HDL Cholesterol
HDL cholesterol measures the cholesterol carried on high-density lipoprotein particles, which return cholesterol from peripheral tissues to the liver for disposal. Higher levels are associated with lower cardiovascular risk, while very low HDL (under 40 mg/dL in men, 50 in women) is a risk factor. Exercise, weight loss, and reduced refined carbs tend to raise HDL.
Units: mg/dL; some labs report mmol/L (mmol/L = mg/dL × 0.0259). Check the units on your report before comparing to any range here.
Optimal range: who says what
Institutions, researchers and practitioners draw the line in different places. Each position is listed with who holds it and, where a document states it, a link. How we verify ranges.
- Institution or study≥60 mg/dLNCEP ATP III (NHLBI, 2001)ATP III classifies 60 mg/dL or above as high and counts it as a negative risk factor; below 40 mg/dL is classified low.
- Institution or studyAbout 73 mg/dL (men), 93 mg/dL (women) lowest mortalityCopenhagen cohorts (Madsen et al. 2017, Eur Heart J)The curve was U-shaped: men at 116 mg/dL or more had 2.06 times the all-cause mortality of the lowest-risk group
- Named practitioner>60 mg/dLChris Kresser · The Functional Medicine Approach to High Cholesterol
- Named practitioner≥50 mg/dLLife Extension · Lab Testing Protocol (Suggested Optimal Ranges)Disclosure: Life Extension sells lab panels that appear in our blood-test comparisons.
- Named practitioner50-85 mg/dLTracey O'Shea (Kresser Institute) · The Lipid Panel Was Fine. The Patient Was Not: A Case in Advanced Cardiovascular Risk Assessment
- Lab reference intervalMen: >40 mg/dL, Women: >50 mg/dLWhat a lab report flags against. A lab interval is not an optimal target.
Practitioner targets are individual positions, often tighter than guideline ranges. Each was checked against its article before publishing.
21 of 21 itemized panels
Lipid Panel / Cardiovascular Health
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
Interpretation bands (curated, PMID-backed)
Holder: OptimizeBiomarkers editorial synthesis of: Extreme high high-density lipoprotein cholesterol is paradoxically associated with high mortality in men and women: two prospective cohort studies (Madsen et al., 2017); The U Shaped Relationship Between High-Density Lipoprotein Cholesterol and All-Cause or Cause-Specific Mortality in Adult Population (Huang et al., 2020); Serum Cholesterol Levels and Risk of Cardiovascular Death: A Systematic Review and a Dose-Response Meta-Analysis of Prospective Cohort Studies (Jung et al., 2022). No single paper sets these cutoffs; for attributed targets see who says what.
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
Adequate40-60 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
- Extreme high high-density lipoprotein cholesterol is paradoxically associated with high mortality in men and women: two prospective cohort studies.
- The U Shaped Relationship Between High-Density Lipoprotein Cholesterol and All-Cause or Cause-Specific Mortality in Adult Population.
- Serum Cholesterol Levels and Risk of Cardiovascular Death: A Systematic Review and a Dose-Response Meta-Analysis of Prospective Cohort Studies.
What raises or lowers HDL Cholesterol
Causes of high HDL Cholesterol
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 HDL increase)
- Extreme HDL (>100 mg/dL): Usually genetic (CETP deficiency). May not be additionally protective
Causes of low HDL Cholesterol
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
Symptoms when HDL Cholesterol is high or low
When high
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
Extremely high HDL (>120 mg/dL) rarely indicates a problem but offers no additional benefit over 60-80 mg/dL.
When low
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)
Low HDL is asymptomatic. It increases cardiovascular risk silently over decades. Screen regularly and address underlying causes.
How to move HDL Cholesterol
Effect sizes (how much something moves the marker) appear only where the paper cited under the item states them. Talk to your clinician before starting or changing any medication or supplement.
Exercise - Most Effective HDL Intervention
- Aerobic exercise: 150-300 min/week moderate to vigorous intensity. Raises HDL modestly. 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
Weight Loss and Body Composition
- Weight loss: HDL rises as weight comes off. Effect most pronounced if overweight/obese
- Visceral fat reduction: Abdominal fat lowers HDL more than subcutaneous fat. Measure waist circumference and track it
- 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
Dietary Strategies
- Mediterranean diet: Olive oil, nuts, fish, vegetables. Raises HDL modestly
- Omega-3 fatty acids: 2-4g EPA+DHA daily. Modest HDL increase
- 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: Alcohol raises HDL, but that is not a reason to drink. However, also raises triglycerides. Not recommended solely to raise HDL
- Purple/blue foods: Anthocyanins in berries, red wine, purple vegetables may improve HDL function
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: Better glycemic control 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
- Thyroid: Hypothyroidism lowers HDL. Have TSH checked and hypothyroidism treated
- Testosterone: Low testosterone in men associated with low HDL. Consider evaluation if HDL <35 mg/dL with low muscle mass
Lifestyle Factors
- Smoking cessation: Quitting raises HDL 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 but doesn't reduce cardiovascular events and causes flushing, hyperglycemia. No longer recommended for low HDL
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 a modest 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 a modest 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
In four US studies (Framingham, LRC, CPPT and MRFIT), each 1 mg/dL higher HDL cholesterol was associated with 2% lower coronary heart disease risk in men and 3% in women, after adjustment for LDL and other risk factors. HDL was unrelated to non-cardiovascular death.
