Understanding the Relationship Between Testosterone and Sleep in Men.

February 26, 2024

Testosterone is a hormone primarily associated with male reproductive health and secondary sexual characteristics, such as sperm production, fertility, having a deep voice, body and facial hair growth and increased muscle mass to name a few. But as it turns out, this hormone also plays a significant role in sleep patterns. The intricate relationship between testosterone and sleep involves a complex interplay, where disruptions in sleep can impact testosterone levels and vice versa.

Typically, testosterone levels follow a natural rhythm, peaking during sleep. Studies on the nocturnal testosterone rhythm in men have indicated that testosterone levels are highest around 8 a.m. and lowest around 8 p.m., with sleep facilitating this normal cycle of testosterone production. However, insufficient sleep or sleep disorders like obstructive sleep apnea (OSA) can interfere with this rhythm, potentially affecting testosterone levels. Studies have shown that by getting an extra hour of sleep per night, a male can potentially increase their testosterone production. Researchers have tested sleep and testosterone production, and lack of sleep will cause an increase in cortisol as well as a decrease in testosterone.

Similar research has shown that insufficient sleep and sleepdisorders may influence testosterone levels, confirming what scientists have suspected and discovered in previous testing. For instance, a study of healthy young males found that a week of sleeping less than five hours per night was associated with a 10-15% decrease in testosterone levels.

Moreover, obstructive sleep apnea (OSA) has been linked to low testosterone levels, although it remains unclear whether OSA directly causes low levels or vice versa. Some evidence suggests that treating OSA may lead to an increase in testosterone levels, highlighting the bidirectional relationship between sleep and testosterone.

Low testosterone levels in men have been associated with sleep disturbances. Symptoms of low testosterone can include some of the following:

  1. Reduced sex drive (libido)
  2. Erectile dysfunction or difficulty maintaining erections
  3. Fatigue or decreased energy levels
  4. Loss of muscle mass or strength
  5. Increased body fat, especially around the abdomen
  6. Decreased bone density or osteoporosis
  7. Mood changes, including irritability, depression, or anxiety
  8. Decreased cognitive function or difficulty concentrating
  9. Insomnia or sleep disturbances
  10. Decreased facial or body hair growth
  11. Hot flashes or excessive sweating
  12. Decreased motivation or drive
  13. Infertility or reduced sperm count
  14. Gynecomastia (enlarged breast tissue in males)
  15. Decreased physical stamina or endurance.

What can be problematic is when low T symptoms cause difficulty falling or staying asleep, leading to insomnia-like problems. This exacerbates the problem of having low T and the cycle continues. Without testosterone, its difficult to get enough quality sleep. Without sleep, its hard to produce enough testosterone to influence the sleep cycle. By focusing on getting rest, one could conceivably improve their hormonal health, but this requires guidance from experts in this field of sleep-related issues such a:

1.   Sleep Medicine Specialists: These doctors specialize in diagnosing and treating sleep disorders, such as sleep apnea, insomnia, narcolepsy, and restless leg syndrome.

2.   Pulmonologists: Pulmonologists focus on respiratory issues and may diagnose and treat sleep-related breathing disorders like sleep apnea.

3.   Neurologists: Neurologists may evaluate and manage sleep disorders related to neurological conditions, such as narcolepsy or REM sleep behavior disorder.

4.   Otolaryngologists (ENTs): ENT doctors specialize in conditions affecting the ears, nose, and throat. They may address sleep apnea related to airway obstruction or other upper airway issues.

5.   Psychiatrists or Psychologists: Mental health professionals may help address sleep disorders that are related to psychiatric conditions such as anxiety, depression, or PTSD.

6.   Primary Care Physicians (PCPs): PCPs often evaluate initial sleep complaints and may refer patients to specialists for further evaluation or treatment if necessary.

7.   Dentists (Dental Sleep Medicine Specialists): Dentists who specialize in dental sleep medicine can provide oral appliances for treating sleep apnea or snoring.

8.   Pediatricians: Pediatricians specialize in children's health and may address sleep issues in infants, children, and adolescents, such as bedtime difficulties, nightmares, or sleep-disordered breathing.

