Sleep apnea is more than a sleep disorder. It can affect your health in significant ways, including increasing your risk of serious health problems such as heart attack, stroke, and type 2 diabetes. Many people don’t realize that sleep apnea can also lower levels of the sex hormone testosterone.

If you’re living with sleep apnea, talk with your doctor about how it may affect both your physical and mental health, including low testosterone. To help guide that conversation, here’s what to know about sleep apnea and low testosterone.

Understanding Testosterone

Testosterone is present in everyone. However, Cleveland Clinic notes that compared with women, men have much higher levels of this hormone, which plays a key role in:

• Development of male sex organs and physical traits
• Sex drive and fertility
• Bone and muscle health
• Red blood cell production
• Mood and energy levels

Testosterone levels naturally drop with age, often starting in the late 30s. Lower testosterone can also be linked to other factors, including:

• Inherited conditions
• Injury to the testicles (where testosterone is made)
• Certain health conditions such as obstructive sleep apnea, type 2 diabetes, and obesity

Low testosterone can cause a range of symptoms and affect quality of life. Common signs of low testosterone include:

• Low sex drive
• Erectile dysfunction (trouble getting or keeping an erection)
• Low sperm count
• Depression
• Problems concentrating
• Muscle weakness and loss of muscle mass
• Low energy
• Weight gain and increased body fat
• Hot flashes and night sweats

Talk with your doctor if you notice any of these symptoms.

Testosterone and Sleep in General

Sleep helps regulate hormone levels that affect many aspects of your health. During a normal sleep cycle, hormone levels rise and fall based on what the body needs. For instance, growth hormone rises during sleep, whereas cortisol — also known as the stress hormone — drops.

Over a typical 24-hour period with a healthy sleep cycle, testosterone is usually lowest in the evening (around 8 p.m.) and highest in the morning (around 8 a.m.). If you don’t get enough sleep, your testosterone levels may fall. At the same time, low testosterone can also lead to sleep problems.

Sleep Apnea and Low Testosterone

Sleep apnea is often called a sleep disorder, but it’s actually a breathing disorder. In obstructive sleep apnea (OSA) — the most common type — the throat muscles relax too much during sleep and block the upper airway, disrupting breathing. Each time this happens, you briefly wake up, which can lead to poor sleep quality and sleep deprivation.

Common symptoms of OSA include loud snoring, gasping for air during sleep, and daytime sleepiness.

When breathing is interrupted, oxygen levels drop. In people with sleep apnea, low oxygen levels can lead to hormonal changes linked to poor sleep, including a rise in cortisol. Higher cortisol levels can affect signals from the pituitary gland that are needed for testosterone production.

Sleep and oxygen disruptions can also lead to other changes linked to low testosterone, including:

• Oxidative stress, which can damage cells
• Increased sympathetic nervous system activity, which can raise heart rate and trigger other reactions
• Insulin resistance, which can raise blood sugar levels

Because low testosterone can affect muscles, it may worsen OSA by weakening throat muscles and leading to more breathing interruptions. Over time, this cycle can both worsen OSA and lower testosterone.

Similar Symptoms of Sleep Apnea and Low Testosterone

Sleep apnea and low testosterone can share symptoms, including:

• Mood swings, including depression
• Fatigue and low energy
• Trouble concentrating
• Night sweats
• Sexual dysfunction

If you notice these symptoms and haven’t been tested for either sleep apnea or low testosterone, talk with your healthcare provider. Early diagnosis can help ensure you get the right treatment.

Health Complications of Low Testosterone With Sleep Apnea

Low testosterone combined with sleep apnea can raise the risk of several health problems. Low levels of testosterone have been linked to cardiovascular disease, metabolic syndrome, type 2 diabetes, and cognitive issues (problems with thinking and memory), as well as sexual function and reproductive health concerns.

Cardiovascular Disease and Low Testosterone

Research shows strong links between sleep apnea, low testosterone, and heart disease. Sleep apnea can strain the heart due to low oxygen levels and hormone changes from disrupted sleep. Low testosterone may add to this strain because this hormone plays a role in regulating blood flow, blood pressure, and cholesterol levels.

Metabolic Health and Low Testosterone

Low testosterone levels may affect metabolic health — how the body turns food into energy. Metabolic health problems can lead to unwanted weight gain and affect how the body controls insulin and blood sugar.

Low testosterone is linked to metabolic syndrome. This condition involves a group of risk factors, such as a large waist size, high cholesterol, high blood sugar, and hypertension (high blood pressure). Metabolic syndrome raises the risk of heart disease, stroke, and type 2 diabetes.

Cognitive Problems and Low Testosterone

Testosterone affects areas of the brain that regulate thinking, decision-making, memory, and emotions. Testosterone helps regulate brain chemicals such as serotonin and dopamine, which affect mood and other functions. Low testosterone can raise your risk of cognitive problems and can contribute to mood swings, depression, and fatigue.

Muscles, Bones, and Low Testosterone

Low testosterone can affect bone health and muscle health. Testosterone helps the body use protein to build muscle and keep bones strong. Low levels can lead to loss of muscle mass, muscle weakness, and weaker bones, raising the risk of osteoporosis and bone fractures.

Treatment of Low Testosterone and Sleep Apnea

Both low testosterone and sleep apnea can be treated. If you have both, your healthcare team should consider your full health history and risk factors when choosing a plan.

Low testosterone is often treated with testosterone replacement therapy (TRT) to restore normal testosterone levels. However, in people with untreated or severe obstructive sleep apnea, TRT may worsen sleep apnea.

Some studies suggest that higher testosterone may be linked to a higher risk of cardiovascular disease, including heart attack and stroke. Other research has not found this link but suggests TRT may raise the risk of irregular heartbeat, pulmonary embolism (blood clots in the lungs), and kidney problems.

Some studies have shown that treating sleep apnea with continuous positive airway pressure (CPAP) may help improve testosterone levels. However, research is limited, and some studies show CPAP may not increase testosterone levels.

Lifestyle Changes

Healthy lifestyle changes can support hormonal balance, heart health, and better sleep. Helpful strategies include:

• Eating a balanced diet with plenty of fruits, vegetables, whole grains, and lean protein
• Getting regular exercise
• Losing weight, if recommended by your doctor
• Managing stress with practices such as meditation, yoga, and mindfulness

Both sleep apnea and low testosterone are often missed or not diagnosed. If you notice symptoms of sleep apnea or low testosterone, talk with your doctor. Getting the right diagnosis can help find the best treatment options for your needs.

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