From the Guidelines
Yes, obstructive sleep apnea (OSA) can cause very low testosterone levels in men. OSA disrupts normal sleep patterns and reduces oxygen levels during sleep, which interferes with the body's hormonal regulation, particularly affecting the hypothalamic-pituitary-gonadal axis that controls testosterone production. The fragmented sleep and intermittent hypoxia (low oxygen) associated with OSA can suppress testosterone secretion, leading to hypogonadism in many affected men.
Key Points to Consider
- Studies have shown that approximately 30-50% of men with OSA have low testosterone levels 1.
- Treatment of OSA, primarily with continuous positive airway pressure (CPAP) therapy, can help improve testosterone levels in many patients.
- CPAP therapy typically involves wearing a mask during sleep that delivers pressurized air to keep airways open, and should be used nightly for optimal results.
- For men with both OSA and low testosterone, treating the sleep apnea first is generally recommended before considering testosterone replacement therapy, as improving sleep quality alone may normalize hormone levels 1.
- Weight loss can also help improve both conditions, as obesity is a common factor in both OSA and low testosterone.
Important Considerations
- The relationship between testosterone and OSA is complex, with some studies suggesting that testosterone may worsen OSA symptoms 1.
- However, the most recent and highest quality study suggests that treating OSA can improve testosterone levels, and that testosterone replacement therapy should be considered only after OSA has been adequately treated 1.
From the Research
Obstructive Sleep Apnea and Testosterone Levels
- Obstructive sleep apnea (OSA) has been associated with decreased testosterone secretion in middle-aged men, often in conjunction with obesity and aging 2.
- A meta-analysis of 24 case-control studies found that serum testosterone levels in male OSA patients were significantly lower than in control groups, with a standardized mean difference of -0.97 [95% CI (-1.47, -0.47)] 3.
- However, another study found that continuous positive airway pressure (CPAP) treatment did not reliably increase testosterone levels in men with OSA, with no significant change in total testosterone levels before and after CPAP treatment [SMD = -0.14,95% CI: -0.63 to 0.34, z = 0.59, p = 0.558] 4.
Factors Influencing Testosterone Levels in OSA Patients
- Age, body mass index (BMI), and detection method were found to be sources of high heterogeneity in the relationship between OSA and testosterone levels 3.
- A study of severely obese men found that OSA was associated with low total and free testosterone levels, with a significant negative correlation between apnea-hypopnea index (AHI) and testosterone levels 5.
- The prevalence of metabolic syndrome and continuous metabolic syndrome score were also found to be significantly correlated with testosterone levels in OSA patients 5.
Treatment and Management of OSA and Testosterone Deficiency
- Testosterone replacement therapy (TRT) may be used to improve hypogonadism and erectile/sexual dysfunction in OSA patients, but should be used with caution as it may exacerbate OSA in some patients 2.
- CPAP treatment has been shown to be effective in reducing the severity of OSA, but its impact on testosterone levels is unclear 4, 6.
- Oral appliance therapy has been found to be effective in reducing the severity of OSA, but its impact on testosterone levels has not been studied 6.