9.   Geriatricians: Geriatricians focus on the health and well-being of older adults and may address sleep disorders that are more common in this population, such as insomnia or sleep apnea.

10.  Certified Sleep Technologists: Sleep technologists conduct sleep studies and assist in the diagnosis and treatment of sleep disorders under the supervision of sleep medicine specialists.

Conversely, high testosterone levels may also impact sleep quality, although the relationship is less straightforward. While high testosterone levels do not always cause symptoms in males, research suggests a potential link between poor sleep and high testosterone, particularly with treatment using high doses of synthetic testosterone. In females, conditions like polycystic ovary syndrome (PCOS), characterized by elevated testosterone levels, may contribute to poor sleep quality. Symptoms of high testosterone in women may include excess hair growth on the face and body, male-patterned hair loss, deepening of the voice, acne, and irregular menstrual periods. Low T levels in women can also have a negative impact on their health, which is why some patients opt for BHRT, or testosterone therapy for women. Understanding the signs and symptoms as well as interpreting blood work is important in determine which direction is best suited for the individual.

Testosterone replacement therapy (TRT) is often prescribed for individuals diagnosed with low testosterone levels. While TRT may improve sleep quality in some cases, it can also pose risks, particularly when administered in high doses or in individuals with certain medical conditions, which is why seeking expert guidance from a qualified and experienced doctor is so important. For instance, testosterone therapy may increase the risk of developing or worsening obstructive sleep apnea, a condition characterized by fragmented sleep patternsand breathing difficulties during sleep. Additionally, TRT may interfere with sleep, especially in high-dose treatments, once again, emphasizing the importance of careful monitoring and individualized treatment approaches from a licensed healthcare provider. When monitored by a doctor that specializes in this fields, the results and improvement in overall health and wellness can be life changing. Men that want to see how they can get a prescription for testosterone can speak to their primary care physician or look for help from a specialist such as an endocrinologist, urologist or hormone replacement therapy specialist.

In conclusion, the relationship between testosterone and sleep is intricate and bidirectional. Disruptions in sleep can impact testosterone production, while abnormal testosterone levels may affect sleep quality. Understanding this complex interplay is essential for effectively managing sleep-related issues in individuals with testosterone imbalances, highlighting the need for comprehensive evaluation and tailored treatment strategies from experts in the field of hormone replacement, endocrinology or sleep specialists.


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Blood Work Request Form

This subsequent lab panel is necessary for males undergoing Testosterone Replacement Therapy (TRT) through NovaGenix Health and Wellness. It allows physicians to assess the patient's response to prescribed medications, covering sex hormone levels, thyroid function, adrenal health, hematocrit, and liver and kidney function. The panel includes tests such as:

  • Complete Blood Count
  • Comprehensive Metabolic Panel
  • Testosterone (Free and Total)
  • Estradiol Sensitive
  • Thyroid Stimulating Hormone
  • Prostate Specific Antigen

Each test serves a specific purpose in monitoring overall health and treatment effectiveness. When required, Dr Mackey may require LH and FSH (Luteinizing hormone, follicle stimulating hormone) SHBG (Sex hormone binding globulin) or any other tests which may be important for your health and optimizing your hormones.

The Comprehensive Hormone and Wellness Panel for Women offers a foundational assessment of sex hormones, thyroid function, adrenal health, metabolic activity, and overall well-being. This panel serves as a diagnostic tool for identifying testosterone and estrogen deficiencies, assessing health risks, and detecting potential thyroid issues before considering hormone replacement therapy. Additionally, it includes insights into hematocrit (red blood cell volume), as well as liver and kidney function. The panel encompasses various tests such as:

  • Complete Blood Count (CBC)
  • Complete Metabolic Panel
  • Testosterone (free and total)
  • Estradiol
  • Thyroid Stimulating Hormone (TSH)
  • Progesterone

When indicated, Dr. Mackey may require additional tests such as Follicle Stimulating Hormone (FSH), and IGF-1 and Cortisol.

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