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Testosterone and Disordered Sleep

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Controversies in Testosterone Deficiency

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Abstract

Disordered sleep may be insufficient, misaligned, or disrupted and is known to adversely impact cardiometabolic health. The effect of insufficient, misaligned, or disrupted sleep on andrological health – including hypogonadism and systemic testosterone exposure, fertility, and erectile function – is only now becoming recognized. Restricting sleep decreases overall mean 24-hour blood testosterone concentrations, and lower sleep duration is associated with smaller testicular volumes and reduced sperm concentrations. Misaligned sleep due to night shift work does not alter overall systemic testosterone levels, but it does shift the diurnal rise in testosterone to coincide with the timing of sleep irrespective of whether sleep occurs during the day or during the night. Accordingly, testosterone should be measured in blood soon after awakening, not necessarily in the early morning, to assess hypogonadism in shift workers. Disrupted sleep due to obstructive sleep apnea (OSA) is associated with low blood testosterone concentrations, symptoms of hypogonadism, and erectile dysfunction. Adherent continuous positive airway pressure (CPAP) treatment of OSA improves erectile function and some symptoms of hypogonadism and may also increase testosterone levels. On the other hand, testosterone therapy may induce or worsen OSA, but any possible effects are moderate in degree and these effects may not persist with longer term, more physiological replacement therapy. Longer-term interventional studies in larger cohorts are required to better understand the complex relationship between disordered sleep and andrological health, and to document its reversibility.

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References

  1. Dijk DJ. Regulation and functional correlates of slow wave sleep. J Clin Sleep Med. 2009;5(2 Suppl):S6–15.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Tasali E, Leproult R, Ehrmann DA, Van Cauter E. Slow-wave sleep and the risk of type 2 diabetes in humans. Proc Natl Acad Sci U S A. 2008;105(3):1044–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  3. Institute of Medicine (IOM). In: Colten HR, Altevogt BM, editors. Sleep disorders and sleep deprivation: an unmet public health problem. The National Academies Collection: reports funded by National Institutes of Health. Washington, DC: National Academies of Science; 2006.

    Google Scholar 

  4. Luboshitzky R, Zabari Z, Shen-Orr Z, Herer P, Lavie P. Disruption of the nocturnal testosterone rhythm by sleep fragmentation in normal men. J Clin Endocrinol Metab. 2001;86(3):1134–9.

    Article  CAS  PubMed  Google Scholar 

  5. Gonnissen HK, Hursel R, Rutters F, Martens EA, Westerterp-Plantenga MS. Effects of sleep fragmentation on appetite and related hormone concentrations over 24 h in healthy men. Br J Nutr. 2013;109(4):748–56. https://doi.org/10.1017/S0007114512001894.

    Article  CAS  PubMed  Google Scholar 

  6. Hirshkowitz M, Whiton K, Albert SM, Alessi C, Bruni O, DonCarlos L, et al. National Sleep Foundation’s sleep time duration recommendations: methodology and results summary. Sleep Health. 2015;1(1):40–3. https://doi.org/10.1016/j.sleh.2014.12.010.

    Article  PubMed  Google Scholar 

  7. Liu Y, Wheaton AG, Chapman DP, Cunningham TJ, Lu H, Croft JB. Prevalence of healthy sleep duration among adults — United States, 2014. Morb Mortal Wkly Rep. 2016;65:137–41. https://doi.org/10.15585/mmwr.mm6506a1.

    Article  Google Scholar 

  8. Liu PY. A clinical perspective of sleep and andrological health: assessment, treatment considerations and future research. J Clin Endocrinol Metab. 2019;104(10):4398–417. https://doi.org/10.1210/jc.2019-00683.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Luboshitzky R, Lavi S, Thuma I, Lavie P. Testosterone treatment alters melatonin concentrations in male patients with gonadotropin-releasing hormone deficiency. J Clin Endocrinol Metab. 1996;81(2):770–4.

    CAS  PubMed  Google Scholar 

  10. Schmid SM, Hallschmid M, Jauch-Chara K, Lehnert H, Schultes B. Sleep timing may modulate the effect of sleep loss on testosterone. Clin Endocrinol. 2012;77(5):749–54. https://doi.org/10.1111/j.1365-2265.2012.04419.x.

    Article  CAS  Google Scholar 

  11. Leproult R, Van Cauter E. Effect of 1 week of sleep restriction on testosterone levels in young healthy men. J Am Med Assoc. 2011;305(21):2173–4. https://doi.org/10.1001/jama.2011.710.

