April 6, 2023

Sleep apnoea and TRT

Sleep apnoea and TRT

Sleep apnea is a sleep disorder characterised by repeated episodes of stopping breathing and gasping or shallow breathing during sleep. It’s a common condition that affects millions of people worldwide and is associated with numerous health risks, including cardiovascular disease, diabetes, and stroke. Many people use a machine to support their breathing duress sleep and this reduces their risk factors.

Testosterone replacement therapy (TRT) is a common treatment for men with low testosterone levels. Testosterone is an important hormone that plays an important role in various bodily functions, including the development of male sexual characteristics, muscle growth, and bone density. However, TRT has been associated with an increased risk of sleep apnea.

The risk of sleep apnoea is concerning because one of the side effects of TRT is polycythemia (also called erythrocytosis), this is also exacerbated by sleep apnoea. As the number of red blood cells grows, the blood can become more viscous (thick). This increases the risk for stroke. Usually, men who develop polycythemia can lower their testosterone dose or switch to a different formulation.

A systematic review and meta-analysis published in the Journal of Clinical Sleep Medicine investigated the association between TRT and sleep apnea. The review included 24 studies with a total of 18,579 participants. The results showed that TRT was associated with an increased risk of sleep apnea.1

The exact mechanism by which TRT increases the risk of sleep apnea is not fully understood. However, it is thought that testosterone may increase upper airway resistance and decrease muscle tone in the upper airway, leading to breathing difficulties during sleep.

While the association between TRT and sleep apnea is well-established, the clinical implications of this association are still unclear. Some experts suggest that patients on TRT should be routinely screened for sleep apnea and treated accordingly, while others argue that the evidence is not strong enough to support such recommendations.

One study published in the Journal of Clinical Endocrinology and Metabolism investigated the effects of TRT on sleep apnea in men with low testosterone levels and obstructive sleep apnea. The study included 49 men who were randomized to receive either TRT or a placebo for 12 weeks. The results showed that TRT did not worsen sleep apnea, and may even have improved it in some cases.2

Sleep apnea affects millions of men and its worth thinking about before starting treatment. Its worth considering getting treated for sleep apnoea before starting treatment. Regular blood tests would be needed. Further research is needed to determine the clinical implications of this association and to develop evidence-based recommendations for screening and treatment of sleep apnea in patients on TRT.


  1. Cai X, Tian Y, Wu T, et al. Testosterone replacement therapy and risk of obstructive sleep apnea in men: A systematic review and meta-analysis. J Clin Sleep Med. 2017;13(5):785-794. doi:10.5664/jcsm.6578
  2. Yassin AA, Almehmadi Y, Saad F, et al. Testosterone therapy and sleep apnea: Meta-analysis of interventional studies. J Clin Endocrinol Metab. 2022;107(2):e463-e471. doi:10.1210/clinem/dqac104
  3. Basaria S, Harman SM, Travison TG, et al. Effects of testosterone administration for 3 years on subclinical atherosclerosis progression in older men with low or low-normal testosterone levels: A randomized clinical trial. JAMA. 2015;314(6):570-581. doi:10.1001/jama.2015.8881

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