Sleep apnea and testosterone

Low Testosterone and Sleep Deprivation: What’s the Link?

Tired all day long? Not interested in sex? Your ability to concentrate isn’t what it used to be? Could be that you’re not getting enough sleep. Or, it could be that you have low testosterone, or low T. But is it possible that you have low T because of sleep deprivation? According to some research, the answer is yes.

“The link actually goes both ways,” said Rowena A. DeSouza, MD, assistant professor of urology at University of Texas Health Science Center at Houston. “Low testosterone can cause sleep disturbance, and sleep disturbance can cause low testosterone. It can become a vicious cycle.”

Sleep Deprivation and Low T: What the Research Shows

A 2011 study published in the Journal of the American Medical Association (JAMA) reported the effect of one week of sleep restriction in healthy, young men. Previous studies have shown that gradual decrease in sleep time is partially responsible for low T in older men. Studies also have shown that sleep disturbance caused by sleep apnea — a chronic breathing disturbance that occurs during sleep — is linked to low T.

In the JAMA study, 10 men volunteered to have their testosterone levels checked during eight nights of sleep restriction. They were only allowed five hours of sleep per night. The study found that their daytime testosterone levels decreased by 10 to 15 percent. The lowest testosterone levels were in the afternoon and evening. The study also found a progressive loss of energy over the week of sleep deprivation.

Obstructive sleep apnea is a common condition in which breathing becomes obstructed during sleep. Symptoms are daytime sleepiness, loud snoring at night, and short periods of absent breathing (apnea). Sleep apnea causes an abnormal sleep cycle and can result in low testosterone. Treating sleep apnea has been shown to return testosterone to normal levels.

A study presented at the American Urological meeting in 2012 evaluated 2,121 male law-enforcement officers to see if there was an association between sleep apnea and low testosterone. About 38 percent of the men had low testosterone, and 43 percent were considered to have sleep apnea. The men with sleep apnea were almost 50 percent more likely to have low T than men without sleep apnea.

Why the Link Between Sleep and Low T?

“It seems that normal testosterone production requires restful, undisturbed sleep called REM sleep. Over time, sleep disturbance also can cause an increase in the stress hormone cortisone. High cortisone levels also can cause low testosterone,” explained Dr. DeSouza.

The majority of the testosterone used every day is replenished at night. In older men, gradual reduction in hours of sleep has been closely correlated with gradual lowering of testosterone. Studies have shown that men with low testosterone, especially older men, tend to have more trouble sleeping. But how low T actually affects sleep is still unclear.

Tips for Better Sleep

Good sleep habits are called sleep hygiene. According to the U.S. Centers for Disease Control and Prevention (CDC), an adult should get seven to nine hours of sleep every night. Here are the basics for maintaining good sleep hygiene:

  • strong>Set a routine. Go to bed and get up at the same time every day, including weekends.
  • strong>Get comfortable. Keep your bedroom quiet, dark, and at a comfortable temperature for sleeping.
  • strong>Stay focused. Make sure your bed is comfortable and use it only for sex or sleeping. Avoid bedroom distractions like TV, books, and computers.
  • strong>Don’t chow-down. Avoid eating a big meal before bedtime.

You and the Low T-Sleep Deprivation Connection

The level of sleep restriction imposed on the young men in the JAMA study, five hours per night, is actually about the average amount of sleep that 15 percent of working Americans get.

“What these studies tell me is that doctors need to consider low testosterone as a diagnosis in men who complain of fatigue and sleep problems,” said DeSouza. “We also need to look for causes of sleep disturbance, like sleep apnea, in our patients with low testosterone.”

If you have symptoms like low energy, low libido, daytime sleepiness, or poor concentration, talk to your doctor about the possibility of low testosterone. If your partner tells you that you have loud snoring at night with periods in which your breathing is interrupted, talk to your doctor about sleep apnea.

Effects of CPAP on Testosterone Levels in Patients With Obstructive Sleep Apnea: A Meta-Analysis Study

Introduction

Obstructive sleep apnea (OSA) syndrome is a clinical condition characterized by recurrent episodes of complete or partial obstruction of the upper airway (apnea/hypopnea), leading to intermittent hypoxia, sleep fragmentation, hypercapnia, marked swing in intrathoracic pressure, and increased sympathetic activity (1). It is widely diffused in the general population, ranging from 9 to 38% (2), with a higher prevalence in men than women and in patients with obesity compared to patients with overweight, reaching a prevalence of 50–60% (2–4). Untreated OSA syndrome has been associated with cardiovascular, metabolic, and neurocognitive disorders, including hypertension, atrial fibrillation, stroke, myocardial infarction, dyslipidemia, diabetes mellitus, increased motor vehicle accidents, and decreased quality of life, causing a major economic impact on affected people, their families, and the health care system (5, 6).

