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How a man breathes whilst asleep impacts testosterone

Updated: Mar 25

Man snoring

Male testosterone shows a 24 hour (circadian) variation with levels higher during the morning and lower at the end of the day. Testosterone levels begin to increase upon falling asleep, generally reaching a peak during the first 3 hours of uninterrupted sleep or about the time of the first period of rapid eye movement (REM) sleep.

The relationship between testosterone and obstructive sleep apnoea (OSA) is complex and not yet completely understood.

Aging is an important factor associated with the lowering of morning testosterone level.

Also obesity is strongly linked with low testosterone levels in men and OSA is more common with obesity.

Although this meta-analysis (cited in comments) after matching for age and BMI showed OSA does lower testosterone and as OSA severity increases the further the testosterone level falls.

It is thought the frequent wakening due to the airway closing fragments the sleep and/ or the repetitive drop in oxygen levels interferes with the natural 24 hour testosterone production.

Unfortunately, prescribing testosterone replacement therapy for individuals with OSA is advised with caution in the British National Formulary (BNF) because of concerns it worsens OSA. Possible reasons are:

The muscles of the upper airway are controlled by nerves influenced by serotonin and noradrenaline . Both these nerves types may be impacted by age and testosterone level.

Could higher testosterone levels increase the metabolic requirements of the body leading to greater use of oxygen and a drop in oxygen level?

Testosterone has a role in the nerve response pathway to low oxygen (hypoxia) and high carbon dioxide (hypercapnia). Could an altered response to oxygen and carbon dioxide worsen OSA?

The effects of OSA treatment on testosterone levels show inconsistent results therefore further studies are needed.

The basic foundation of efficient breathing is correct tongue position, nasal breathing, strong throat muscles, breathing the volume of air we actually need (a lot of us over breathe in modern society), using the diaphragm and breathing slowly.

Nasal CPAP is more effective and better tolerated than full mask CPAP however generally an individual who uses the nose to breathe is more likely to be given a nasal CPAP machine and full face mask given to those who are using the mouth to breathe whilst asleep. Therefore I believe everyone with sleep disordered breathing should ensure they are breathing efficiently.

My breathing re-education programmes are open to any adult click here for more details

Su L, Meng YH, Zhang SZ, Cao Y, Zhu J, Qu H, Jiao YZ. Association between obstructive sleep apnea and male serum testosterone: A systematic review and meta-analysis. Andrology. 2022 Feb;10(2):223-231. doi: 10.1111/andr.13111. Epub 2021 Sep 30. PMID: 34536053.

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