Brother your protocol is dialed. 200mg split into 3 pins, trough timing on the bloods, baseline IGF-1, no orals, no ancillaries. This is what doing it right actually looks like and I wanted to call that out before getting into the lipid stuff.
Honest read you already diagnosed yourself right. Genetic dyslipidemia. HDL in the toilet natural, doesn't move with cardio or clean eating, LDL runs high. That's not a cycle problem you can lifestyle-fix, that's a "your liver handles lipoproteins differently than average" problem and it's with you for life. The cycle isn't the cause, it's an amplifier on top of an existing baseline. Important distinction because it changes what the right move is.
For most guys with cycle-induced lipid problems, "drop the orals, run TRT, eat clean, retest in 8 weeks" works because their liver returns to a normal baseline when the insult stops. Your baseline isn't normal. That's why you've been frustrated you're doing everything right and the numbers stay stubborn. Lifestyle gets you a little improvement on top of where your genetics put you. It doesn't reset where the floor is.
3wt gave you good advice and I want to back him up not contradict him. His stack (pita 2 + ezetimibe 5 + bempedoic 90, LDL under 50 on 2g of gear plus orals) is real-world proof the combo works at way higher doses than you'd ever need. You're at 200 test no orals you don't need anywhere near his protocol. But the category of intervention is right for you.
The statin hesitation I get it but it's based on outdated info. The horror stories are mostly from older statins (simvastatin, atorva at 40-80mg) or from trials that pushed people to the highest tolerated dose. Newer-gen statins at low doses are a different conversation:
Pitavastatin 1-2mg myalgia rate barely above placebo. Doesn't go through CYP3A4 so no grapefruit issue, fewer drug interactions, slightly favorable on glucose vs other statins. Expensive but worth it for the side effect profile.
Rosuvastatin 5mg sweet spot. Drops LDL 35-40%, very low side effect rate, cheap. Slightly easier on the liver than atorva which matters for cycle guys.
Atorva 10mg cheap, well-studied, fine at low dose. The side effect rate climbs hard at 40-80mg, that's where the muscle pain stories come from.
The "statins gave me muscle pain" thing is real but it's much more about dose than the drug itself. 80mg atorva = ~10% myalgia rate. 2mg pita or 5mg rosuva = rates near placebo (2-3%). Most guys who got wrecked were on the wrong drug at the wrong dose or had low vit D, low CoQ10, hard training without recovery, or a thyroid issue feeding into it.
On Repatha this is the move you should actually pursue for your situation. PCSK9 inhibitors are a totally different class, monoclonal antibody not a pill, side effect profile in trials basically indistinguishable from placebo. Different mechanism they stop PCSK9 from degrading your LDL receptors so your liver clears more LDL from blood. Biweekly inj, drops LDL 50-60% on top of whatever else you're doing, FOURIER and ODYSSEY showed real CV event reduction.
For genetic dyslipidemia + family CV history insurance often covers it. Criteria are usually LDL over 100 (you're 118, you qualify) plus family hx of cardiac events OR documented statin intolerance OR diagnosed FH. The catch is most insurance protocols want you to have tried a statin first, which is actually another reason to start with low-dose pita or rosuva partly to lower lipids, partly to document the trial so Repatha gets approved later if needed. For someone who plans to cycle for decades with bad lipid genetics this is potentially the answer.
Lowest hanging fruit you're not exploiting — your fish oil dose is way too low. "1 cap morning + 1 cap night" is probably 600-700mg EPA+DHA total. Dose that actually moves lipids is 3-4g EPA+DHA daily. DocMcGains is right about this, he's running 8g/day for post-cycle recovery. For you 4g/day split AM/PM is the move.
Buy a high-concentration product Nordic Naturals Ultimate Omega, Carlson Maximum, Sports Research Triple Strength, anything where one cap has 700-1000mg EPA+DHA combined. Take 4 caps/day split. Costco Kirkland triple-strength is the cheap option, fine at this dose. Real effect at 4g daily: trigs down 20-30%, HDL up 3-5 points, hs-CRP down, ApoB down slightly, BP slightly improved. Not magic but real and it stacks with everything else. This single change will probably move your numbers more than any other supplement tweak.
The red meat question you asked DocMcGains most guys get this wrong. Saturated fat generally raises HDL (counterintuitive but true, sat fat tends to bump HDL more than unsaturated does), raises LDL (especially in hyperresponders which guys with genetic dyslipidemia often are), doesn't really move trigs in either direction at normal intake. Trigs are driven more by carbs, alcohol, excess calories than by fat type.