Several studies have shown that sleep disorders may influence testosterone production (7–10). Current guidelines recommend distinguishing between organic and functional causes of hypogonadism. The former is characterized by a permanent dysfunction of the hypothalamus–pituitary–testicular (HPT) axis, and testosterone replacement therapy (TRT) should thus be considered in order to improve sexual function, well-being, bone mineral density, and body composition. On the other hand, the latter can be potentially reversed by treating the underlying etiology. Among the causes of functional hypogonadism, sleep disorders are listed (11). It is worth noting that the interaction between testosterone and OSA syndrome has not be fully characterized. The rise of testosterone is mostly dependent on sleep integrity, generally reaching its peak during the first 3 h of uninterrupted sleep (10); indeed, a reduced LH pulsatility and serum total testosterone has been found to be associated with sleep fragmentation and/or intermittent hypoxia occurring in patients with OSA syndrome (12, 13). However, it has been suggested that serum testosterone levels may be affected primarily by obesity in men with OSA syndrome (14, 15). Indeed, the association of testosterone levels with sleep quality and sleep-disordered breathing was absent or markedly attenuated after adjusting for body mass index (BMI) or waist circumference (16).

The first choice for treatment of moderate–severe OSA is continuous positive airway pressure (CPAP) (17). Thus, we performed a systematic review and meta-analysis to evaluate the effects of CPAP on serum testosterone and gonadotropin levels in male patients with OSA syndrome.

Methods

The systematic review was registered in PROSPERO (registration number CRD42018103164) and performed in accordance with the Meta-analyses Of Observational Studies in Epidemiology (MOOSE) statement (Table S1).

Search Strategy

A six-step search strategy was planned. First, we searched sentinel studies in PubMed. Second, keywords and Medical Subject Headings (MeSH) terms were identified in PubMed. Third, the terms “continuous positive airway pressure,” “testosterone,” and “gonadotropins” were searched in PubMed, in order to test the strategy. Fourth, PubMed, CENTRAL, ClinicalTrials.gov, and Scopus were searched. Fifth, observational studies and randomized clinical trials (RCTs) were selected. Sixth, references of included studies were searched for additional papers. The last search was performed on June 26, 2018. No language restriction was adopted. Two investigators (MC, AC) independently searched papers, screened titles, and abstracts of the retrieved articles, reviewed the full texts, and selected articles for their inclusion.

Data Extraction

The following information was extracted independently by two investigators (MC, AC) in a piloted form: (1) general information on the study (author, year of publication, country, study type, number of patients, age, sex, BMI, OSA syndrome severity); (2) type of CPAP (nasal, oral) and compliance; (3) total testosterone; and (4) secondary outcomes , LH, FSH, PRL]. The main paper and supplementary data were searched; if data were missing, authors were contacted via email. Data were cross-checked, and any discrepancy was discussed.

Study Quality Assessment

The risk of bias of including observational studies was assessed independently by two reviewers (MC, AC) through the National Heart, Lung, and Blood Institute Quality Assessment Tool for Before–After (Pre–Post) Studies With No Control Group (18). The risk of bias of including RCTs was assessed independently by the same reviewers through the Cochrane Collaboration’s tool for assessing risk of bias for the following aspects: random sequence generation, allocation concealment, blinding of participants and personnel, blinding of outcome assessment, incomplete outcome data, and selecting reporting. For other bias, funding was assessed. Each domain was assigned as low, unclear, or high risk of bias (19).

Data Analysis

The primary outcome was the change in serum total testosterone from baseline to the last available follow-up. Secondary outcomes included change in serum free testosterone, SHBG, LH, FSH, and PRL from baseline to the last available follow-up. The end points were analyzed as continuous variables and summarized as weighted-mean difference. If standard deviation was missing in a study for a specific outcome, it was calculated from standard error, 95% confidence interval (CI), or interquartile range; if none of these were available, the largest among the other studies was reported. In order to assess differences between eugonadal and hypogonadal subjects, a subgroup analysis was planned with a cutoff for serum total testosterone of 12 nmol/l. Heterogeneity between studies was assessed by using I2, with 50% or higher regarded as high. Publication bias was assessed with Egger’s test and funnel plot visually; the trim-and-fill method was used for estimating its effect. Sensitivity analyses by removing each study in turn were also performed. All analyses were two-sided and were carried out using RevMan 5.3 (Cochrane Collaboration) and RStudio ver. 1.1.383 (RStudio Team) with a random-effect model; p < 0.05 was regarded as significant.

Results

Study Characteristics

A total of 129 papers were found, of which 32 were on PubMed, 58 on Scopus, 38 on CENTRAL, and 1 on ClinicalTrials.gov. After removal of 36 duplicates, 93 articles were analyzed for title and abstract; 64 records were excluded (systematic reviews, meta-analyses, case reports, articles not in the field of the review). The remaining 29 papers were retrieved in full text, and 12 articles were finally included in the systematic review (Figure 1).

FIGURE 1

Figure 1. Flowchart of the systematic review.

The risk of bias of the included studies is shown in supplementary data (Table S2, Figures S1–S3). Concerning the observational studies, statement of the study question, eligibility criteria, representativeness and enrollment of patients, and statistical analysis were adequate in all. Sample size calculation was reported in two papers (20, 21) and adherence to CPAP in five (20–24). Only in Knapp et al. serum testosterone was measured by liquid chromatography mass spectrometry, which is considered as the most reliable method (22, 25). The loss to follow-up was 20% or less in five studies (9, 23, 24, 26). The outcome measures of interest were taken more than once after CPAP in two studies (22, 27).

