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HDL Cholesterol

HDL cholesterol is the cholesterol carried in HDL particles. Low levels are linked to more heart risk, but very high levels aren't clearly protective.

AI-drafted. Awaiting verificationAlso called HDL-C, HDL, HDLCLOINC 2085-9

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What it is

HDL stands for high-density lipoprotein. These particles carry cholesterol and other fats through your blood, and HDL cholesterol is the amount of cholesterol they hold. It is often called "good cholesterol" because people with higher levels tend to have fewer heart attacks. That label is too simple, though. HDL particles do many jobs, and medicines or gene changes that raise HDL cholesterol have not been shown to prevent heart attacks. HDL cholesterol is part of the standard lipid panel.

Why it matters

A low HDL cholesterol is linked to higher heart disease risk. It often travels with high triglycerides, extra weight around the middle, high blood sugar and low physical activity, so it can be a clue to overall metabolic health. HDL cholesterol is also used in heart-risk calculators, and subtracting it from total cholesterol gives non-HDL cholesterol. It works better as a risk marker than as a treatment target, and guidelines do not set a goal number to chase.

If it’s low

A low HDL cholesterol is common. On its own it isn't a diagnosis, but it is linked to higher heart disease risk, especially when triglycerides are also high. Many everyday factors can lower it, and several of them can be changed.

Common causes

  • Insulin resistance, prediabetes or type 2 diabetes
  • Extra body weight, especially around the middle
  • High triglycerides
  • Little physical activity
  • Cigarette smoking
  • A diet very high in carbohydrates (more than about 60% of calories)
  • Some medicines, including beta-blockers, anabolic steroids, progestins and thiazide diuretics
  • Kidney failure
  • Rare inherited conditions

What can help

  • Regular aerobic exercise; trials show a modest average rise of about 2 to 3 mg/dL
  • Quitting smoking
  • Losing extra weight if you carry it
  • Swapping refined carbohydrates for whole grains, nuts, beans and healthy oils
  • Ask your clinician how your HDL fits with your triglycerides, LDL or non-HDL cholesterol, ApoB and blood sugar

If it’s high

A higher HDL cholesterol is usually fine. It is common in people who exercise, in women before menopause, and in people with certain inherited traits. Older US guidelines count 60 mg/dL or more as a protective factor. But in two large Danish studies, people with extremely high HDL cholesterol (about 116 mg/dL or more in men and 135 mg/dL or more in women) had higher death rates than people in the middle. Those findings need confirmation, and many other things can cause a high result.

Common causes

  • Inherited differences, such as changes in the CETP gene
  • Regular aerobic exercise
  • Moderate alcohol intake
  • Female sex and estrogen
  • Some medicines, such as niacin, fibrates and statins

What can help

  • For most people a high result needs no action
  • If it is unusually high, ask your clinician whether alcohol use or any of your medicines could be involved

Usual ranges

What labs print as the reference range, by who was tested. Ranges differ a little between labs, so the range on your own report is the one your result is judged against.

The usual range depends on age. Choose an age to see the one that applies.

Children and teens 1 ranges

See HDL by age and sex, with the U.S. survey numbers where they exist.

NCEP ATP III HDL cholesterol classification (adults)

  • Lowbelow 40 mg/dL
  • Between low and high40 to under 60 mg/dL
  • High (counted as a protective factor)60 and above mg/dL

NCEP ATP III metabolic syndrome criterion for HDL cholesterol (women)

  • Under 50: meets the low-HDL criterion for womenbelow 50 mg/dL
  • 50 or higher: does not meet the criterion50 and above mg/dL

AHA/ACC childhood HDL cholesterol values (children and adolescents)

  • Lowbelow 40 mg/dL
  • Borderline40 to under 45 mg/dL
  • Acceptable45 and above mg/dL

If this applies to you

HDL means a little more for some people. Open the one that fits you.

High cholesterol or heart risk

HDL is measured in every standard lipid panel. It is needed to work out non-HDL cholesterol, which is total cholesterol minus HDL.

Blood tests for heart health and high cholesterol

Strength training

Anabolic steroids lower HDL cholesterol, especially steroids taken by mouth. A low HDL is one of the lab signs the Endocrine Society says might suggest steroid use.