So the red meat swap probably didn't hurt your HDL if anything it should've nudged it up. What it likely did was bump your LDL, which is a tradeoff. For someone with genetic dyslipidemia the LDL bump from sat fat is more pronounced than for average guys, which is why 3wt's "keep saturated fat low" advice is right for you specifically.
What probably drove your trig number more than the meat swap meal timing relative to the draw, carbs/alcohol the days before, and honestly the 13-hour fast itself (long fasts can elevate trigs in some people via fatty acid mobilization from adipose, weird but real).
Right answer for your diet isn't no red meat. It's moderate red meat (couple times a week), more lean protein (chicken/turkey/fish), more soluble fiber (oats, beans, psyllium soluble fiber binds bile acids and forces your liver to make new ones from cholesterol, which lowers LDL), and high-EPA fish (salmon, sardines) for the omega-3 hit.
Quick hits on the rest
Hematocrit you said is controllable, agreed. Watch the trend. Trough HCT (what you measured at 73h post-pin) is your lowest. Peak is 24-36h post-pin and runs higher. So if trough is creeping up, peak is closer to the threshold than you realize. Crosses 52-53% at trough, donate blood, easiest fix in the world.
RYR is doing more than you think. Red yeast rice contains naturally occurring monacolin K which is chemically identical to lovastatin. Depending on product and dose you might already be getting the equivalent of 5-10mg lovastatin. Two implications if you add a prescription statin drop the RYR, you don't want to double-dip. And the muscle/liver considerations for statins apply to RYR at smaller scale, just so you know. Glad you're already taking CoQ10 with it.
81mg aspirin defensible on cycle, stable BP, real bleeding risk at that dose is low. Stop it 7-10 days before any surgery or contact sport situation. Otherwise fine.
Reta at 4mg/week LDL 150 → 118 is a real response, consistent with published data on tirzepatide/reta lipid effects. You're getting CV benefit from it independent of weight loss. Worth knowing it's pulling its weight beyond the obvious stuff.
E2 at 57 zero symptoms leave it. Chasing it down with an AI at TRT doses for an asymptomatic guy is the classic mistake. Your test:E2 ratio is fine.
Practical priority order
Bump fish oil to 4g EPA+DHA daily, this week. Biggest cheapest fastest move.
Add soluble fiber 10-15g/day. Psyllium husk (unflavored Metamucil) is easiest, 2 tsp/day. Drops LDL 5-10% in hyperresponders, also helps the gut microbiome side of lipid metabolism.
Book the statin conversation with your doc. Frame it: "I have genetic dyslipidemia, family history if applicable, my LDL has been chronically elevated despite lifestyle, I'd like to try low-dose pitavastatin 2mg or rosuvastatin 5mg." If you get pushback, ask about Repatha eligibility. Go in informed not defeated.
Drop RYR if you start a real statin. Overlap doesn't help and the liver burden adds up.
Keep doing everything else. Protocol's good, supplements mostly sensible, macros reasonable.
Honest long view you're not going to lifestyle your way out of genetic dyslipidemia, you already figured that out. Choice you have is (a) keep cycling and accept slowly progressing CV risk over decades, (b) keep cycling and actually treat the dyslipidemia with appropriate meds, or (c) stop cycling, which doesn't fix the baseline anyway, just removes the amplifier.
Option B is the lane that makes sense for your situation. Modern lipid meds at appropriate doses have changed the math on this. Guys who would've died of MI at 55 thirty years ago now live to 80 because pita + Repatha + ezetimibe collectively make hereditary lipid problems manageable. There's no glory in white-knuckling it untreated.
3wt is running 2g of gear plus orals with LDL <50 because he's properly medicated. You can run 200 test indefinitely with LDL in target range on way less aggressive treatment. The protocol exists, you just need to access it.
Good luck brother, you're doing this right, just need to add one more tool to the box.

For lipids I would highly recommend Pitavastatin, ezetimibe, and Bempedoic acid (only if necessary). If you can get your doctor to prescribe repatha that would be your best bet as far as efficacy vs side effects (effectively none). The criteria for insurance to cover it are ldl > 100 and family history of cardiovascular events or ldl >100 and history of not tolerating statins.

I have genetic dyslipidemia and can maintain an ldl <50 and low triglycerides while taking 2g of gear + aggressive orals. I take 2mg Pitavastatin, 5mg ezetimibe, and 90mg Bempedoic acid. Keeping dietary saturated fats as low as possible is also very important.