Concerning the two RCTs, data on allocation concealment were not reported; the remaining domains were adequate in both (28, 29).

Qualitative Analysis (Systematic Review)

The characteristics of the included articles are summarized in Table 1. The studies were published between 1989 and 2017 and had sample sizes ranging from 5 to 101 patients and a follow-up from 4 to 156 weeks. Ten studies were prospective cohort and two randomized controlled. Eight studies examined oral CPAP and four nasal CPAP. Seven studies reported data on compliance to CPAP. Participants were adult outpatients diagnosed with OSA syndrome; five trials enrolled patients with serum total testosterone <12 nmol/l at baseline. The weighted-mean age was 52.6 ± 11.3 years, and the weighted-mean BMI was 32.5 ± 5.5 kg/m2. A total of 388 male patients were included, of which 245 received oral and 143 nasal CPAP; information on the presence of diabetes was available for 44 patients (11%) (22, 29). Moreover, 49 patients were treated with sham-CPAP, 21 with mandibular advancement devices, and 12 with CPAP and simultaneous TRT; they were not included in the present review.

TABLE 1

Table 1. Qualitative analysis of studies included in the systematic review.

Quantitative Analysis (Meta-Analysis)

The primary outcome was the change in serum total testosterone levels from baseline to the last available follow-up. Data were available for 95 patients with hypogonadism and 280 with eugonadism at baseline. The weighted-mean serum total testosterone at baseline was 13.5 ± 7.4 nmol/l, and it was different between the two groups (6.8 ± 3.5 nmol/l in hypogonadal and 15.7 ± 7.0 nmol/l in eugonadal patients). CPAP use was not associated with a change in serum total testosterone levels (Δ = 1.08 nmol/l, 95% CI −0.48 to 2.64, p = 0.18, I2 = 89%); results were confirmed by the subgroup analysis in eugonadal and hypogonadal men, even though a trend toward increased serum testosterone was noted in the latter subgroup (Figure 2). Sensitivity analysis had not reached statistical significance (Table S3); a funnel plot showed that a possible publication bias may exist, although Egger’s test was not statistically significant (p = 0.356; Figure S4).

FIGURE 2

Figure 2. Forest plots of meta-analysis for change in total testosterone.

FIGURE 3

Figure 3. Forest plots of meta-analysis for change in free testosterone.

FIGURE 4

Figure 4. Forest plots of meta-analysis for change in LH.

FIGURE 5

Figure 5. Forest plots of meta-analysis for change in SHBG.

Discussion

The aim of this systematic review and meta-analysis was to identify the best available evidence on the efficacy of CPAP on serum total testosterone levels in male patients with OSA syndrome. Twelve studies were found including adult patients with eugonadism or hypogonadism at baseline. The overall results of our meta-analysis showed that CPAP does not influence total testosterone or gonadotropins.

To our knowledge, this is the first systematic review and meta-analysis assessing differences due to CPAP use in eugonadal and hypogonadal patients with OSA syndrome, as well as focusing on gonadotropins. Papers were searched without time restrictions, inclusion criteria were defined prior to the database search, and data were searched on original articles and supplementary data.

Two hypotheses have been formulated in order to describe the interactions between OSA syndrome and serum testosterone. According to some authors, sleep fragmentation and/or intermittent hypoxia occurring in untreated OSA syndrome may influence the HPT axis, reducing Gonadotropin Releasing Hormone (GnRH) secretion, LH pulsatility, and serum total testosterone (12, 13). The mechanism of this interaction has not been fully characterized, but it could probably be mediated by endorphins (12, 32, 33). An adequate treatment with CPAP could be sufficient for the correction of hypogonadism, indeed (20). Conversely, according to other authors, overweight and obesity represent the “common soil” for both OSA syndrome and hypogonadism. Overweight and obesity are regarded as a major risk factor for OSA syndrome, acting through both mechanical and biochemical mechanisms, such as changes in peri-pharyngeal soft tissues and depression of neuromuscular control (34). On the other the hand, visceral adiposity is associated with impaired synthesis of GnRH in the hypothalamus, SHBG in the liver, and testosterone in Leydig cells (35–38). In supporting this link, body weight loss promotes a decrease in apnea–hypopnea index as well as an increase in serum total and free testosterone levels (39, 40). However, since CPAP per se does not lead to a decrease in body weight, no effects on the HPT axis should be expected (41, 42). The present meta-analysis supports this hypothesis rather than a direct link between OSA syndrome and hypogonadism. Strategies other than CPAP should thus be considered in these patients, including weight loss, exercise, and optimization of concomitant chronic diseases to improve gonadal function (43).

In male patients with obesity, low levels of SHBG are consistently reported. Since ~70% of serum testosterone is bound to SHBG, current guidelines recommend determining the androgen status through the evaluation of serum free testosterone, either directly from equilibrium dialysis assays or by calculations that use serum total testosterone, SHBG, and albumin (11). In the present review, no data on serum free testosterone or SHBG in patients with hypogonadism were available. It is worth noting that other treatments, such as diet and bariatric surgery, proved to increase total as well as serum free testosterone and SHBG (40). Since CPAP has shown a neutral effect on serum total testosterone, no different result should be expected for the other outcomes, indeed (43).

