World Journal of Urology

, Volume 37, Issue 7, pp 1449–1453 | Cite as

Impaired sleep is associated with low testosterone in US adult males: results from the National Health and Nutrition Examination Survey

  • Premal Patel
  • Benjamin Shiff
  • Taylor P. Kohn
  • Ranjith RamasamyEmail author
Original Article



Testosterone deficiency has been linked to several adverse health outcomes and recent data have suggested that abnormal sleep quality may result in lower testosterone levels. We assessed the effect of self-reported sleep patterns on serum testosterone while controlling for co-morbidities, and baseline demographics.

Materials and methods

Using data collected from the 2011–2012 National Health and Nutrition Examination Survey (NHANES), we extracted serum total testosterone level, sleep duration, demographic, and co-morbidities for men aged 16 years and older. Univariate and multivariate linear regression was used to estimate the association of number of hours slept, co-morbidities, and demographics with serum testosterone.


Among the 9756 individuals in the NHANES dataset, 2295 (23.5%) were males 16 years and older with a median (interquartile range) age of 46 years (29–62) who also had serum testosterone levels drawn. Median serum testosterone level was 377 ng/dL (IQR: 279–492 ng/dL). Median number of hours slept was 7 h (IQR: 6–8 h). On multivariate linear regression, we found serum testosterone decreased by 0.49 ng/dL per year of age (p = 0.04), 5.85 ng/dL per hour loss of sleep (p < 0.01) and 6.18 ng/dL per unit of body mass index (BMI) increase (p < 0.01).


Among men aged 16–80 in the United States, we found increasing age, impaired sleep and elevated BMI is associated with low testosterone. It is important, therefore, that evaluation and treatment of reduced serum testosterone should also include improving sleep duration in combination with weight management.


Sleep Testosterone National Health and Nutrition Examination Survey Male Hormones 


Author contributions

Protocol/project development: PP, TK, RR. Data collection or management: PP, TK. Data analysis: PP, TK. Manuscript writing/editing: PP, BS, TK, RR.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Premal Patel
    • 1
  • Benjamin Shiff
    • 2
  • Taylor P. Kohn
    • 3
  • Ranjith Ramasamy
    • 1
    Email author
  1. 1.Department of UrologyUniversity of Miami Miller School of MedicineMiamiUSA
  2. 2.Section of UrologyUniversity of ManitobaWinnipegCanada
  3. 3.Johns Hopkins UniversityBaltimoreUSA

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