Testosterone and Sleep
There are so many factors that go into getting a good night’s 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.
Testosterone and Sleep
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 you’re not sleeping enough, it can decrease your testosterone levels too — which will then further disrupt your sleep.
Does Lack of Sleep Affect Testosterone?
“Sleep deprivation can cause a significant decline in testosterone production,” Dr.Tun Min, General Practitioner in the UK’s 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.
What Are Normal Testosterone Levels?
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).
Normal Male Testosterone Levels
According to the AUA, normal serum testosterone levels for males are:
- Age 20-24: 409-558 ng/dL
- Age 25-29: 413-575 ng/dL
- Age 30-34: 359-498 ng/dL
- Age 35-29: 352-478 ng/dL
- Age 40-44: 350-473 ng/dL
Normal Female Testosterone Levels
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:
- 7.1–49.8 ng/dL
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.
Does High Testosterone Affect Sleep?
High testosterone levels can absolutely disrupt your sleep. And if you’re 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.
Symptoms of High Testosterone
Harvard Health notes that excess testosterone isn’t a very common issue in males, but if it does occur, it can lead to symptoms such as:
- Low sperm counts
- Testicle shrinkage
- Impotence
- Prostate enlargement and thus, trouble urinating
- Acne
- Swelling in the legs and feet
- Insomnia
- Headaches
- Mood swings
In females, excess testosterone can be associated with:
- Polycystic ovary syndrome (PCOS), which causes irregular periods, excess body and facial hair, and acne
- Infertility
- Obesity
- Blood sugar imbalances
- Extra hair growth
- Male-pattern baldness
- Depression
- Anxiety
Does Low Testosterone Affect Sleep?
Low testosterone is connected to poor sleep, but the exact relationship isn’t 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 Men’s 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 can’t show if men aren’t 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 it’s both — it does show there is a connection between poor sleep and low testosterone.
It’s important to note that women have naturally lower levels of testosterone and don’t seem to be affected in the same way as men with low testosterone levels.
Symptoms of Low Testosterone
The AUA explains that in males, symptoms of low testosterone include:
- Decreased sex drive
- Fatigue
- Lower levels of lean muscle mass
- Irritability
- Erectile dysfunction
- Depression
Symptoms of low testosterone are broad and can be similar to symptoms of many other conditions, says Rokhsar, so it’s 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.
Testosterone and Sleep Apnea
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 isn’t entirely clear on causation. While we know that males with OSA have definitively lower levels of testosterone, the studies that show this note it’s 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 World’s Journal of Men’s 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 it’s not a clear-cut answer.
Rokhsar points out that many different sleep disorders and difficulties are associated with reduced testosterone levels. These include:
- Abnormalities of sleep quality
- Insufficient sleep duration
- Circadian rhythm disruption
- Sleep-disordered breathing, such as sleep apnea
These disorders can all cause testosterone levels to drop, which will then further impact sleep.
How to Improve Your Sleep
Realize how Important Sleep Is to Healthy Testosterone Levels
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, it’s to your advantage to do everything you can to prioritize sleep in your life.
Do a Sleep Health Assessment
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:
- Maintaining a regular sleep schedule
- Avoiding caffeine and alcohol before bed
- Creating a relaxing sleep environment
- Staying off all screens at least two hours before bed
- Using your bed only for sleep
- Getting some physical activity every day
Rule Out Other Medical Conditions
Low testosterone can be diagnosed through a simple blood test, says Rokhsar, so it’s important to start by talking to your doctor. Symptoms of low testosterone can overlap with many other medical conditions, so you’ll 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.
Correct Testosterone Levels with Your Doctor
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.
Ask for a Sleep Study
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.
The Last Word From Sleepopolis
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, it’s 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.
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Testosterone — What It Does And Doesn’t Do. Health.Harvard.edu. Published August 29, 2019. Accessed April 13, 2024. https://www.health.harvard.edu/medications/testosterone–what-it-does-and-doesnt-do.
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Insomnia in Older Adults: Tips to Master Sleep as We Age. SMB.org. Accessed April 13, 2024. https://www.sbm.org/healthy-living/insomnia-in-older-adults-tips-to-master-sleep-as-we-age?gclid=CjwKCAjw0N6hBhAUEiwAXab-TRHBLE4MKtHXRLCuB-TNflxwMQyXjlVpXIxLwP929ICocpj2NgkyAxoC7L4QAvD_BwE.
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Rokhsar, Cameron. MD, FAAD, FAACS New York Cosmetic Skin & Laser Surgery Center. Personal interview April 5, 2024.
Min, Tun. General Practitioner in the UK’s National Health System. Personal interview April 5, 2024.