The Low Testosterone and Sleep Apnea Connection

According to the National Sleep Foundation, more than 18 million American adults across all age groups and both sexes have sleep apnea, including 11.3 percent of men between 45 and 64—the age group that’s also highly susceptible to chronic low testosterone.

A man covers his face with his hands as he suffers from lack of sleep, possibly caused by a on of

What Is Sleep Apnea?

Obstructive sleep apnea (OSA) is a sleep disorder in which a person’s breathing repeatedly suffers brief interruptions during sleep. These interruptions occur when the muscles in the back of the throat fail to maintain an open airway, which inhibits a person’s efforts to breathe.

These pauses often last ten seconds or more, resulting in fragmented sleep and poor blood oxygen levels, which may complicate a person’s daily life or lower their effectiveness on the job by causing:

  • Insomnia
  • Sleep deprivation
  • Excessive daytime sleepiness

Over time, these harmful conditions may contribute to more serious health problems that include:

  • Hypertension
  • Heart disease
  • Mood swings
  • Memory problems

The Sleep Apnea and Low Testosterone Connection

During sleep, the testosterone (and other hormones) that was used by your body throughout the day is naturally replenished. This replenishment is most effective during REM sleep.

When your sleep is constantly interrupted by a sleep disorder like sleep apnea, the amount of REM sleep you get at night is reduced, which hinders the replenishment cycle. The possible result is insufficient production of testosterone, leading to chronically low levels and some or all of the accompanying symptoms of hypogonadism (the medical term for Low T).

Research Supports the Connection

In one study, researchers from Fujian Medical University separated subjects into four groups based on the severity of their sleep apnea and measured their testosterone levels. Results showed that men suffering from severe OSA had much lower testosterone levels and a higher rate of erectile dysfunction compared to the groups suffering from simple snoring or mild OSA.

A second study showed that men suffering from clinically diagnosed low testosterone:

  • Got less REM sleep
  • Experienced increased nighttime awakenings
  • Suffered from reduced sleep efficiency
  • Exhibited a higher number of complications and symptoms associated with sleep apnea

This study also associated both sleep apnea and low testosterone with obesity, which would indicate the possibility of a cycle of poor health—each of these conditions perpetuating and exacerbating the others, with researchers suggesting continued research into any cause-and-effect relationships.

TRT—Breaking the Cycle

For health to be restored, a vicious cycle must be broken.

Assuming these 3 conditions (low testosterone, sleep apnea, and obesity) all play a role in overall poor health with the potential to cause serious medical consequences, determining which condition to medically treat first could be challenging.

When obesity is a prominent factor, significant weight loss through lifestyle intervention is often assumed to be the best course of action. However, weight loss of an amount sufficient to improve testosterone levels and disrupt the harmful relationship between these conditions often involves extreme changes to lifestyle that are exhausting to achieve and difficult to maintain.

Instead, consider that Testosterone Replacement Therapy (TRT) uses supplementary testosterone to restore testosterone levels to normal, in balance with estrogen and other hormones.

Healthy hormone balance in turn promotes lean muscle production and reduces adipose tissue (body fat) production.

Therefore, it would make good sense that TRT could attack 2 links of the chain simultaneously, contributing to the relief of obstructive sleep apnea symptoms.

That said, some studies have suggested that Testosterone Replacement Therapy (TRT) may exacerbate the severity of pre-existing Sleep Apnea. Talk to your healthcare professional to determine if you consider a sleep study prior to initiating TRT.

Learn More About TRT and Your Health

Our comprehensive guide provides more information on our methods and the associated health benefits of TRT. We have included facts and answers to the most common questions regarding the treatment of Low Testosterone.

Read the Guide


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(Bill) William J. White, PA-C

(Bill) William J. White, PA-C brings over 20 years of surgical experience to our practice. He is a decorated veteran of the United States Army where he served for nearly 6 years with duty assignments, both here and abroad.   During his military career, Bill was trained as a Certified Surgical Technologist, and following an Honorable Discharge from the Army, he attended Texas Tech University.   He graduated with a Bachelor of Science in Biology and went on to attend PA School at the University of Texas Southwestern Medical Center at Dallas. He spent the first 10 years of his career in Neurosurgery.

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  1. Kerry young on 08/24/2020 at 4:57 am

    I have no energy like before my anxiety is terrible.Im lucky to get 5 hours a sleep at night. What kind of test will I be prescribed and for how many weeks? And can I take HGH with it..And what kind of HGH will I take? And I’ve tried everything for my panic attacks and nothing seems to work. Klonopin valium, and Xanax. The Xanax is the only thing that works , and it doesn’t always work. Money isnt a issue….I just want to get back to feeling great again.

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