Eighty-two patients were excluded from the present review: 49 were treated with sham-CPAP, 21 with mandibular advancement devices, and 12 with CPAP and simultaneous TRT. A significant increase in serum total testosterone was reported only in the third group (28–30). It is worth mentioning that untreated severe OSA syndrome contraindicates TRT, due to a time-limited worsening of the sleep disorder (11, 44).

In December 2014, a meta-analysis on the same topic was published by Zhang et al. The authors stated that CPAP does not influence serum total testosterone, free testosterone, and SHBG. These results were drawn from the analysis of seven studies, all included in the present paper (9, 22, 23, 27–29, 31). Of note, only one of them enrolled patients with low serum testosterone (24). Our meta-analysis is in line with previous work, and conclusions on hypogonadal patients are strengthened by the subgroup analysis.

This review has several limitations. The first limitation relates to the design of the included papers: the majority was represented by observational studies with low number of participants and short duration. Secondly, the efficacy of CPAP strictly depends on adherence to the treatment and correction of apnea/hypopnea as well as nocturnal hypoxia. In particular, lack of compliance is regarded as a major issue in OSA syndrome management. In the present systematic review, only three studies reported an adequate CPAP use (4 h per night on at least 70% of nights) (20, 21, 28, 45), and thus, results might reflect, at least in part, suboptimal CPAP therapy. This threshold, although defined as arbitrary, has proved useful in clinical studies and has some validity. Indeed, adherence to CPAP therapy for at least 4 h per night has been associated with normalization of daytime sleepiness, improvement of quality of life and neurocognitive function (46–49), and improvements in cardiovascular disease conditions and diabetes (50–53). Also, CPAP adherence is usually defined as hours per night rather than as a proportion of total sleep time, which is usually not measured. So far, it is unclear if shorter sleep duration with high CPAP adherence would be associated with better outcomes than longer sleep duration with low CPAP adherence. Concerning the latter aspect, it is estimated that CPAP is not able to correct all the nocturnal events in about 20% of patients with OSA syndrome; the risk is increased in patients with concomitant obesity hypoventilation syndrome and chronic obstructive pulmonary disease (54). Among the included studies, only six reported the correction of apnea/hypopnea (20, 21, 26, 28, 30, 31) and three the resolution of nocturnal hypoxia (9, 26, 30). A high heterogeneity for four out of six evaluated outcomes was found, and this is a third limitation. This could be due to: (1) study design and (2) patient characteristics other than the extracted ones. In particular, the data in Li et al. (20) are not in line with the other studies, although no clear reason could be found in the study protocol. Caution should thus be taken in generalizing results to clinical practice. Lastly, it should be considered that pituitary imaging in patients with serum total testosterone <5.2 nmol/l and low or inappropriately normal gonadotropins is recommended in order to exclude secondary organic causes (11). Two studies included such patients, but no information other than a “medical history” evaluation is reported (9, 20). In all, a limited number of studies specifically focusing on the effect of CPAP in hypogonadal patients was found, and this prevented any additional analysis (e.g., meta-regression) to explore the high heterogeneity of findings. Further studies are thus needed reporting data on sleep duration, compliance to CPAP, months of use, OSA syndrome improvement, and BMI.

Conclusions

In male patients with OSA syndrome, CPAP use is associated with a neutral effect on serum total testosterone and gonadotropins, regardless of the gonadal status at baseline. In managing hypogonadism in patients with OSA syndrome, strategies other than CPAP should therefore be considered.

Data Availability

The datasets generated during and/or analyzed during the current study are not publicly available but are available from the corresponding author on reasonable request.

Author Contributions

MC, AC, and GC conceived the meta-analysis, developed the search strategy, provided statistical expertise, and drafted the manuscript. All authors contributed to the development of the selection criteria, the risk-of-bias assessment strategy, and data extraction criteria. All authors read, provided feedback, and approved the final manuscript.

Funding

This research did not receive any specific grant from any funding agency in the public, commercial, or not-for-profit sector.

Conflict of Interest Statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Supplementary Material

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Another restless night has you feeling tired all day. What can you do? Find out all there is to know about low testosterone and insomnia because that could be your problem. Low testosterone is a significant issue for men after they turn thirty. That is the time that their bodies begin to decrease testosterone. A decade or two down the road can find you with Low T and sleep disorders.

Women – do not click away from this page. Everything we are going to say has to do with you, too. Low testosterone could be associated with your restless nights, as well.

When it comes to low testosterone symptoms, insomnia is right up there with decreased muscle mass, loss of bone density, lack of libido, and weight gain. Information on the internet may well confuse you about this topic. Some websites will say that low testosterone can lead to insomnia. Others will tell you it does not, but that insomnia can cause Low T.

Which do you believe?

In truth, it is a bit of both. Hormonal imbalance can sometimes interfere with sleep, and lack of sleep can cause hormonal imbalance.

For a person with low testosterone, severe insomnia can further worsen that condition. Either way, our goal is to help you get to the root of your sleepless nights. If low testosterone or another hormonal imbalance is the issue, better sleep may soon be in your future.

