What If Lower Cholesterol Isn't Actually Better For Your Health?

February is Heart Health Month, and everyone's talking about lowering cholesterol. But here's what almost no one is discussing: when it comes to cholesterol, lower is not always better.

In fact, driving your cholesterol too low can devastate your hormones, tank your energy, and leave you feeling like a shell of yourself—even while your cardiologist celebrates your "excellent" lab results.

Let me explain why your fatigue, low libido, brain fog, and hormonal dysfunction might have everything to do with that impressively low cholesterol number.

The Cholesterol Paradox: Too Low Is a Problem

Most of us have been taught that total cholesterol should be below 200 mg/dL. Fair enough—excessively high cholesterol does correlate with increased cardiovascular risk in certain contexts.

But here's what you're rarely told: there's a lower threshold below which cholesterol becomes problematic.

When total cholesterol drops below 160 mg/dL, your body often stops prioritizing sex hormone production and reproduction. Why? Because cholesterol is the essential building block for all your sex hormones—estrogen, progesterone, testosterone.

No cholesterol = no hormones. It's that simple.

Cholesterol: The Foundation of Your Hormones

Let's clarify what cholesterol actually does in your body, because the narrative you've been fed is incomplete.

Cholesterol is not just about heart disease risk. Cholesterol is a precursor molecule for:

• All sex hormones - Estrogen, progesterone, testosterone

• Cortisol - Your primary stress hormone

• Vitamin D - Which functions more like a hormone than a vitamin

• Bile acids - Essential for fat digestion and nutrient absorption

• Cell membrane integrity - Every cell in your body needs cholesterol for structure and function

• Brain health - Your brain is about 25% cholesterol; it's essential for neurotransmitter function and cognitive performance

When your cholesterol falls too low, these systems begin to fail. Your body makes a survival decision: reproduction and sex hormones are not essential for immediate survival, so production gets deprioritized.

The Patients I See: A Pattern You Should Recognize

I frequently see patients who come to me with:

• Crushing fatigue

• Low libido or complete loss of sexual desire

• Irregular or absent menstrual cycles

• Low testosterone (in both men and women)

• Hypothyroid symptoms or suboptimal thyroid function

• Brain fog and poor concentration

• Depression or anxiety

• Poor stress resilience

When I run their labs, I often find total cholesterol below 160 mg/dL—sometimes as low as 120-140 mg/dL. Their sex hormones are tanked. Their thyroid function is suboptimal. Their body is struggling.

And almost always, the low cholesterol is the result of one or more of these factors:

1. Excessive dietary restriction - Low-fat diets, calorie restriction, chronic dieting

2. Over-exercise relative to caloric intake - High energy expenditure without adequate fuel

3. Lipid-lowering medications - Statins, in particular, that have driven cholesterol too low

Here's the critical piece: most of these patients aren't intentionally trying to over-restrict or over-exercise. They're following mainstream health advice. They think they're being healthy. They don't realize they're not providing adequate calories and nutrients for the demands they're placing on their bodies.

The Cardiology Blind Spot

Here's where conventional medicine fails these patients.

Cardiologists see low cholesterol as a win. From a purely cardiovascular standpoint, they've been trained to believe "the lower, the better." I rarely—almost never—see cardiologists appropriately reducing lipid-lowering medications when cholesterol dips below 160 mg/dL.

They're not monitoring hormone levels. They're not asking about fatigue, libido, menstrual cycles, or mood. They're focused exclusively on cardiac risk reduction.

But here's the problem: they aren't in charge of your hormone health.

That's when patients get referred to endocrinologists or functional medicine practitioners like me who specialize in hormones. And when I see these patients—exhausted, hormonally depleted, often desperate for answers—the solution isn't what they expect.

We Don't Start with Hormone Replacement

When I see a patient with low hormones, fatigue, and low cholesterol, we don't immediately start hormone replacement therapy.

Why? Because their body isn't broken. It knows what to do. It's designed to produce hormones efficiently.

The problem isn't that their body has forgotten how to make hormones. The problem is that they don't have the raw materials—the substrate—to build those hormones.

You cannot manufacture hormones without cholesterol. It's biochemically impossible.

Giving someone testosterone or estrogen when their cholesterol is 140 mg/dL is like trying to build a house when you haven't delivered the lumber to the construction site. You're treating the symptom (low hormones) without addressing the cause (insufficient building blocks).

The Functional Medicine Approach: Restore the Foundation First

Here's what actually works:

Step 1: Identify Why Cholesterol Is Low

Is it dietary restriction?

