Got sleep? How sleep affects testosterone

Too many men don’t see a doctor until there’s a crisis. I’ve written about why in In defense of men’s health. We’ve been taught to put it off and play it down. But some of the most common reasons men feel worn down are things we can look at early, and sleep is near the top of the list.

Signs of low testosterone

Low testosterone can be missed, partly because its signs are easy to blame on stress or age. A widely used screening questionnaire for aging men asks questions like these:

1. Do you have a lower sex drive?
2. Do you lack energy?
3. Has your strength or endurance gone down?
4. Have you lost height?
5. Are you enjoying life or your hobbies less?
6. Are you sad or grumpy?
7. Are your erections less strong?
8. Has your ability to play sports or exercise slipped?
9. Do you fall asleep after dinner?
10. Has your work performance (focus, memory, productivity) slipped recently?

Answering yes to several of these doesn’t mean you have low testosterone. Many have other causes, including poor sleep itself. A diagnosis takes symptoms plus blood tests: the American Urological Association uses a total testosterone below 300 ng/dL, confirmed on two separate early-morning tests, as a reasonable cutoff.⁴ You can also take our free energy & vitality quiz.

What the research says about sleep and testosterone

In a study of 2,295 U.S. men aged 16 to 80, testosterone was lower by about 6 ng/dL for every hour of sleep lost, and by about 6 ng/dL for every point of body mass index (BMI) gained, compared with about half a point per year of age.¹ In other words, sleep and body weight were more strongly linked to testosterone than age was.

The picture isn’t perfectly simple. A larger 2023 analysis of 8,748 adults found the link between sleep length and testosterone varied by age: short sleep wasn’t tied to low testosterone in younger men, and some middle-aged men who slept longer had lower levels.² Studies like these show associations, not cause and effect.

Sleep apnea is clearer. A review of 18 studies with 1,823 men found lower testosterone in men with obstructive sleep apnea, especially severe apnea, even after accounting for age and weight.³ Loud snoring, gasping at night or falling asleep during the day are worth mentioning to your doctor.

Sleep problems are an overlooked cause

In my experience, sleep problems are one of the most frequently missed contributors to low testosterone: sleep apnea, insomnia, jet lag, frequent travel across time zones and shift work. When we improve sleep and body composition, we’re working on the foundations that hormones depend on. If testosterone is still low after those foundations are in place, that’s a conversation to have with your doctor about the next step.

Make sleep a priority

The CDC recommends at least 7 hours of sleep a night for adults.⁵ I encourage my patients to aim for about 8 hours most nights, with a consistent bedtime. A few habits help:

• Go to bed and wake up at the same time every day, even on weekends.
• Avoid caffeine in the afternoon and evening.
• Turn off screens at least 30 minutes before bed.
• Talk with your healthcare provider if you regularly have trouble sleeping. A sleep study may be the next step.⁵

Testosterone, thyroid and adrenal health all matter for muscle, heart, bone, energy and sexual health. Good sleep is one of the simplest places to start. Is your current health journey getting to the root causes of how you feel?

This article is general education, not medical advice, and does not create a doctor–patient relationship. Talk with your own doctor before changing your diet, supplements or medications.

Sources

1. Patel et al. (World Journal of Urology, 2018): Impaired sleep is associated with low testosterone in US adult males: results from NHANES (2,295 men)
2. Hernández-Pérez et al. (Andrology, 2023): Association of sleep duration and quality with serum testosterone concentrations among men and women: NHANES 2011–2016 (8,748 adults)
3. Su et al. (Andrology, 2021): Association between obstructive sleep apnea and male serum testosterone: a systematic review and meta-analysis (18 studies, 1,823 men)
4. American Urological Association: Evaluation and Management of Testosterone Deficiency guideline
5. CDC: About Sleep

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