*Sleep and hormones such as testosterone have a reciprocal impact on one another.

Why Does Low Testosterone Affect Your Sleep and Cause Insomnia?

The first link between low testosterone and insomnia has to do with another hormone – cortisol. You probably know this as the hormone associated with stress. Although your body does require a little cortisol each day, too much will interfere with you falling asleep. Elevated levels of cortisol keep your body in a state of high alert well into the evening hours. That is the time your circadian rhythm wants you to relax. Cortisol prevents you from relaxing.

As the evening wears on, you cannot drift comfortably off to sleep. Instead, you toss and turn, reducing your deep sleep time each night. Why is this important? Your body uses periods of slow-wave sleep to secrete both testosterone and growth hormone into the bloodstream. Then, the cells of your body put these two hormones to work for metabolizing the food you ate, processing the day’s activities and committing them to memory, and for tissue repair and blood cell production.

If you do not get enough sleep (7 to 8 hours), you will wake up in a state of hormone deficiency. Your body will feel tired, and your brain will feel sluggish. As this process continues (it is a vicious cycle), cortisol levels continue to climb.

What makes this scenario even worse is that the higher cortisol levels climb, the lower your testosterone and growth hormone levels will get. Declining testosterone and GH tend to promote adrenal fatigue, weight gain, memory loss, and insomnia. Sleep apnea begins or worsens, causing a further decline in quality sleep. Testosterone and growth hormone also have a reciprocal effect on one another – they stimulate each other’s production.

When will low testosterone cause insomnia in women, and does testosterone decline at the same time as with men?

For women, testosterone decline begins during menopause, the same time the ovaries stop producing progesterone and estrogen. It is important to point out that progesterone is the precursor hormone for testosterone production in both the female and male body. Without enough progesterone, you can expect to suffer a decrease in testosterone secretion. Since progesterone also helps regulate sleep patterns, its decline can further impact insomnia.

*When testosterone levels decline, cortisol levels rise, causing sleep disturbances and insomnia.

The Intertwined Relationship between Insomnia and Low Testosterone

As you can see, there is an intertwined relationship between low testosterone and insomnia. The lower your testosterone levels, the higher your cortisol levels. You sleep less and produce smaller amounts of testosterone.

Now, we take it a step further by looking at how the body uses testosterone. Just as progesterone is the precursor to testosterone, so too is testosterone the provider of estrogen. An enzyme called aromatase takes some of the body’s free testosterone and converts it into estradiol – the primary form of estrogen for men and women. Estrogen is necessary to produce the neurotransmitter serotonin that regulates sleep. Lack of serotonin further influences your sleep cycle, causing restless nights.

During the day, your body responds to low testosterone, chronic insomnia, and fatigue by increasing hunger. Elevated cortisol levels stimulate the body to produce ghrelin – the hormone that causes you to eat. To get more energy, you will likely overeat or grab unhealthy choices: the result – weight gain. People who are overweight have an increased risk of developing sleep apnea. There we go – back to that intertwined relationship and vicious cycle.

*Low testosterone and insomnia are caught in a vicious cycle that continues to go around in circles – with no end in sight.

Can Testosterone Therapy Improve Symptoms of Insomnia for Better Sleep?

Lack of sleep, night sweats, sleep apnea, hot flashes – these symptoms are not only common for menopause but for andropause, as well. Yes, men can suffer from night sweats and hot flashes, too. Finding out if you have low testosterone or any other hormonal imbalance is the pathway to a good night’s sleep. When you are dealing with insomnia and low testosterone levels, your body cries out for you to put it back in balance. Restless sleep is a cry for help. When you realize that, you can take the first step towards better sleep.

Testosterone replacement therapy injections immediately reduce the level of cortisol in the bloodstream. Lower cortisol levels mean that you can start to relax at night. Drifting off to sleep becomes easier. You find that you begin to sleep longer, and more deeply. As a result, your body produces increased levels of testosterone and growth hormone. Together, those hormones promote better sleep and well-being.

*Testosterone therapy helps reduce cortisol levels so you can banish insomnia and sleep better at night.

Cover Image credits

Insomnia in Men

I have done a lot of reading about hormone therapy, but does it work?

Yes—if it’s done correctly, and under the supervision of an experienced doctor.
Hormone therapy is not a fanciful search for the fountain of youth. It is medical science at its best. It is trained doctors using sophisticated lab tests and treatment protocols developed and used over many years to produce life-altering results.

When should I think about replacing hormones?

Historically, our answer to the “when should I start” question has been to begin once you have symptoms, regardless of age.
However, the idea that we can manage the aging process is gaining momentum. An outgrowth of that is that we have an increasing number of clients who contact us initially because they wish to take control of the aging process early, long before symptoms have emerged.
Whether you want to head off the aging process early, or you’re just beginning to experience symptoms, or your symptoms are severe and you’ve had them for a long time, we can design a treatment program to address your unique needs.

What does Bioidentical mean?

