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Testosterone and Sleep Apnea


Men with sleep apnea are more likely to suffer from low testosterone, but testosterone products can actually worsen sleep apnea.

Testosterone is typically thought of in terms of its roles in libido, male fertility, energy, aggression and drive, so the fact that sleep patterns and testosterone levels are closely related may come as a surprise to many. In fact, sleep apnea and low testosterone levels often go hand in hand.

So does that mean that men with sleep apnea should be treated with testosterone therapy? Not necessarily. In fact, treating low testosterone alone can make matters worse, increasing the severity – and the health effects – of sleep apnea.

What is Sleep Apnea?

Sleep apnea is a common and serious sleep disorder that causes an individual’s breathing to be interrupted repeatedly during sleep. Pauses in breathing can last anywhere from a few seconds to more than a minute and may occur as frequently as 30 times or more per hour in severe sleep apnea cases. This leads to low oxygen levels, which rouses the individual from deep sleep. When this happens, breathing starts again, often with a loud snore, gasp or choking sound. According to the American Sleep Apnea Association, sleep apnea affects more than 18 million Americans.

Because it causes fragmented, poor-quality sleep, untreated sleep apnea results in excessive daytime sleepiness. A lack of restful sleep can over time take a harsh toll on overall health, increasing a person’s risk of developing high blood pressure, heart attack, heart failure, cardiac arrhythmia, stroke, obesity, diabetes and depression.

Sufferers are often unaware of their condition, since they are generally not awakened fully by sleep interruptions. The vast majority of people affected by the disorder remain undiagnosed and untreated.

Testosterone Levels and Sleep Apnea

Sleep quality and quantity both affect testosterone levels. Levels of sex hormones, including testosterone, rise as we sleep and decrease when we’re awake, with the most marked increase occurring during periods of deep, restorative sleep, called REM sleep. Sleep disorders like sleep apnea reduce the amount of REM sleep a person gets.

Given the association between sleep and testosterone levels, it is no surprise that studies show that men affected by sleep apnea are more likely to have sexual problems such as low libido and erectile dysfunction, issues in which low testosterone levels may be a contributing factor.

This interaction between testosterone levels and sleep apnea can become a viscous cycle for some men. Low testosterone can lead to more sleep-quality issues. According to a study published in the Journal of Clinical Endocrinology, men with low testosterone have reduced sleep efficiency, increased nighttime awakenings, less REM sleep and more severe symptoms related to sleep apnea and other forms of sleep-disordered breathing.

Testosterone Products and Sleep Apnea

If you have low testosterone and/or problems with sexual function along with sleep problems, having a sleep evaluation before undergoing testosterone therapy may be wise. If you have sleep apnea, having that issue diagnosed and treated first is essential, since testosterone products can make untreated sleep apnea worse.


If you had a heart attack or experienced another side effect after taking a testosterone drug, you have legal options.

According to authors of a 2008 study published in the Journal of Clinical Endocrinology, testosterone therapy may even induce sleep apnea. Researchers studied five hypogonadal (testosterone deficient) men to determine the whether testosterone therapy may play a role in sleep apnea. After six weeks of treatment, obstructive sleep apnea developed in one man and markedly worsened in another in association with testosterone administration. Both also had significantly decreased oxygen levels and developed cardiac arrhythmias during sleep.

Treating sleep apnea — as opposed to treating the Low-T condition — often causes a rebound in testosterone levels once restful sleep is restored. That can help you avoid testosterone therapy and its risks and side effects.

An increasing number of scientific studies link testosterone products to increased risk of death, stroke and heart attack. Sleep anea treatments are not linked to these life-altering conditions.

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