempted

Scientific Evidence

HDL and Cardiovascular Risk - Observational Data

Framingham and other cohort studies show inverse relationship between HDL and cardiovascular risk. Each 1 mg/dL increase in HDL correlates with 2-3% lower cardiovascular risk. HDL <40 mg/dL in men and <50 mg/dL in women approximately doubles cardiovascular risk. However, this is association, not proven causation.

Source:Gordon DJ, et al. High-density lipoprotein cholesterol and cardiovascular disease. Circulation. 1989;79(1):8-15.

HDL-Raising Therapy Fails to Reduce Events

Multiple trials of HDL-raising therapies (niacin, CETP inhibitors) failed to reduce cardiovascular events despite successfully raising HDL 20-40%. AIM-HIGH, HPS2-THRIVE (niacin) and dal-OUTCOMES (dalcetrapib CETP inhibitor) all showed no benefit. This proved raising HDL pharmacologically doesn't reduce cardiovascular risk—HDL is a marker, not a target.

Source:Boden WE, et al. Niacin in patients with low HDL cholesterol levels receiving intensive statin therapy. N Engl J Med. 2011;365(24):2255-2267.

HDL Functionality vs Quantity

HDL cholesterol efflux capacity (ability to remove cholesterol from macrophages) predicts cardiovascular events independent of HDL level. Patients with high efflux capacity have lower risk even with low HDL, while those with low efflux have higher risk despite high HDL. This suggests HDL function is more important than quantity, but efflux testing is not widely available.

Source:Rohatgi A, et al. HDL cholesterol efflux capacity and incident cardiovascular events. N Engl J Med. 2014;371(25):2383-2393.

Exercise and HDL

Meta-analyses of exercise interventions show aerobic exercise raises HDL 3-9% (typically 2-8 mg/dL). Effect is dose-dependent—more exercise, greater HDL increase. Combination of aerobic and resistance training is most effective. HDL increase occurs within 3-4 months and requires ongoing exercise to maintain. This makes exercise the most effective HDL-raising intervention.

Source:Kodama S, et al. Effect of aerobic exercise training on serum levels of high-density lipoprotein cholesterol:a meta-analysis. Arch Intern Med. 2007;167(10):999-1008.

Very Low HDL and Metabolic Syndrome

HDL <40 mg/dL is a component of metabolic syndrome and strongly associated with insulin resistance. Low HDL in metabolic syndrome reflects underlying metabolic dysfunction rather than being causal. Treatment focuses on weight loss, exercise, and treating insulin resistance (metformin, GLP-1 agonists) which secondarily raise HDL. Fibrates raise HDL but don't reduce cardiovascular events unless triglycerides >200 mg/dL.

Source:Grundy SM, et al. Diagnosis and management of the metabolic syndrome:an AHA/NHLBI scientific statement. Circulation. 2005;112(17):2735-2752.

Which Providers Test HDL Cholesterol?

Full Provider Comparison

Provider	Includes	Annual Cost	Biomarkers
Superpower	✓	$199	100+ (150 with ratios)
WHOOP Advanced Labs	✓	$349	65
Labcorp OnDemand	✓	$398	30+
Life Extension	✓	$486	40+
Everlywell	✓	$468	83
Mito Health	✓	$349	100+
InsideTracker	✓	$680	54
Function Health	✓	$365	100+
Marek Health Base	✓	$250	65
Marek Health Comprehensive	✓	$495	70+
Marek Health Complete	✓	$895	100+
Marek Health Executive	✓	$1950	150+
Blueprint	—	$399	100+
Quest Health	—	$Varies	75+
Empirical Health	✓	$190	100+
Oura Health Panels	✓	$99	50
SiPhox Health	✓	$125	60
Hims Labs Base	✓	$199	50
Hims Labs Advanced	✓	$499	120+
Healthspan	✓	$4188	80+
Vitality Blueprint Standard	✓	$375	85
Vitality Blueprint Elite	✓	$700	129

Ready to Test HDL Cholesterol?

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Frequently Asked Questions

What does HDL Cholesterol test for?

HDL Cholesterol is a lipid panel / cardiovascular health biomarker. High-density lipoprotein, or "good"cholesterol The normal reference range is Men:>40 mg/dL, Women:>50 mg/dL, Optimal:>60 mg/dL.

Which providers include HDL Cholesterol?

21 of 22 providers include this test:Superpower, Blueprint, Mito Health, WHOOP and others.

How often should I test HDL Cholesterol?

For most people, testing 2-4 times per year is recommended to establish baseline levels and track trends. Consult your healthcare provider for personalized recommendations.

What is the optimal range?

The standard reference range is Men:>40 mg/dL, Women:>50 mg/dL, Optimal:>60 mg/dL. Many functional medicine practitioners recommend tighter optimal ranges for peak health. Your ideal range may vary based on age, sex, and health goals.

Why is HDL Cholesterol important?

Removes cholesterol from arteries and transports to liver for disposal. Higher levels protective against heart disease. Low HDL increases cardiovascular risk.

Medical Disclaimer

This information is for educational purposes only and is not medical advice. Always consult with a qualified healthcare provider about your specific health needs.