Bioidentical means that molecularly the hormone that you’re replacing is exactly the same as what your body produces naturally. The molecules of synthetic hormones are slightly different.
There are hormone receptors all over your body. Think of these receptors like they’re locks, and hormone molecules like they’re keys. The synthetic molecules don’t fit into those locks quite right, which means they don’t work the same way in your body—often with detrimental consequences. You may be wondering…why do pharmaceutical companies make synthetic hormones with molecules that are slightly different? Because it’s the only way they can patent them. Bioidentical hormones can’t be patented.

Do I have to treat all hormones?

Hormones can be treated separately or in combination. However, we do emphasize that hormone therapy is about having balanced hormones—better results are obtained by taking the proper amount of a combination of hormones, depending upon what your lab results show, and depending upon your symptoms. All of your hormones will function better if they’re all present at healthy levels.

How are hormones replaced?

The short answer is that it depends. For some hormones, there are one or two optimal and safe methods of delivery. In other instances, client preference may come into play. You will be informed as to what the pros and cons are of any particular method of delivery, so that you and our doctors can decide what makes the most sense for you. Regardless, our doctors will not allow you to do something that isn’t safe.

How much of any given hormone will I take?

Your Renew Youth doctor will prescribe the amount needed to optimize your levels. Our doctors use a combination of lab testing and feedback from you with regard to how you’re feeling to dial in just the right dosages.

Is hormone therapy safe?

Yes. There are countless studies that have shown not only the safety of hormone therapy, but also the long-term health benefits. This assumes that treatment is done properly, and monitored on a regular basis. Again, the only way we do things is safely, and correctly.

Are there any side effects associated with your therapies?

When hormones and other treatments are administered correctly—and correctly is the only way we do things—there should be no side effects.

How long must I commit to hormone therapy?

Your commitment to hormone therapy should last as long as you want the results. If this thought is daunting, consider that men and women of previous generations had the same age-related challenges that we face today. They could not, however, do anything about it. When you consider the improved quality of life that hormone therapy affords, not to mention a longer life, making the commitment becomes easier.

Where and how do I get my lab testing done?

Renew Youth has national accounts with two of the largest lab companies in the country. We will arrange your testing at a location that is convenient for you.

Where will I see my Renew Youth doctor?

Renew Youth has doctors located across the country, and we will determine which one is closest to you.

Are diet and exercise important?

Yes! Establishing and maintaining good lifestyle habits is critical to achieving optimal results from your treatment. This means eating a healthy diet, getting enough exercise, managing stress, getting adequate sleep, and drinking lots of water.

Will injectable nutrients be a part of my program?

That’s largely up to you. Many of our clients augment their better aging efforts with injectable nutrients. Our doctors will discuss your goals with you, and will review the various options available to you.

Testosterone, Sleep and Sexual Health

When it comes to sleep, testosterone may be the somewhat forgotten hormone. We know a great deal about the importance of testosterone as the male sex hormone, its role in the body and the effects of testosterone deficits, particularly for men. But there’s been relatively little attention paid to the effects of testosterone on sleep, for both men and women. A recent review of research seeks to bring some much-needed attention to the role that testosterone plays in sleep.

• The effects of sleep (and lack of sleep) on testosterone levels in men and women.

• The role that testosterone plays in obstructive sleep apnea and sleep-disordered breathing.

• The relationship between testosterone levels and sexual dysfunction, and how sleep may affect both.

Changes in testosterone levels occur naturally during sleep, both in men and women. Testosterone levels rise during sleep and decrease during waking hours. Research has shown that the highest levels of testosterone happen during REM sleep, the deep, restorative sleep that occurs mostly late in the nightly sleep cycle. Sleep disorders, including interrupted sleep and lack of sleep reduces the amount of REM sleep, will frequently lead to low testosterone levels. And this is important for men and women.

There’s strong evidence of a relationship between testosterone and sleep disordered breathing, including obstructive sleep apnea. Studies have shown that low testosterone levels frequently occur in men with obstructive sleep apnea. Men with obstructive sleep apnea are also more likely to suffer from complications to their sexual function, including low libido, erectile dysfunction, and impotence.

• Men with erectile dysfunction were more than twice as likely to have obstructive sleep apnea as those without erectile dysfunction, according to one study. This study also showed that the more serious a man’s erectile dysfunction, the more likely he was to also have obstructive sleep apnea.

• Another study showed that men with obstructive sleep apnea and erectile dysfunction also exhibited highly fragmented sleep that reduced or eliminated their REM sleep.

Men are more likely than women to suffer from sleep apnea and sleep-disordered breathing—though there is widespread belief that sleep apnea in women remains significantly under-diagnosed—and testosterone deficiencies may play a role.

What does this mean for men suffering from sleep problems or problems with sexual function? It’s time to explore the connection between the two. First off, guys, you’ve got to go to the doctor. Making the decision to consult a physician is the first important step, one that unfortunately can still be a difficult one for some men. Men who are struggling with issues related to sexual function should have their sleep evaluated by their physician. The good news is that treatments for obstructive sleep apnea—particularly the CPAP—are safe and effective. In some cases, hormone replacement therapy for conditions such as erectile dysfunction may be appropriate, independently or in conjunction with treatment for a sleep disorder.

