Obstructive Sleep Apnea and Testosterone Deficiency In Men: What’s The Link?

Sleep Apnea and Testosterone Deficiency in Men

Key Points About sleep apnea and testosterone deficiency

Numerous studies have found a link between obstructive sleep apnea and low testosterone.

Obstructive sleep apnea (OSA) is a common sleep disorder characterized by repeated episodes of partial or complete cessation of breathing during sleep. Men who are obese, particularly men who are “thick-necked,” are at much greater risk of developing OSA than men who are of normal weight. Therein lies the link between OSA and low testosterone. Since men with low testosterone tend to be overweight or obese, they are at greater risk of developing OSA.

The two conditions, low testosterone and OSA, are also symbiotic, meaning that each negatively impacts the other. Testosterone production is lowered by poor sleep; therefore, OSA lowers testosterone, and in turn, OSA can lower testosterone.

Studies have found that testosterone replacement therapy for men can improve sleep and help men lose weight and, therefore, can lower the risk of developing OSA or improve the symptoms of sleep apnea in men that have OSA and low testosterone. 


Sleep and hormones are a two-way street. Too much or not enough sleep can lead to hormone imbalances, and hormone imbalances can lead to impaired sleep or insomnia. This link is quite apparent when it comes to testosterone levels and poor or disturbed sleep.

There is quite a bit of research that shows a connection between poor or disturbed sleep and a drop in testosterone levels. There is also evidence that the reverse is true — men with low testosterone tend to suffer from insomnia and other sleep disorders.

Much of the relationship between testosterone and poor sleep has to do with testosterone’s connection to a common condition known as obstructive sleep apnea, or OSA. You may sometimes see OSA simply referred to as “sleep apnea.”

OSA is a condition where you stop breathing for brief intervals during the night. The condition is marked by loud snoring, which occurs as the person with sleep apnea gasps for air. Sleep apnea is more common in men than women. It is also more common in men who are overweight. It is this link between obesity and OSA that lies at the heart of the connection between OSA and testosterone deficiency.

The Link between OSA and Testosterone Deficiency

OSA is more than just snoring that can disturb your partner. Sleep apnea leading to poor sleep can cause any number of health problems for men, from daytime to fatigue to an increased risk of cardiovascular disease. 

Several published studies have shown that a significant contributing factor to the development of OSA is low testosterone levels in men. Sleep apnea is more common in men than women. It is also more common in men who are overweight, and it is this link between OSA and obesity and metabolism that is one of the main reasons for the connection between sleep apnea and low testosterone. 

There are several ways in which low testosterone levels may contribute to the development of OSA. But one of the primary ones is that low testosterone can lead to an increase in body fat, particularly around the abdomen, which can contribute to the narrowing of the airways and increase the risk of OSA. Obesity is a well-known risk factor for OSA, and testosterone plays a role in regulating body fat distribution.

Another way in which low testosterone can increase your risk of OSA is through its impact on your ability to build lean muscle mass. Testosterone is essential for the development and maintenance of muscle mass. Men with low testosterone have a decreased ability to build and maintain lean muscle. This can lead to a weakening of muscles, including the muscles of the upper airway, that play a crucial role in maintaining an open airway while you sleep. When these muscles are weakened due to low testosterone, they are more likely to collapse and obstruct the airway, leading to OSA.

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Symptoms of OSA and Testosterone Deficiency

OSA and low testosterone are comorbid, meaning they often occur together in the same individual. As we have already stated, one condition also influences the other in a kind of vicious cycle. While OSA and testosterone deficiency often occur together, each condition has its individual symptoms, which also can overlap to some degree and can be interrelated.

OSA Symptoms

  • The main symptom of OSA is loud snoring. Other symptoms include:
  • Gasping or choking during sleep
  • Excessive daytime sleepiness
  • Morning headaches
  • Difficulty concentrating and memory problems
  • Irritability and mood swings
  • High blood pressure

If you have these symptoms, you may have OSA, but the only way to know for sure is to have a sleep study done. These are usually done in a sleep lab; however, there are now kits that your doctor can give you to do the sleep study at home in your own bed.

Testosterone Deficiency Symptoms

The most common symptoms of age-related testosterone deficiency include the following:

  • Fatigue and lack of energy.
  • Weight gain, particularly belly fat.
  • Inability to build muscle, even whilst exercising.
  • Poor or disturbed sleep.
  • Erectile dysfunction or other sexual health issues.
  • Mood swings and decreased cognitive function.

Symptoms of OSA and low testosterone are interrelated

How Are the Symptoms of OSA and Low Testosterone Interrelated?

The symptoms of OSA and low testosterone overlap and interrelate with those issues relating to sleep, metabolism, and weight gain. Low testosterone tends to lower the metabolism and cause weight gain, particularly belly fat. That increases the risk of OSA. Deep or REM sleep is critical to testosterone production; OSA interferes with deep sleep and lowers testosterone production. 

As you look at the two lists of symptoms above, other symptoms that could be related to either OSA or Low T or both include:

  • Tiredness
  • Irritability
  • Cognitive issues
  • Increased risk of metabolic conditions such as high blood pressure.

How Do Both Conditions Impact Men’s Overall Health and Wellbeing

Either OSA and/or low testosterone can have several negative impacts on a man’s overall health and wellbeing. OSA has been associated with many health problems, including cardiovascular disease, hypertension, and metabolic disorders. Low testosterone can also cause an increased risk of heart disease and other metabolic conditions such as diabetes and high blood pressure, as well as contribute to erectile dysfunction, weight gain, and cognitive issues. 

What Are the Best Treatment Options for OSA

The most common treatment recommended for OSA is a Continuous Positive Airway Pressure (CPAP) machine. A CPAP is a specialized mask that is fitted over the nose and/or mouth that is connected to a machine that delivers a continuous stream of air pressure, which helps to keep the airway open during sleep.

Other treatments could include:

  • Mandibular devices or appliances that keep the airway open.
  • Dental or oral surgery.
  • Lifestyle changes
  • Positional therapy.

Since there is a definite link between low testosterone and sleep apnea, our patients with both conditions have seen elimination or a reduction in OSA symptoms after completing a course of testosterone replacement therapy.


There is a complex relationship between sleep apnea and testosterone, with OSA influencing low testosterone and low testosterone increasing the risk of OSA. Therefore, taking steps to get better sleep will help to maintain healthy testosterone levels, and maintaining healthy testosterone levels can produce better quality sleep and may lower your risk of developing OSA.

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