    Article  Google Scholar 

  12. Reynolds AC, Dorrian J, Liu PY, Van Dongen HPA, Wittert GA, Harmer LJ, et al. Impact of five nights of sleep restriction on glucose metabolism, leptin and testosterone in young adult men. PLoS One. 2012;7(7):e41218. https://doi.org/10.1371/journal.pone.0041218.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  13. Liu PY, Takahashi PY, Yang RJ, Iranmanesh A, Veldhuis JD. Age and time-of-day differences in the hypothalamo-pituitary-testicular, and adrenal, response to total overnight sleep deprivation. Sleep. 2020;43(7):zsaa008. https://doi.org/10.1093/sleep/zsaa008.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Liu PY, Takahashi P, Nehra A, Pincus SM, Keenan DM, Veldhuis JD. Neuroendocrine aging: pituitary–gonadal axis in males. In: Editor-in-Chief: Larry RS, editor. Encyclopedia of neuroscience. Oxford: Academic Press; 2009. p. 317–26.

    Google Scholar 

  15. Wise LA, Rothman KJ, Wesselink AK, Mikkelsen EM, Sorensen HT, McKinnon CJ, et al. Male sleep duration and fecundability in a North American preconception cohort study. Fertil Steril. 2018;109(3):453–9. https://doi.org/10.1016/j.fertnstert.2017.11.037.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Jensen TK, Andersson AM, Skakkebaek NE, Joensen UN, Blomberg Jensen M, Lassen TH, et al. Association of sleep disturbances with reduced semen quality: a cross-sectional study among 953 healthy young Danish men. Am J Epidemiol. 2013;177(10):1027–37. https://doi.org/10.1093/aje/kws420.

    Article  PubMed  Google Scholar 

  17. Chen Q, Yang H, Zhou N, Sun L, Bao H, Tan L, et al. Inverse U-shaped Association between sleep duration and semen quality: longitudinal observational study (MARHCS) in Chongqing, China. Sleep. 2016;39(1):79–86. https://doi.org/10.5665/sleep.5322.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  18. Wang X, Chen Q, Zou P, Liu T, Mo M, Yang H, et al. Sleep duration is associated with sperm chromatin integrity among young men in Chongqing, China. J Sleep Res. 2018;27(4):e12615. https://doi.org/10.1111/jsr.12615.

    Article  PubMed  Google Scholar 

  19. Alvarenga TA, Hirotsu C, Mazaro-Costa R, Tufik S, Andersen ML. Impairment of male reproductive function after sleep deprivation. Fertil Steril. 2015;103(5):1355–62 e1. https://doi.org/10.1016/j.fertnstert.2015.02.002.

    Article  PubMed  Google Scholar 

  20. Choi JH, Lee SH, Bae JH, Shim JS, Park HS, Kim YS, et al. Effect of sleep deprivation on the male reproductive system in rats. J Korean Med Sci. 2016;31(10):1624–30. https://doi.org/10.3346/jkms.2016.31.10.1624.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  21. Rizk NI, Rizk MS, Mohamed AS, Naguib YM. Attenuation of sleep deprivation dependent deterioration in male fertility parameters by vitamin C. Reprod Biol Endocrinol. 2020;18(1):2. https://doi.org/10.1186/s12958-020-0563-y.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  22. Zhang W, Piotrowska K, Chavoshan B, Wallace J, Liu PY. Sleep duration is associated with testis size in healthy young men. J Clin Sleep Med. 2018;14(10):1757–64.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Reppert SM, Weaver DR. Coordination of circadian timing in mammals. Nature. 2002;418(6901):935–41. https://doi.org/10.1038/nature00965.

    Article  CAS  PubMed  Google Scholar 

  24. Welsh DK, Takahashi JS, Kay SA. Suprachiasmatic nucleus: cell autonomy and network properties. Annu Rev Physiol. 2010;72:551–77. https://doi.org/10.1146/annurev-physiol-021909-135919.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  25. James SM, Honn KA, Gaddameedhi S, Van Dongen HPA. Shift work: disrupted circadian rhythms and sleep-implications for health and well-being. Curr Sleep Med Rep. 2017;3(2):104–12. https://doi.org/10.1007/s40675-017-0071-6.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Bisanti L, Olsen J, Basso O, Thonneau P, Karmaus W. Shift work and subfecundity: a European multicenter study. European Study Group on Infertility and Subfecundity. J Occup Environ Med. 1996;38(4):352–8.

    Article  CAS  PubMed  Google Scholar 

  27. Sheiner EK, Sheiner E, Carel R, Potashnik G, Shoham-Vardi I. Potential association between male infertility and occupational psychological stress. J Occup Environ Med. 2002;44(12):1093–9.

    Article  PubMed  Google Scholar 

  28. Tuntiseranee P, Olsen J, Geater A, Kor-anantakul O. Are long working hours and shiftwork risk factors for subfecundity? A study among couples from Southern Thailand. Occup Environ Med. 1998;55(2):99–105.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  29. Irgens A, Kruger K, Ulstein M. The effect of male occupational exposure in infertile couples in Norway. J Occup Environ Med. 1999;41(12):1116–20.

