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Testosterone and Sleep – Sleepopolis

May 12th, 2023

There are so many factors that go into getting a good nights sleep, and balanced hormones is one of them. Hormones, such as testosterone, are intricately tied to sleep. If your testosterone is too high or too low, it can affect how well you sleep, how long you stay asleep, how easily you fall asleep, and even if you experience certain sleep disorders like sleep apnea.

And even more frustrating, if your testosterone levels disrupt your sleep, your hormone levels may drop even more, creating a vicious cycle, Cameron Rokhsar, M.D., FAAD, FAACS with New York Cosmetic Skin & Laser Surgery Center, tells Sleepopolis.

Fortunately, there are some solutions to help you break the cycle read on to uncover the connection between testosterone and sleep, and how you can overcome the associated challenges.

There is a circular connection between testosterone and sleep. That means that having too high or too low testosterone levels can disrupt your sleep, but it also means that if youre not sleeping enough, it can decrease your testosterone levels too which will then further disrupt your sleep.

Sleep deprivation can cause a significant decline in testosterone production, Dr.Tun Min, General Practitioner in the UKs National Health System, tells Sleepopolis. For instance, Min references a study done by the University of Chicago which found that in young healthy men, sleeping less than five hours a night decreases their testosterone level by 15 percent in only one week.

The study was a small one, involving only ten men, but it did demonstrate how much of an impact sleep can have on testosterone levels, even on a small scale.

Additionally, a 2021 systematic review and meta-analysis of available studies done by Sleep Medicine found that serum testosterone (the amount of testosterone that can be measured in the blood) in males significantly decreased after only 24 hours of total sleep deprivation, and decreased even more so after the 40-48 hour sleep deprivation mark.

Normal testosterone levels vary by sex and also by age for males. That means that a male in their 20s will have a normal testosterone level that is higher than a male in their 40s.

In males, normal testosterone levels range from 300-1,000 ng/dL, with the highest levels seen during the teenage years, notes Rokhsar. Anything under 300 ng/dl (nanograms per deciliter) is considered to be low testosterone levels, according to the American Urological Association (AUA).

According to the AUA, normal serum testosterone levels for males are:

Female testosterone levels tend to be more steady. According to the Centers for Disease Control and Prevention (CDC), normal serum testosterone levels for females are:

Testosterone levels also decline naturally as we age. For instance, the Journal of the American Medical Association explains that men will see a normal 1-2 percent decrease in testosterone levels every year starting around the age of 30 or 40.

Min adds that because testosterone is primarily produced in the ovaries of premenopausal women, levels will decline rapidly after menopause. Like men, serum testosterone levels vary widely [in women], and it is important to correlate clinical symptoms with [hormone] levels to determine true deficiencies, he says.

High testosterone levels can absolutely disrupt your sleep. And if youre someone who is using steroids, Rokhsar warns that high testosterone levels due to the misuse of anabolic steroids have been linked to reduced sleep time, insomnia, and waking up more often during the night.

Harvard Health notes that excess testosterone isnt a very common issue in males, but if it does occur, it can lead to symptoms such as:

In females, excess testosterone can be associated with:

Low testosterone is connected to poor sleep, but the exact relationship isnt 100 percent clear. Low testosterone levels could cause disruptions in sleep, or it could be that sleep disruptions themselves could lead men to develop lower testosterone levels.

For instance, a 2018 study in the American Journal of Mens Health found that men who are sleep-deprived defined as regularly sleeping less than 5 hours per night have lower testosterone levels than males who get enough sleep.

The study found that sleep duration, independent of age, exercise amount, and body mass, was positively associated with testosterone levels. Men who slept for less than four hours had 60 percent lower total testosterone than men who slept for more than eight hours, says Rokhsar.

And while the study cant show if men arent getting enough sleep because they have low testosterone to begin with or if having low testosterone levels causes them not to sleep well or if its both it does show there is a connection between poor sleep and low testosterone.

Its important to note that women have naturally lower levels of testosterone and dont seem to be affected in the same way as men with low testosterone levels.

The AUA explains that in males, symptoms of low testosterone include:

Symptoms of low testosterone are broad and can be similar to symptoms of many other conditions, says Rokhsar, so its important to speak to your doctor about any symptoms you are experiencing to get accurately diagnosed and treated appropriately. For instance, the AUA notes that using opioids, having certain medical conditions, damage to the testicles, diabetes, and obesity can all lead to low testosterone levels.

Moreover, aging and the natural decline of total testosterone could affect sleep too. Older people report finding it harder to fall asleep and stay asleep, which could be linked to lower testosterone levels as well, says Rokhsar.

Obstructive sleep apnea (OSA) has a well-studied link to low testosterone levels. There is a clear connection between testosterone levels and sleep apnea, says Rokhsar. He explains that testosterone levels usually peak at the time of rapid eye movement (REM) sleep, but people with sleep apnea will have reduced REM sleep, reduced deep sleep time, increased nighttime awakenings, and sleep fragmentation all of which can yield low testosterone production.