• Are they eating adequate healthy fats? (Avocados, olive oil, nuts, seeds, fatty fish, eggs, grass-fed meat)

• Are they getting enough total calories for their activity level?

• Are they on a chronic low-fat diet?

Is it excessive exercise relative to intake?

• What's their training volume? (Hours per week, intensity)

• Are they fueling adequately for their activity?

• Are they in chronic caloric deficit?

Is it medication-induced?

• Are they on statins or other lipid-lowering drugs?

• Has the dose been appropriate, or has it driven cholesterol too low?

• Can the medication be reduced or discontinued under medical supervision?

Step 2: Restore Adequate Cholesterol Levels

Dietary interventions:

• Increase healthy fat intake (aim for 25-35% of total calories from fat)

• Include cholesterol-rich foods: eggs (especially yolks), full-fat dairy if tolerated, grass-fed meat, organ meats

• Ensure adequate total caloric intake for activity level

• Stop chronic low-fat dieting

Exercise modifications:

• Reduce training volume if over-exercising

• Ensure adequate rest and recovery

• Match caloric intake to energy expenditure

Medication adjustments:

• Work with prescribing physician to reduce or discontinue statins if appropriate

• Monitor lipid levels as they normalize

• Consider whether statin therapy is truly necessary given individual cardiovascular risk profile

Step 3: Monitor Hormone Recovery

As cholesterol levels rise back into the optimal range (generally 160-200 mg/dL), we monitor:

• Sex hormone levels (estrogen, progesterone, testosterone)

• Thyroid function (TSH, Free T3, Free T4)

• Energy levels and symptom improvement

• Menstrual cycle regularity (for menstruating women)

• Libido and sexual function

In the vast majority of cases, hormones recover naturally once cholesterol is restored. The body does exactly what it's supposed to do—it starts producing hormones again because it finally has the substrate to work with.

No hormone replacement necessary. The body wasn't broken. It was just starved of raw materials.

The Optimal Cholesterol Range

So what should your cholesterol be?

For hormone production and overall health:

• Total cholesterol: 160-200 mg/dL is generally optimal for most people

• Below 160 mg/dL increases risk of hormone dysfunction

• Above 200 mg/dL may increase cardiovascular risk depending on particle size, inflammation, and other factors

Important nuance: Total cholesterol is only part of the story. In functional medicine, we also look at:

• HDL (the "good" cholesterol) - Should be above 50 mg/dL for women, 40 mg/dL for men

• Triglycerides - Should be below 100 mg/dL ideally

• LDL particle size - Small, dense LDL particles are more problematic than large, fluffy particles

• Inflammatory markers - hs-CRP, oxidized LDL

• Overall metabolic health - Blood sugar regulation, insulin sensitivity

Cholesterol doesn't exist in isolation. Context matters enormously.

The Statin Question

If you're on a statin and experiencing fatigue, low libido, muscle pain, cognitive issues, or other symptoms, your medication may be driving your cholesterol—and your hormones—too low.

This doesn't mean statins are never appropriate. For certain high-risk cardiovascular patients, they can be life-saving.

But statins are overprescribed. Many people on statins don't actually need them, and even those who do often need lower doses than they're taking.

If you're on a statin:

• Check your total cholesterol—is it below 160 mg/dL?

• Assess your symptoms—fatigue, hormone issues, muscle pain, brain fog?

• Discuss with your physician whether dose reduction is appropriate

• Consider more comprehensive cardiovascular risk assessment beyond just cholesterol numbers

Never stop medications without medical supervision, but do advocate for a conversation about whether your current regimen is serving your overall health.

Your Body Isn't Broken

If you're experiencing hormonal dysfunction, crushing fatigue, or other symptoms and your cholesterol is below 160 mg/dL, the solution isn't necessarily hormone replacement, thyroid medication, or antidepressants.

The solution might be as simple as giving your body what it needs to produce hormones naturally: adequate cholesterol, sufficient calories, appropriate exercise balance, and proper recovery.

Your body knows how to heal. It knows how to produce hormones. It knows how to regulate itself.

But it can't do any of that without the raw materials.

This Heart Health Month, don't just focus on driving cholesterol lower. Focus on finding the sweet spot—the range that protects your heart without sacrificing your hormones, energy, and quality of life.

Because heart health isn't the only kind of health that matters. And cholesterol isn't just a number to minimize—it's a critical molecule your entire body depends on.

Definition of Health provides virtual, telemedicine-based functional medicine care to patients in Idaho, Oregon, and Utah. Click here to begin your health journey.