    Article  CAS  PubMed  Google Scholar 

  30. Eisenberg ML, Chen Z, Ye A, Buck Louis GM. Relationship between physical occupational exposures and health on semen quality: data from the Longitudinal Investigation of Fertility and the Environment (LIFE) Study. Fertil Steril. 2015;103(5):1271–7. https://doi.org/10.1016/j.fertnstert.2015.02.010.

    Article  PubMed  PubMed Central  Google Scholar 

  31. Pastuszak AW, Moon YM, Scovell J, Badal J, Lamb DJ, Link RE, et al. Poor sleep quality predicts hypogonadal symptoms and sexual dysfunction in male nonstandard shift workers. Urology. 2017;102:121–5. https://doi.org/10.1016/j.urology.2016.11.033.

    Article  PubMed  Google Scholar 

  32. Jensen MA, Hansen AM, Kristiansen J, Nabe-Nielsen K, Garde AH. Changes in the diurnal rhythms of cortisol, melatonin, and testosterone after 2, 4, and 7 consecutive night shifts in male police officers. Chronobiol Int. 2016;33(9):1–13. https://doi.org/10.1080/07420528.2016.1212869.

    Article  CAS  Google Scholar 

  33. Smith AM, Morris P, Rowell KO, Clarke S, Jones TH, Channer KS. Junior doctors and the full shift rota – psychological and hormonal changes: a comparative cross-sectional study. Clin Med (Lond). 2006;6(2):174–7.

    Article  CAS  Google Scholar 

  34. Touitou Y, Motohashi Y, Reinberg A, Touitou C, Bourdeleau P, Bogdan A, et al. Effect of shift work on the night-time secretory patterns of melatonin, prolactin, cortisol and testosterone. Eur J Appl Physiol Occup Physiol. 1990;60(4):288–92.

    Article  CAS  PubMed  Google Scholar 

  35. Papantoniou K, Pozo OJ, Espinosa A, Marcos J, Castano-Vinyals G, Basagana X, et al. Increased and mistimed sex hormone production in night shift workers. Cancer Epidemiol Biomark Prev. 2015;24(5):854–63. https://doi.org/10.1158/1055-9965.EPI-14-1271.

    Article  CAS  Google Scholar 

  36. Axelsson J, Ingre M, Akerstedt T, Holmback U. Effects of acutely displaced sleep on testosterone. J Clin Endocrinol Metab. 2005;90(8):4530–5.

    Article  CAS  PubMed  Google Scholar 

  37. Bhasin S, Brito JP, Cunningham GR, Hayes FJ, Hodis HN, Matsumoto AM, et al. Testosterone therapy in men with hypogonadism: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2018;103(5):1715–44. https://doi.org/10.1210/jc.2018-00229.

    Article  PubMed  Google Scholar 

  38. Peppard PE, Young T, Barnet JH, Palta M, Hagen EW, Hla KM. Increased prevalence of sleep-disordered breathing in adults. Am J Epidemiol. 2013;177(9):1006–14. https://doi.org/10.1093/aje/kws342.

    Article  PubMed  PubMed Central  Google Scholar 

  39. Drager LF, McEvoy RD, Barbe F, Lorenzi-Filho G, Redline S, Initiative I. Sleep apnea and cardiovascular disease: lessons from recent trials and need for team science. Circulation. 2017;136(19):1840–50. https://doi.org/10.1161/CIRCULATIONAHA.117.029400.

    Article  PubMed  PubMed Central  Google Scholar 

  40. Melehan KL, Hoyos CM, Hamilton GS, Wong KK, Yee BJ, McLachlan RI, et al. Randomised trial of CPAP and vardenafil on erectile and arterial function in men with obstructive sleep apnea and erectile dysfunction. J Clin Endocrinol Metab. 2018;103(4):1601–11. https://doi.org/10.1210/jc.2017-02389.

    Article  PubMed  PubMed Central  Google Scholar 

  41. Torres M, Laguna-Barraza R, Dalmases M, Calle A, Pericuesta E, Montserrat JM, et al. Male fertility is reduced by chronic intermittent hypoxia mimicking sleep apnea in mice. Sleep. 2014;37(11):1757–65. https://doi.org/10.5665/sleep.4166.

    Article  PubMed  PubMed Central  Google Scholar 

  42. Cignarelli A, Castellana M, Castellana G, Perrini S, Brescia F, Natalicchio A, et al. Effects of CPAP on testosterone levels in patients with obstructive sleep apnea: a meta-analysis study. Front Endocrinol (Lausanne). 2019;10:551. https://doi.org/10.3389/fendo.2019.00551.