He also notes that low testosterone levels appear to be linked to lower-quality sleep and fewer deep sleep cycles. And in general, he says that as testosterone goes down, the hormone cortisol increases. This can cause an increase in stress, which can negatively impact sleep quality, Rokhsar adds.

But again, the link between low testosterone and sleep apnea isnt entirely clear on causation. While we know that males with OSA have definitively lower levels of testosterone, the studies that show this note its not immediately clear if males develop OSA as a result of having low testosterone levels or if OSA causes testosterone levels to drop.

The study in Worlds Journal of Mens Health also explained that treating OSA did not seem to raise testosterone levels, but giving males who had OSA and low testosterone levels testosterone treatment therapy did seem to improve their sleep apnea symptoms, as well as other associated symptoms like erectile dysfunction.

However, the study also noted that for some men, hormonal therapy with testosterone actually made OSA worse, so its not a clear-cut answer.

Rokhsar points out that many different sleep disorders and difficulties are associated with reduced testosterone levels. These include:

These disorders can all cause testosterone levels to drop, which will then further impact sleep.

First things first: It is essential to recognize the relationship between sleep and testosterone levels and take steps to improve your sleep quality, says Rokhsar. So if you know you have low testosterone levels, its to your advantage to do everything you can to prioritize sleep in your life.

So how exactly do you prioritize sleep? Well, you can start by assessing your current sleep hygiene practices and making changes as needed. Rokhsar suggests starting by:

Low testosterone can be diagnosed through a simple blood test, says Rokhsar, so its important to start by talking to your doctor. Symptoms of low testosterone can overlap with many other medical conditions, so youll want to rule out all other conditions first.

Additionally, certain medical conditions can cause low testosterone, so you may need to address the root cause of your testosterone levels to fix the problem.

Because testosterone levels are different for every person and will be impacted by many different factors, such as medical conditions, medications, your age, and body type, you will need to work with a doctor to develop an individual treatment plan for you. Low testosterone levels can be treated through testosterone replacement therapy, which can be administered in various forms, including injections, gels, patches, or pellets, Rokhsar explains.

If you are frequently waking up at night, find yourself gasping for air at night, or wake up feeling extremely tired, it may also be worthwhile to talk to your doctor about getting checked for sleep apnea.

Sleep apnea is directly connected to low testosterone levels, and the condition has many other negative health impacts. Treating sleep apnea can improve both your sleep quality and other health factors at the same time.

Having excess or low testosterone levels can impact sleep quality, duration, and the ability to fall asleep in both males and females. However, low testosterone in males in particular is associated with poor sleep as well as actual sleep disorders, including sleep apnea.

A doctor can confirm your testosterone levels with a simple blood test, so if you suspect you have a problem with your testosterone levels or are having difficulty sleeping, its important to start by talking to a doctor. They can test your testosterone levels and rule out other conditions that could be contributing or causing your symptoms.

Leproult R, Van Cauter E. Effect of 1 week of sleep restriction on testosterone levels in young healthy men. JAMA. 2011;305(21):2173-2174. doi:10.1001/jama.2011.710.

What is Low Testosterone? Published 2023. Accessed April 13, 2023.

Vesper Hubert W. Serum Total Testosterone Concentrations in the US Household Population from the NHANES 20112012 Study Population. Clin Chem. 2015 December ; 61(12): 14951504. doi:10.1373/clinchem.2015.245969.

Wittert G. The relationship between sleep disorders and testosterone in men. Asian J Androl. 2014;16(2):262-265. doi:10.4103/1008-682X.122586.

Testosterone What It Does And Doesnt Do. Published August 29, 2019. Accessed April 13, 2023.

Abu-Samak MS, Mohammad BA, Abu-Taha MI, Hasoun LZ, Awwad SH. Associations Between Sleep Deprivation and Salivary Testosterone Levels in Male University Students: A Prospective Cohort Study. Am J Mens Health. 2018;12(2):411-419. doi:10.1177/1557988317735412.

Insomnia in Older Adults: Tips to Master Sleep as We Age. Accessed April 13, 2023.

Kim SD, Cho KS. Obstructive Sleep Apnea and Testosterone Deficiency. World J Mens Health. 2019;37(1):12-18. doi:10.5534/wjmh.180017.

Rokhsar, Cameron. MD, FAAD, FAACS New York Cosmetic Skin & Laser Surgery Center. Personal interview April 5, 2023.

Min, Tun. General Practitioner in the UKs National Health System. Personal interview April 5, 2023.

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Chaunie Brusie is a mom of five, a native Michigander, and a Registered Nurse turned writer and editor. She specializes in health and medical writing. Her work has appeared everywhere from The New York Times to Glamour to Parents magazine.

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Testosterone and Sleep - Sleepopolis

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