Obstructive Sleep Apnea and Testosterone Deficiency

[madman]

Obstructive sleep apnea (OSA) is a common disorder characterized by intermittent hypoxia and sleep fragmentation. OSA in middle-aged men is often associated with decreased testosterone secretion, together with obesity and aging. Although OSA treatment does not reliably increase testosterone levels in most studies, OSA treatment with testosterone replacement therapy (TRT) may not only improve hypogonadism but can also alleviate erectile/sexual dysfunction. However, because TRT may exacerbate OSA in some patients, patients should be asked about OSA symptoms before and after starting TRT. Furthermore, TRT should probably be avoided in patients with severe untreated OSA.


*TRT aggravates OSA through several physiologic mechanisms including neuromuscular changes to the airways, changes in metabolic requirements, and changes in the physiologic response to hypoxia and hypercapnia.





Fig. 1. Potential mechanisms linking obstructive sleep apnea (OSA) and obesity to low testosterone. A bidirectional relationship between testosterone and obesity or OSA is shown. While OSA and obesity lead to lower testosterone, low testosterone promotes obesity and affects sleep quality. REM: rapid eye movement, SHBG: sex hormone binding globulin, GnRH: Gonadotropin-releasing hormone, LH: luteinizing hormone.

Fig. 2. The plausible mechanisms by which testosterone replacement therapy (TRT) worsens obstructive sleep apnea (OSA). TRT aggravates OSA through several physiologic mechanisms including neuromuscular changes to the airways, changes in metabolic requirements, and changes in the physiologic response to hypoxia and hypercapnia.

CONCLUSIONS

Testosterone shows circadian variation, but its pattern is not as same as cortisol. Sleep-related increase in serum testosterone is linked with the appearance of the first REM sleep and requires 3 hours of deep sleep. Although the relationship between testosterone and OSA is complex and not yet completely understood, OSA may contribute to low testosterone because of hypoxia and sleep fragmentation. Furthermore, obesity and advanced age may account for lower testosterone secretion levels in middle-aged men with OSA. Although the effects of OSA treatment on testosterone levels remain unclear, OSA treatment may help improve sexual function, especially in men with severe OSA. However, TRT should be probably avoided in patients with severe untreated OSA because TRT may worsen OSA in some patients.

 

[CoastWatcher]

Well organized. Thank you.

 

[Nelson Vergel]

More posts on sleep apnea and testosterone

 

[Kettlebells]

Obstructive sleep apnea (OSA) is one of several comorbidities I have to manage. I use CPAP therapy. I used to be much heavier with a higher pressure (14 cmH2O before, now between 9 and 10 cmH20, depending on level of congestion) . I have not noticed a huge increase in OSA symptoms since going on TRT. In fact, for me, weight was more of a problem than TRT. I recently switched from generic Axiron (I had previously been on AndroGel) to testosterone pellets (6x 75mg Testopel, 4x 87.5mg compounded pellets). I worried about a myriad of side effects that are discussed on this forum. However, the urologist that I added to my list of specialists early this year told me that my testosterone levels on topical testosterone were a large part of the reason why erections were hit or miss with and without PDE5is (his specialty in this large practice is male sexual health). So far, I am still in the honeymoon phase of pellet therapy, but all I can say is "wow, just wow!" My blood glucose readings are lower. I have experienced no negative changes with respect to sleep. The bloating I worried about has not appeared. If anything, I have dropped water weight since switching to pellets from topical testosterone. However, the most amazing thing is that I can now get and maintain a very firm erection even without a PDE5i. My girlfriend is completely amazed by the changes in the bedroom, and she is a medical professional. What this experience has taught me is that no two people react to the same combination of therapies the same way. Our SNPs (single nucleotide polymorphisms) play a large role in how we respond to different therapies.

 

[CoastWatcher]

Obstructive sleep apnea (OSA) is one of several comorbidities I have to manage. I use CPAP therapy. I used to be much heavier with a higher pressure (14 cmH2O before, now between 9 and 10 cmH20, depending on level of congestion) . I have not noticed a huge increase in OSA symptoms since going on TRT. In fact, for me, weight was more of a problem than TRT. I recently switched from generic Axiron (I had previously been on AndroGel) to testosterone pellets (6x 75mg Testopel, 4x 87.5mg compounded pellets). I worried about a myriad of side effects that are discussed on this forum. However, the urologist that I added to my list of specialists early this year told me that my testosterone levels on topical testosterone were a large part of the reason why erections were hit or miss with and without PDE5is (his specialty in this large practice is male sexual health). So far, I am still in the honeymoon phase of pellet therapy, but all I can say is "wow, just wow!" My blood glucose readings are lower. I have experienced no negative changes with respect to sleep. The bloating I worried about has not appeared. If anything, I have dropped water weight since switching to pellets from topical testosterone. However, the most amazing thing is that I can now get and maintain a very firm erection even without a PDE5i. My girlfriend is completely amazed by the changes in the bedroom, and she is a medical professional. What this experience has taught me is that no two people react to the same combination of therapies the same way. Our SNPs (single nucleotide polymorphisms) play a large role in how we respond to difference therapies.

Thanks for the detailed update.