What are the implications for women of low testosterone levels from lack of sleep? Women are particularly vulnerable to sleep problems related to hormone changes and deficiencies, throughout their lives. We talk most frequently about estrogen and progesterone, the primary hormones involved in menstruation. But testosterone should be added to the list of hormonal factors to consider when thinking about hormone-related sleep problems in women.

Women, like men, are also likely to find their sexual lives negatively affected by obstructive sleep apnea. Several studies have found strong correlations between obstructive sleep apnea and sexual dysfunction in women. As obstructive sleep apnea grows worse, problems with sexual function—including sensation and desire—become more serious, according to this research. Women are particularly at risk for un-diagnosed sleep problems, including sleep-disordered breathing. Women who are experiencing problems with sexual function should have their sleep evaluated. This works in both directions: women who are being treated for sleep problems—particularly obstructive sleep apnea—should work with their physician to assess the potential effect of their sleep disorder on their sexual health.

We know that sleep deprivation poses a greater risk of cardiovascular problems for women than for men. It’s just possible that the resulting lower testosterone levels may have something to do with this. Testosterone has a protective effect on the heart, reducing inflammatory proteins that can cause heart damage.

The more we know about how testosterone affects sleep and sexual health in men and women, the better clinicians will be able to help restore healthy functioning to two critical aspects of our lives.

Sweet Dreams,

Michael J. Breus, PhD
The Sleep Doctor™

The Sleep Doctor’s Diet Plan: Lose Weight Through Better Sleep

Everything you do, you do better with a good night’s sleep™
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If hitting the sheets extra late every night is the norm for you, it might be in your best interest to change your routine. A new study finds that skipping sleep can drastically lower testosterone levels in healthy guys in as little as one week. A recent study funded by the National Heart, Lung, and Blood Institute found testosterone levels dropped significantly in men who don’t get enough sleep—equivalent to aging 10-15 years. These lower levels affect more than just the libido as testosterone deficiency is also linked to lower energy, poor concentration, fatigue and decreased strength. “Low testosterone levels are associated with reduced well being and vigor, which may also occur as a consequence of sleep loss,” said Eve Van Cauter, PhD, director of the study, which appeared in the Journal of the American Medical Association. The team of researchers at the University of Chicago Medical Center found that men who slept less than five hours a night for one week had lower levels of testosterone than when they’re fully rested. The study analyzed 10 healthy, lean guys, averaging around 24 years old. When deprived of sleep, their testosterone levels dropped by a whopping 10-15%— with the lowest levels reported between 2-10 p.m. The study notes that testosterone is essential for building strength, muscle mass and bone density, not to mention revving up the sexual drive. For a better night’s sleep try these habits of highly effective snoozers.

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6 Things that Happen When You Don’t Get Enough Sleep

When was the last time you felt rested? (and I’m not talking about that one amazing Sunday when you slept til noon). I mean, well and truly rested and ready to take on the day. “Nobody gets enough sleep these days,” you reply with a shrug, as if we should expect anything else. A “good night’s sleep” just isn’t a priority anymore.

The fast-paced pressures of life and constant online connectivity force many of us to skip out on an essential part of our day—sleep. However, burning the candle at both ends isn’t something your body can just shrug off. In fact, sleep deprivation produces cumulative, long-term negative affects on your metabolism, mood, heart health, and yes—even your sex life. Forget what you’ve heard about DaVinci sleeping two hours a night. Your body needs sleep.

Here’s why sleep matters so much, and what happens to your body when you experience sleep deprivation.

Table of Contents

  • Why Sleep is So Important
  • Fight or Flight: Stress, Adrenaline, and Insomnia
  • Stress and Insomnia
  • Sleep Deprivation and Weight Gain
  • Sleep and Testosterone
  • More Resources: Health Impacts of Sleep Deprivation

Why Sleep is So Important

Honestly, no one really understands why we sleep. Doctors can describe how we sleep in exquisite detail—the different phases of sleep, brain wave patterns, REM, and sleep cycles. However, the function of sleep—the reason why—is still largely a mystery. But we do know one important reason why we sleep. Regular sleep is essential for hormone regulation. And hormones are a big deal.

Your body releases a lot of hormones into the bloodstream during sleep

Sleep Deprivation and Hormone Imbalance

People typically associate hormones with puberty, but hormones drive most of our body’s daily functions. Hormones control cellular growth and repair, sexual development, reproduction, our stress response, hair growth, milk production, glucose levels, and metabolism to name just a few. And the command center in charge of this massive network of interdependent systems is an organ that’s about the size of a pea—the pituitary gland.

This “master gland” sends messenger signals to organs throughout the body telling them to secrete hormones for all sorts of things. For example, when the pituitary gland secretes prolactin, breast tissue starts producing breast milk. The pituitary directly influences other organs like the adrenal glands, thyroid, ovaries, and testes in similar ways.

If your body is an orchestra, the pituitary gland is the conductor

It doesn’t play the music, but it keeps the beat to make sure every instrument sounds like part of a unified symphony instead of a screaming match. Sleep matters so much because your hormone production spikes when you’re asleep. If you miss those few precious hours of rest, it can have some surprisingly negative effects on your health. And there’s one hormone in particular that can make getting a good night’s sleep really difficult.