    Article  Google Scholar 

  43. Hoekema A, Stel AL, Stegenga B, van der Hoeven JH, Wijkstra PJ, van Driel MF, et al. Sexual function and obstructive sleep apnea-hypopnea: a randomized clinical trial evaluating the effects of oral-appliance and continuous positive airway pressure therapy. J Sex Med. 2007;4(4 Pt 2):1153–62.

    Article  PubMed  Google Scholar 

  44. Meston N, Davies RJ, Mullins R, Jenkinson C, Wass JA, Stradling JR. Endocrine effects of nasal continuous positive airway pressure in male patients with obstructive sleep apnoea. J Intern Med. 2003;254(5):447–54.

    Article  CAS  PubMed  Google Scholar 

  45. Luboshitzky R, Lavie L, Shen-Orr Z, Lavie P. Pituitary-gonadal function in men with obstructive sleep apnea. The effect of continuous positive airways pressure treatment. Neuroendocrinol Lett. 2003;24(6):463–7.

    PubMed  Google Scholar 

  46. Santamaria JD, Prior JC, Fleetham JA. Reversible reproductive dysfunction in men with obstructive sleep apnea. Clin Endocrinol. 1988;28:461–70.

    Article  CAS  Google Scholar 

  47. Liu PY, Yee BJ, Wishart SM, Jimenez M, Jung DG, Grunstein RR, et al. The short-term effects of high dose testosterone on sleep, breathing and function in older men. J Clin Endocrinol Metab. 2003;88(8):3605–13.

    Article  CAS  PubMed  Google Scholar 

  48. Schneider BK, Pickett CK, Zwillich CW, Weil JV, McDermott MT, Santen RJ, et al. Influence of testosterone on breathing during sleep. J Appl Physiol. 1986;61:618–23.

    Article  CAS  PubMed  Google Scholar 

  49. Snyder PJ, Peachey H, Hannoush P, Berlin JA, Loh L, Holmes JH, et al. Effect of testosterone treatment on bone mineral density in men over 65 years of age. J Clin Endocrinol Metab. 1999;84(6):1966–72.

    CAS  PubMed  Google Scholar 

  50. Hoyos CM, Killick R, Yee BJ, Grunstein RR, Liu PY. Effects of testosterone therapy on sleep and breathing in obese men with severe obstructive sleep apnea: a randomised placebo-controlled trial. Clin Endocrinol. 2012;77:599–607. https://doi.org/10.1111/j.1365-2265.2012.04413.x.

    Article  CAS  Google Scholar 

  51. Killick R, Wang D, Hoyos CM, Yee BJ, Grunstein RR, Liu PY. The effects of testosterone on ventilatory responses in men with obstructive sleep apnoea: a randomized placebo-controlled trial. J Sleep Res. 2013;22:331–6.

    Article  PubMed  Google Scholar 

  52. Matsumoto A, Sandblom RE, Schoene RB, Lee KA, Giblin EC, Pierson DJ, et al. Testosterone replacement in hypogonadal men: effects on obstructive sleep apnea, respiratory drives and sleep. Clin Endocrinol. 1985;22:713–21.

    Article  CAS  Google Scholar 

  53. Calof OM, Singh AB, Lee ML, Kenny AM, Urban RJ, Tenover JL, et al. Adverse events associated with testosterone replacement in middle-aged and older men: a meta-analysis of randomized, placebo-controlled trials. J Gerontol A Biol Sci Med Sci. 2005;60(11):1451–7.

    Article  PubMed  Google Scholar 

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Author information

Authors and Affiliations

  1. Division of Endocrinology, Department of Medicine, The Lundquist Institute at Harbor-UCLA Medical Center, Torrance, CA, USA

    Fiona Yuen, Danya Waqfi & Peter Y. Liu

  2. Department of Graduate Medical Education, St. Mary Medical Center, Long Beach, CA, USA

    Bahman Chavoshan

  3. David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA

    Bahman Chavoshan & Peter Y. Liu

  4. David Geffen School of Medicine at UCLA, Division of Endocrinology and Metabolism, Department of Medicine, Harbor UCLA Medical Center and Los Angeles Biomedical Research Institute, Torrance, CA, USA

    Peter Y. Liu

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  1. Fiona Yuen
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  2. Bahman Chavoshan
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  3. Danya Waqfi
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  4. Peter Y. Liu
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Correspondence to Peter Y. Liu .

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Editors and Affiliations

  1. Department of Urology, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    John P. Mulhall

  2. Endocrinology, University of Firenze, Firenze, Firenze, Italy

    Mario Maggi

  3. Male Fertility and Peyronie’s Clinic, Orem, UT, USA

    Landon Trost

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Yuen, F., Chavoshan, B., Waqfi, D., Liu, P.Y. (2021). Testosterone and Disordered Sleep. In: Mulhall, J.P., Maggi, M., Trost, L. (eds) Controversies in Testosterone Deficiency . Springer, Cham. https://doi.org/10.1007/978-3-030-77111-9_5

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