Source: High-density lipoprotein cholesterol and cardiovascular disease. Four prospective American studies.
Raising HDL With Niacin Did Not Help
In 3,414 patients with cardiovascular disease and LDL below 70 mg/dL on statins, niacin raised HDL from 35 to 42 mg/dL and lowered triglycerides but did not reduce cardiovascular events (16.4% vs 16.2%). The trial stopped early for lack of efficacy.
Source: Niacin in patients with low HDL cholesterol levels receiving intensive statin therapy.
HDL Function vs Quantity
In 2,924 Dallas Heart Study adults, HDL cholesterol level was not associated with cardiovascular events after adjustment, while the highest quartile of cholesterol efflux capacity carried 67% lower risk than the lowest (HR 0.33).
Source: HDL cholesterol efflux capacity and incident cardiovascular events.
Which Providers Test HDL Cholesterol?
Cheapest: Oura Health Panels at $99/year. Most comprehensive: Function Health, 160+ biomarkers for $365/year.
21 panels that include it, cheapest first
| Provider | Annual Cost | Total Biomarkers | $/Biomarker |
|---|---|---|---|
| $99 | 50 | $1.98 | |
| $190 | 100+ | $1.90 | |
| $250 | 65 | $3.85 | |
| $297 | 100+ | $2.97 | |
 Labcorp OnDemand | $338 | 50+ | $6.76 |
 Superpower | $349 | 100+ | $3.49 |
| $349 | 75+ | $4.65 | |
 WHOOP Advanced Labs | $349 | 65 | $5.37 |
 Function Health | $365 | 160+ | $2.28 |
| $365 | 100+ | $3.65 | |
| $375 | 108 | $3.47 | |
| $449 | 83 | $5.41 | |
| $495 | 80+ | $6.19 | |
| $499 | 100+ | $4.99 | |
| $700 | 138 | $5.07 | |
| $829 | 54 | $15.35 | |
| $895 | 100+ | $8.95 | |
| $996 | 59 | $16.88 | |
| $1188 | 70+ | $16.97 | |
| $1198 | 40+ | $29.95 | |
| $1950 | 130+ | $15.00 |
$/Biomarker is annual cost divided by the panel's advertised biomarker count, not the price of this one test. We track 23 blood test providers (32 plans); 21 of those plans are itemized marker by marker. Compare all of them.
11 providers not itemized in our matrix
We have not itemized these marker by marker (some sell tests one at a time), so this page cannot say whether they offer HDL Cholesterol. Check with them directly.
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Experts discussing HDL Cholesterol
Podcast episodes where clinicians and researchers cover this marker in depth. Curated by hand; an episode is listed only when the marker is a substantial topic, not a passing mention.
- Dr. Casey Means: Transform Your Health by Improving Metabolism & Blood Sugar RegulationDisclosure: Huberman Lab has been sponsored by Function Health, which appears in our blood-test comparisons.
- Does omega-3 reduce cardiovascular disease? Comparing major trials
- Episode 171: July 2022 Bloodwork Review
- Sky High LDL on Keto/Carnivore: Should You Worry?
- When You Should Worry About LDL Cholesterol
- Episode 385: Carnivore Diet and Dr. Baker's Blood Work
Frequently Asked Questions
What is the optimal range for HDL Cholesterol?
Published positions differ: ≥60 mg/dL (NCEP ATP III (NHLBI, 2001)); About 73 mg/dL (men), 93 mg/dL (women) lowest mortality (Copenhagen cohorts (Madsen et al. 2017, Eur Heart J)). Named practitioners target: >60 mg/dL (Chris Kresser); ≥50 mg/dL (Life Extension); 50-85 mg/dL (Tracey O'Shea (Kresser Institute)). Lab reference interval: Men: >40 mg/dL, Women: >50 mg/dL. That is what a lab report flags against, not an optimal target.
Which blood test providers include HDL Cholesterol?
21 of the 21 blood testing panels we itemize marker by marker include HDL Cholesterol in their panels. This biomarker is widely available across major providers.
Related: YouBoost rates lifestyle and supplement interventions by evidence; HRV Zone tracks recovery trends.
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.
Last reviewed Sep 23, 2026 · First published Sep 30, 2025