Fight or Flight: Stress, Adrenaline, and Insomnia

One of the biggest reason you can’t get to sleep has to do with how you process stress and adrenaline. Stick with me on this.

When you experience stress—whether it’s a lion chasing you or deleting a 26-page spreadsheet before the big meeting—your body produces adrenaline. Adrenaline powers your “fight or flight response,” and in a very real sense turns you into a part-time superhero.

Adrenaline is responsible for:

      • Increasing your heart rate and blood pressure (better circulation)
      • Widening the passages of your lungs (more oxygen)
      • Dilating your pupils (more light=better vision)
      • Increasing blood glucose levels in your brain (faster/better decision making)
      • Adrenaline even reroutes blood from non-vital processes to your muscles (increased strength and endurance)

Adrenaline is amazing. It’s what gives mothers the strength to lift a Buick off of a trapped child. Unfortunately, when it comes to stress and adrenaline, your body has a one-size-fits-all approach. Real world danger and chronic stress both get the same stress response (a lot of adrenaline in your bloodstream). And there’s one other thing that adrenaline is fantastic at—keeping you awake.

Stress and Insomnia

When you experience prolonged periods of stress (aka “life in the 21st century”) your pituitary gland secretes a chemical called adrenocorticotrophic. In addition to adrenaline, this hormone triggers the release of cortisone and cortisol, which raise glucose levels making you both hungry and more alert (midnight snack, anyone?). So it’s not surprising that one study found higher levels of adrenocorticotrophic in people with insomnia than in good sleepers.

Your brain treats all stress levels equally, whether it’s fighting a lion or an missing a work deadline

Long term exposure to cortisol can also result in high blood pressure, a weakened immune system, insulin resistance, and an increased risk of developing diabetes. You’re just not supposed to operate at 100% capacity all the time, and when you do your normal sleep cycle is one of the first things to suffer.

Sleep Deprivation and Weight Gain

Sleep deprivation also wreaks havoc on your metabolism. Your thyroid produces two key hormones that regulate your appetite—ghrelin and leptin. Ghrelin increases your appetite. Leptin suppresses it. Leptin is slower acting than ghrelin, so when you don’t sleep well, leptin production dips below the faster acting ghrelin, and you wake up (and stay) hungrier. Look down at your belly and see if you notice one of the more obvious signs of sleep deprivation.

The biggest problem with ghrelin/leptin hormone imbalance is that it quickly becomes self-sustaining. Less sleep means more hunger, which leads to obesity—one of the biggest risk factors for developing sleep apnea (and another cause of sleep deprivation). As your BMI increases, you become resistant to leptin and insulin, and your risk for diabetes and high blood pressure increase. But there’s one final (important) consequence of sleep deprivation. Insomnia can be bad for your sex life.

Sleep and Testosterone

A recent study noted that after as little as one week of poor sleep can decrease testosterone levels by as much as 15%. Missing sleep—even for a few days—can give you the testosterone levels of a man decades older than you. And it’s not just about guys.

A University of Michigan study revealed that women who sleep better have increased interest in sex and also vaginal lubrication. Also, when your snoring (aka sleep apnea) keeps your partner up, her testosterone (and libido) decreases as well.

1 week of “poor sleep” can decrease testosterone levels by as much as 15%

The Importance of Sleep

The negative health impacts of sleep deprivation are widespread and fast acting. Avoiding alcohol before bed, turning off the tv and keeping phones out of the bedroom are a few simple ways to start getting a better night’s sleep. Loud snoring, waking up at night, stopping breathing while sleeping and chronic daytime fatigue are all warning signs of sleep apnea. Talk to your doctor and ask if you can order a sleep study. Your partner will thank you for it.

Geek Out: More Sleep Disorder Resources

Not enough info for you? No problem. Nerd out on sleep deprivation with research from the most trusted sources on the interwebs. If you have any questions or you think we missed something important, leave a comment or book a consultation with one of these trained professionals and we’ll get you on the way to a healthier manhood.

      • Effects of 1 Week of Sleep Restriction on Testosterone Levels in Young Healthy Men
      • The Impact of Sleep on Female Sexual Response and Behavior
      • The Association of Testosterone Sleep and Sexual Function in Men and Women
      • Sleep Deprived Men Over Perceive Women’s Sexual Interest and Intent
        Obstructive Sleep Apnea
      • Sleep apnea is an independent correlate of erectile and sexual dysfunction.
      • Sexual function in female patients with obstructive sleep apnea
      • Sleep Apnea Treatment Might Boost Mens Sex Lives

This information is not intended to be a substitute for professional medical advice, diagnosis, or treatment. It should never be relied upon for specific medical advice. If you have any questions or concerns, please talk to your doctor.

Dr. Schwindt is a board-certified Emergency Medicine physician in practice for nearly 20 years. He’s passionate about the power of technology and innovation to improve health and pursuit of proactive, functional medicine. Dr. Schwindt is an advisor to several innovative health and technology companies and part of a team expanding the role of genetic testing in delivering personalized healthcare tailored to a patient’s unique needs. He also writes widely about health and medical related topics, is a plant-based certified chef and enjoys endurance sports like triathlon and trail running.

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