Connecting the Dots: Obstructive Sleep Apnea (OSA) and Low Testosterone (Low T)

Sleep apnea and low testosterone (Low T) are closely linked, creating a cycle that can negatively impact men’s health. Sleep apnea, particularly obstructive sleep apnea (OSA), disrupts normal breathing during sleep, leading to intermittent drops in oxygen levels. This repeated oxygen deprivation can interfere with the body’s ability to regulate hormones, including testosterone, resulting in lower production over time. Conversely, low testosterone itself may contribute to the development or worsening of sleep apnea, as the hormone plays a role in regulating sleep patterns and respiratory function, and men with severe sleep apnea often have significantly lower testosterone levels than those without the condition. Addressing sleep apnea through proper treatment can help improve hormone balance, while in some cases, testosterone replacement therapy may be considered under medical supervision to restore healthy levels and overall well-being.

Increasingly more research is showing that Low T and OSA have a bidirectional relationship, where improving one can potentially improve the other. By combining testosterone replacement therapy with your OSA treatment, you could experience an array of benefits, including:

• Better, deeper, more restful sleep
• Improved heart and blood health
• Reduced fat
• Increased muscle mass and bone strength
• Improved libido and sexual function
• Better cognitive health and function
• More energy
• Reduced symptoms of OSA
• Fewer sleep apnea episodes and nighttime interruptions

At Tulsa Men’s Clinic, we take a comprehensive, synergistic approach to men’s health, addressing every area of dysfunction simultaneously to deliver the best possible results. As a leader in advanced hormone replacement therapies like testosterone replacement therapy, our team of board-certified physicians and renowned hormone experts has been at the forefront of effective, science-backed solutions for decades. While other clinics are just now catching up, we’ve been perfecting our medical protocols—including state-of-the-art diagnostics, in-depth lab analysis, and advanced monitoring processes—to ensure truly personalized treatment plans. By combining cutting-edge testing with proven therapies, we can optimize your testosterone levels, improve your sleep, and restore your overall well-being, helping you achieve lasting, life-changing results.

Testosterone is an androgen hormone that plays a key role in numerous bodily functions, particularly in men. While both men and women produce testosterone, men rely on it for essential processes such as red blood cell production, sperm formation, muscle growth, and sexual health. Testosterone levels naturally peak in early adulthood and begin to decline around age 20, dropping at an average rate of 1% per year. For many men, the effects of this decline become noticeable by their 30s or 40s, leading to a variety of symptoms often mistaken for normal aging or high stress. 

Symptoms of low T include:

• Reduced muscle mass

• Increased fat accumulation

• Fatigue

• Difficulty concentrating

• Mood changes

• Diminished libido

• Hair loss

As with many functions and processes of the body, sleep is intricately connected with hormone regulation, including facilitating the normal cycle of hormone production and replenishment. Without the proper amount of deep, restorative sleep, your body can’t produce the appropriate levels of hormones–like testosterone–needed to function properly.

Your body closely controls the levels of testosterone in the blood. Studies indicate that levels are highest in the morning, around 8 a.m. and then gradually fall throughout the day, with levels at their lowest around 8 p.m. In order to replenish the testosterone and other hormones used throughout the day, your body needs to spend at least three hours in the rapid eye movement (REM) stage of deep sleep.

Conversely, testosterone plays a role in regulating your body’s internal biological clock, or circadian rhythm, signaling to your body when it’s time to sleep and when it’s time to wake up. Low testosterone levels can disrupt this natural cycle, causing you to sleep poorly or less and contributing to insomnia-like problems such as difficulty falling asleep and staying asleep.

Sleep apnea is a serious sleep disorder that causes repeated interruptions in breathing throughout the night. These pauses, known as hypopneas, occur when the airway becomes partially or completely blocked, reducing oxygen levels in the blood. In response, the body releases stress hormones like epinephrine to restore normal breathing, increasing heart rate and blood pressure. This cycle repeats multiple times per hour, preventing deep, restorative sleep. As a result, individuals with sleep apnea often wake up feeling exhausted, struggle with daytime sleepiness, and experience difficulties with focus, memory, and mood regulation.

Obstructive sleep apnea (OSA) is the most common form of sleep apnea, occurring when the muscles in the throat relax too much during sleep and cause a temporary blockage of the airway. This obstruction leads to repeated pauses in breathing, forcing the body to wake up briefly to restore airflow by gasping for air and restless tossing and turning.

Other symptoms of OSA can include:

• Loud snoring
• Morning headaches
• Dry or sore throat
• Disruptions in brain function
• Excessive nighttime urination
• Night sweats
• Lack of energy
• Dry mouth
• Insomnia

There is strong evidence that OSA and low testosterone are closely correlated. Low testosterone is more likely to affect men with OSA, and, similarly, men with Low T are more likely to have OSA. Moreover, studies have shown that the severity of OSA in men–as measured by how often breathing stops during sleep, drops in oxygen levels, and the lowest oxygen levels reached–often correlates with lower testosterone levels.