Blood tests for strength training and bodybuilding

Keto or low-carb eating

HDL was slightly higher on low-carb diets than on low-fat diets in a meta-analysis of trials. In the online survey, high HDL with low triglycerides went along with the largest LDL rises.

Blood tests on a keto or low-carb diet

On gender-affirming hormones

Both estrogen and testosterone can shift lipids such as HDL cholesterol and triglycerides, WPATH notes, and a 2021 review links testosterone with lower HDL. The Endocrine Society suggests a fasting lipid profile as part of checking heart risk, and WPATH suggests one before and after starting testosterone.

Blood tests on gender-affirming hormones

Taking isotretinoin

HDL cholesterol fell in some people taking isotretinoin in the label's data. It is often read as part of the same lipid panel, though a 2022 panel of acne experts agreed that HDL and LDL don't need routine checks in otherwise healthy people.

Blood tests on isotretinoin

On testosterone therapy

Testosterone therapy is linked to a small drop in HDL cholesterol, the Endocrine Society says. The FDA label suggests checking the lipid profile periodically, especially after starting.

Blood tests on testosterone therapy

How common is your level?

NHANES describes the US civilian, non-institutionalized population, not a 'healthy' reference group. People with disease, on medication, fasting or not (except fasting-subsample markers), smokers and so on are all included. A percentile says where a value sits among Americans of that sex and age, not whether it is normal.

How HDL varies with age in the U.S.Shaded: middle 90% and middle 50% of people. Line: the median. mg/dL. Point at any age, or focus the chart and use the arrow keys, to read both sexes in words.

Use the left and right arrow keys to read each age. Shift moves five years.

Reference data derived from CDC/NCHS National Health and Nutrition Examination Survey (NHANES), cycles 2015-2016, 2017-March 2020 (pre-pandemic), August 2021-August 2023. Analysis by bloodtesttracker.com; not endorsed by CDC, NCHS or HHS.

Explore HDL by age and sex: every percentile as a table, with a download.

What can affect your result

  • Sex: women tend to have higher HDL cholesterol than men
  • Physical activity, smoking and body weight
  • Diet, especially a very high carbohydrate intake
  • Medicines that raise or lower HDL cholesterol
  • A recent heart attack, severe infection or inflammation, which can lower it for a few months
  • Fasting: HDL cholesterol changes little with eating
  • Lab method: results from different labs can differ a little
  • Labcorp advises waiting about 3 months after a heart attack or a severe infection or inflammation, because HDL cholesterol can be lower during that time.
  • ARUP reports that high levels of N-acetylcysteine, and acetaminophen-overdose levels of its byproduct NAPQI, can make its HDL result read falsely low.
  • Medicines such as androgens, progestogens, anabolic steroids, thiazides and beta-blockers can lower HDL cholesterol (Labcorp).

Usually several weeks to a few months of steady changes in activity, weight or smoking. The effects are modest.

When to talk to a clinician

No HDL cholesterol value is an emergency by itself. Bring a result below 40 mg/dL (1.0 mmol/L), or an unusually high one, to your next routine visit. If you have chest pain, trouble breathing or fainting, call 911 or your local emergency number, whatever your results are.

Questions you could ask

  • How often should I have my cholesterol checked?
  • Is there anything about my alcohol use or medicines that could explain a high HDL?
  • Does a very high HDL change how you look at my other heart-health numbers?
  • How does my HDL fit with my triglycerides, LDL or non-HDL cholesterol, ApoB and blood sugar?
  • Which lifestyle changes might help most for me?
  • Should we recheck my lipids in a few months?

Questions people ask

Is a higher HDL always better?

Not necessarily. Low HDL cholesterol is linked to more heart risk. But raising HDL with medicine has not prevented heart attacks, and in large Danish studies extremely high levels were linked to higher death rates. Those findings need confirmation, so a very high result is worth mentioning to your clinician.

Why do some labs use 40 for everyone and others use 50 for women?

Labcorp and ARUP print one cutoff of 40 mg/dL (1.0 mmol/L) for all adults. Some labs, and the NCEP metabolic syndrome criteria, use 50 mg/dL (1.3 mmol/L) for women because women's HDL cholesterol runs higher on average. Check the range printed on your report.

