Here, our hormone specialists at The Endocrine Center in Houston, Texas, explain the two-way relationship between low testosterone and sleep apnea. Many side effects stem from testosterone levels that are too high. These offer more stable daily testosterone levels but carry a risk of transference, meaning testosterone can transfer to partners, children, or pets through skin contact. A 2018 study in the British Journal of Clinical Pharmacology found men on TRT had a nearly 4% higher risk of sleep apnea. Testosterone replacement therapy (TRT) can restore energy, improve mood, and reverse the effects of low testosterone, but it is not without risks. For those who already have sleep apnea, research shows testosterone replacement therapy can make symptoms worse. There’s also some evidence that suggests testosterone therapy may cause sleep apnea symptoms, but the symptoms may stop when therapy is discontinued. And another study on premenopausal women found testosterone may facilitate the development of central sleep apnea — when your brain doesn’t send the correct signals to the muscles in your airways during sleep. If you’ve got low testosterone levels, you may be thinking about taking supplements or speaking to a doctor about testosterone replacement therapy (TRT). There’s evidence to show testosterone replacement therapy may cause sleep apnea or make it worse, but we still don’t know for sure. The authors stated that CPAP does not influence serum total testosterone, free testosterone, and SHBG. A significant increase in serum total testosterone was reported only in the third group (28–30). Most side effects can be managed through dose adjustment, changes in delivery method, or adding supportive medications. The key is consistent monitoring of hematocrit, prostate markers, cardiovascular health, and estrogen levels to catch and address issues early. Some effects, like testicular atrophy, persist as long as TRT continues unless addressed with adjunct medications. When you have sleep apnea, you wake up often during the night, which leads to sleep loss, less REM sleep from disrupted sleep cycles, and potential weight gain — and all three are linked to lowered testosterone levels. Testosterone replacement therapy may cause or worsen sleep apnea, but what happens if your levels of the hormone are too low? However, it said that testosterone replacement therapy should "probably be avoided" in patients with severe untreated sleep apnea as it may make it worse in some people. Lastly, it should be considered that pituitary imaging in patients with serum total testosterone 11). In the present review, no data on serum free testosterone or SHBG in patients with hypogonadism were available. In supporting this link, body weight loss promotes a decrease in apnea–hypopnea index as well as an increase in serum total and free testosterone levels (39, 40). Sensitivity analysis was conducted to investigate the influence of a single study on overall efficacy of CPAP. Two reviewers (XB Zhang and YT Yuan) independently evaluated the included studies. If the required data of studies was ambiguous, the corresponding author was contacted, after two no response attempt, the studies were also ruled out. The electronic databases PubMed, Cochrane Library, Embase and Web of Science were searched by two reviewers (XB Zhang and B Chen). This section collects any data citations, data availability statements, or supplementary materials included in this article. MC, AC, and GC conceived the meta-analysis, developed the search strategy, provided statistical expertise, and drafted the manuscript. In managing hypogonadism in patients with OSA syndrome, strategies other than CPAP should therefore be considered. 2)OSA was diagnosed with overnight polysomnography; 3) the studies must report serum testosterone levels as primary outcome or secondary outcome before and after application of CPAP; 4) studies must provide sufficient data for meta-analysis. Thus, we performed a systematic review and meta-analysis to evaluate the effects of CPAP on serum testosterone and gonadotropin levels in male patients with OSA syndrome. In conclusion, the present meta-analysis demonstrated that CPAP treatment does not improve testosterone levels in OSA men, irrespective of CPAP therapeutic duration and study design. Several studies found that low serum testosterone levels were observed in patients with OSA –. A subgroup analysis on hypogonadal vs. eugonadal status at baseline was performed. More research needs to be done, but from what we do know, testosterone may make sleep apnea worse, or even cause people to develop the sleep disorder if they don’t already have it. But, if you’ve got sleep apnea as well, taking testosterone may not be safe. Below, we’ll dive into the connection between testosterone and sleep apnea, and whether it’s safe to take testosterone if you have the sleep disorder. And taking testosterone supplements or getting injections may not be the best idea if you have sleep apnea.