Here are some of the ways in which these two conditions interact with each other.

Altered hormone function. Testosterone is regulated by the body’s hormone system, which includes the pituitary gland and the reproductive organs. The hypoxia–or drops in blood oxygen levels–associated with OSA disrupt normal hormone balance, function, and production, impacting the regulation of testosterone production and resulting in lower levels.

Sleep quantity and quality. Men with sleep disorders like OSA get less REM sleep, increased sleep fragmentation, less time in deep sleep, and increased nighttime awakenings, giving their bodies less time to replenish testosterone levels, and without enough sleep, testosterone levels will eventually start to drop. For men already experiencing low or diminishing testosterone production, this just exacerbates the problem.

Fertility. In addition to interrupting the replenishment of testosterone, OSA can lead to oxidative stress in the body, which can damage sperm DNA and impact sperm quality and production.

Respiratory function. Early research indicates that testosterone may also be involved in the regulation of respiratory function by reducing airway inflammation, lessening airway smooth muscle contraction, and improving lung function, all of which may have a positive influence on reducing OSA symptoms.

Symptoms and side effects. Men with OSA are also more likely to experience associated complications like low libido, impotence, and ED, and indeed, OSA and low T share many of the same symptoms and side effects, including:

• Lowered libido
• Fatigue and low energy
• Irritability
• Difficulty concentrating
• Sexual dysfunction, including erectile dysfunction
• Difficulty concentrating
• Weight gain

There is growing evidence that treating low testosterone may help improve OSA, and, vice versa, treating OSA may help increase testosterone levels and help improve erectile or sexual dysfunction; in one study in particular, CPAP resolved ED in 75% of OSA patients.

Beyond disrupting sleep, untreated OSA can have serious consequences for overall health. The repeated drops in blood oxygen levels place significant stress on the heart, increasing the risk of hypertension, heart disease, stroke, and irregular heart rhythms like atrial fibrillation. OSA is also linked to metabolic issues, including insulin resistance and type 2 diabetes, as well as mood disorders like depression and anxiety and hormone deficiencies.

The standard approach to treating OSA includes solutions like mandibular advancement devices or oral appliances–which hold the jaw forward to open the airway–and Continuous Positive Airway Pressure (CPAP) machines, which moves pressurized air through your nose and into your throat to keep it from collapsing while you sleep. By improving your sleep, OSA treatment methods like this can help your body achieve the necessary quantity and quality of sleep it needs to properly regulate testosterone production.

Testosterone deficiency, or low testosterone (Low T), is more than just an issue of aging—it can have significant consequences for overall health and well-being. Low T has been linked to a higher risk of conditions such as cardiovascular disease, osteoporosis, Alzheimer’s disease, and diabetes. Additionally, testosterone is vital for neurological health, playing a role in cognitive function, mood stability, and social behavior. When levels drop too low, men may experience increased anxiety, depression, poor memory, and slower wound healing.

Taking additional measures to treat low testosterone can have an additive effect on OSA treatment. Restoring your testosterone to healthier levels can help your circadian rhythm reset and regulate better for improved sleep, and testosterone replacement therapy may help you lose excess weight, which is associated with both Low T and OSA and can further contribute to the connection between the two conditions. 

Testosterone replacement therapy may help improve your OSA symptoms by:

• Improving energy and reducing fatigue, so you sleep better
• Improving muscle tone, which may help reduce the likelihood of airway collapse during sleep
• Improving red blood cell production, which can help improve overall oxygen levels in the body
• Helping you lose weight
• Improving your sleep regulation and melatonin production

At Tulsa Men’s Clinic, our comprehensive, science-driven approach to optimizing every aspect of your health offers synergistic solutions tailored to your body’s unique needs for maximum results. Our Vitality Blended TRT Therapy goes beyond simply boosting testosterone levels—it addresses the complex, underlying factors of Low T by treating multiple hormone deficiencies simultaneously. With advanced testing, in-depth data analysis, and expert supervision from our experienced, licensed medical professionals, we ensure a personalized treatment plan that delivers real, lasting benefits.

To further optimize results, we integrate additional therapies such as:

• Human chorionic gonadotropin (HCG), to help maintain fertility and testicular size.
• DHEA hormone supplements, to support overall hormonal balance and well-being.
• Omega-3 fatty acids, to promote cardiovascular health and reduce inflammation.
• Nandrolone Decanoate, to enhance muscle growth while mitigating androgenic side effects like hair loss and acne.
• Medical weight loss, to help you lose excess weight and regain your energy.
• Human growth hormone (HGH) to restore balance and vitality by increasing HGH production. 
• Peptide therapy, to help balance and optimize various functions related to health and well-being.

Experience the transformative benefits of optimized testosterone levels for your sleep and your health, and schedule a no-obligation consultation with Tulsa Men’s Clinic today.