Can I raise my HDL cholesterol?

Lifestyle can nudge it. Exercise trials show an average rise of about 2 to 3 mg/dL, and quitting smoking and losing extra weight can help too. Because raising HDL itself has not been shown to prevent heart attacks, clinicians usually focus on LDL or non-HDL cholesterol, ApoB, blood pressure, blood sugar and smoking. Drinking alcohol to raise HDL is not recommended.

Do I need to fast before an HDL test?

No. HDL cholesterol changes little with eating. Follow any fasting instructions for other tests drawn at the same time, such as glucose.

How do I convert HDL from mmol/L to mg/dL?

Multiply mmol/L by 38.67. For example, 1.0 mmol/L is about 39 mg/dL and 1.3 mmol/L is about 50 mg/dL. To go the other way, multiply mg/dL by 0.0259.

Show the science and sources

Units

  • 1 mg/dL = 1 mg/dL
  • 1 mg/dL = 0.02586 mmol/L
  • 1 mg/dL = 0.01 g/L

Open the HDL unit converter

Is a change real?

HDL naturally varies about 5.67% from test to test in the same healthy person. Between two results from the same lab, a change of roughly 16% or more is unlikely to be day-to-day noise or lab variation (95% reference change value). Source: The European Biological Variation Study (EuBIVAS): a summary report.

For clinicians and researchers

HDL-C is the cholesterol content of HDL particles, measured on automated analyzers with a direct enzymatic method (Labcorp lists an enzymatic method). Total cholesterol minus HDL-C gives non-HDL-C. The inverse association between HDL-C and ASCVD is strong in observational data but does not look causal: a Mendelian randomization study found that genetic variants raising HDL-C were not linked to lower myocardial infarction risk (Voight 2012). In the Copenhagen cohorts, all-cause mortality was U-shaped, lowest near 73 mg/dL in men and 93 mg/dL in women (Madsen 2017). NCEP ATP III classes under 40 mg/dL as low and 60 mg/dL or more as high, and sets no HDL-raising goal; it also uses under 40 mg/dL (men) and under 50 mg/dL (women) as the metabolic syndrome criterion. HDL-C is an input to the PREVENT risk equations that the 2026 ACC/AHA guideline uses for risk estimation. The 2018 AHA/ACC guideline (Table 9, from the NCEP pediatric panel) gives childhood values of over 45 mg/dL acceptable, 40-45 borderline and under 40 low, with the low cutoff at about the 10th percentile. A meta-analysis of 25 exercise trials found a mean HDL-C rise of 2.53 mg/dL (Kodama 2007). Pre-analytic notes from Labcorp: fasting is not necessary, and testing should wait about 3 months after a myocardial infarction or similar insult. ARUP notes negative interference with its assay from high N-acetylcysteine and from NAPQI at acetaminophen-overdose concentrations.

LOINC 2085-9 (primary), 14646-4. Specimen: serum-or-plasma.

Sources

  1. HDL Cholesterol (test 001925), Labcorp
  2. HDL Cholesterol (test 0020053), ARUP Laboratories
  3. Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III): Executive Summary, NIH / National Heart, Lung, and Blood Institute (2001)
  4. 2026 ACC/AHA/AACVPR/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA Guideline on the Management of Dyslipidemia, Journal of the American College of Cardiology / Circulation (2026)
  5. 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA Guideline on the Management of Blood Cholesterol, Circulation (2019)
  6. 2026 Dyslipidemia Guideline-at-a-Glance, Journal of the American College of Cardiology (2026)
  7. Plasma HDL cholesterol and risk of myocardial infarction: a mendelian randomisation study, The Lancet (2012)
  8. Extreme high high-density lipoprotein cholesterol is paradoxically associated with high mortality in men and women: two prospective cohort studies, European Heart Journal (2017)
  9. Cholesterol (PubChem compound summary), PubChem, National Library of Medicine
  10. Effect of aerobic exercise training on serum levels of high-density lipoprotein cholesterol: a meta-analysis, Archives of Internal Medicine (2007)

AI-drafted. Awaiting verification. Last reviewed 2026-10-03. How we build and check these pages.

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