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



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.

This is a preview of subscription content, log in to check access.


  1. 1.

    Watson NF, Badr MS, Belenky G et al (2015) Joint consensus statement of the american academy of sleep medicine and sleep research society on the recommended amount of sleep for a healthy adult: methodology and discussion. Sleep 11:931–952

    Google Scholar 

  2. 2.

    Short Sleep Duration Among US Adults. Published 2017. Accessed 7 Mar 2018

  3. 3.

    Ford ES, Cunningham TJ, Croft JB (2015) Trends in self-reported sleep duration among US adults from 1985 to 2012. Sleep 38:829–883

    Article  PubMed  PubMed Central  Google Scholar 

  4. 4.

    Reutrakul S, Van Cauter E (2018) Sleep influences on obesity, insulin resistance, and risk of type 2 diabetes. Elsevier Inc

  5. 5.

    Cappuccio FP, Cooper D, Delia L et al (2011) Sleep duration predicts cardiovascular outcomes: a systematic review and meta-analysis of prospective studies. Eur Heart J 32:1484–1492

    Article  PubMed  Google Scholar 

  6. 6.

    Cappuccio FP, D’Elia L, Strazzullo P et al (2010) Sleep duration and all-cause mortality: a systematic review and meta-analysis of prospective studies. Sleep 33:585–592

    Article  PubMed  PubMed Central  Google Scholar 

  7. 7.

    Dray F, Reinberg A, Sebaoun J (1965) Biological rhythm of plasma free testosterone in healthy adult males: existence of a circadian variation. C R Hebd Seances Acad Sci 261:573–576

    CAS  Google Scholar 

  8. 8.

    Evans J, MacLean A, Ismail A et al (1971) Concentrations of plasma testosterone in normal men during sleep. Nature 229:261–262

    Article  CAS  PubMed  Google Scholar 

  9. 9.

    Leproult R, Van Cauter E (2011) Effect of 1 week of sleep restriction on testosterone levels in young healthy men. JAMA 305:2173–2174

    Article  PubMed  PubMed Central  Google Scholar 

  10. 10.

    Schmid SM, Hallschmid M, Jauch-Chara K et al (2012) Sleep timing may modulate the effect of sleep loss on testosterone. Clin Endocrinol (Oxf) 77:749–754

    Article  CAS  Google Scholar 

  11. 11.

    Arnal PJ, Drogou C, Sauvet F et al (2016) Effect of sleep extension on the subsequent testosterone, cortisol and prolactin responses to total sleep deprivation and recovery. J Neuroendocrinol 28:12346

    Article  CAS  PubMed  Google Scholar 

  12. 12.

    Abu-samak MS, Mohammad BA, Abu-taha MI et al (2018) Associations between sleep deprivation and salivary testosterone levels in Male University students : a prospective cohort study. Am J Mens Health. 12:411–419

    Article  PubMed  Google Scholar 

  13. 13.

    McQuillan GM, McLean JE, Chiappa M et al (2015) National Health and Nutrition Examination Survey Biospecimen Program: nHANES III (1988–1994) and NHANES 1999–2014. Vital Health Stat 2(170):1–14

    Google Scholar 

  14. 14.

    Ritchey J, Zhang H, Karmaus et al (2014) Linearity asssessment methods for sex steroid hormones and carrier proteins among men in the National Health and Nutritional Examination Survey (NHANES III). Steroids 82:23–28

    Article  CAS  PubMed  Google Scholar 

  15. 15.

    R Core Team (2014). R: A language and environment for statistical computing. R Foundation for Statistical Computing, Vienna Austria. Accessed 1 Sep 2017

  16. 16.

    Cooke RR, McIntosh JE, McIntosh RP (1993) Circadian variation in serum free and non-SHBG-bound testosterone in normal men: measurements, and simulation using a mass action model. Clin Endocrinol 39:163–171

    Article  CAS  Google Scholar 

  17. 17.

    Luboshitzky R, Herer P, Levi M et al (1999) Relationship between rapid eye movement sleep and testosterone secretion in normal men. J Androl 20:731–737

    CAS  PubMed  Google Scholar 

  18. 18.

    Luboshitzky R, Zabari Z, Shen-Orr Z et al (2001) Disruption of the nocturnal testosterone rhythm by sleep fragmentation in normal men. J Clin Endocrinol Metab 86:1134–1139

    Article  CAS  PubMed  Google Scholar 

  19. 19.

    Harman SM, Metter EJ, Tobin JD et al (2001) Longitudinal effects of aging on serum total and free testosterone levels in healthy men. J Clin Endocrinol Metab 86:724–731

    Article  CAS  PubMed  Google Scholar 

  20. 20.

    Feldman HA, Longcope C, Derby CA et al (2002) Age trends in the level of serum testosterone and other hormones in middle-aged men: longitudinal results from the Massachusetts male aging study. J Clin Endocrinol Metab 87:589–598

    Article  CAS  Google Scholar 

  21. 21.

    Wu FCW, Tajar A, Pye SR et al (2008) Hypothalamic-pituitary-testicular axis disruptions in older men are differentially linked to age and modifiable risk factors: the European male aging study. J Clin Endocrinol Metab 93:2737–2745

    Article  CAS  Google Scholar 

  22. 22.

    Yeap BB, Knuiman MW, Divitini ML et al (2014) Differential associations of testosterone, dihydrotestosterone and oestradiol with physical, metabolic and health-related factors in community-dwelling men aged 17–97 years from the Busselton Health Survey. Clin Endocrinol (Oxf) 81:100–108

    Article  CAS  Google Scholar 

  23. 23.

    Eriksson J, Haring R, Grarup N et al (2017) Causal relationship between obesity and serum testosterone status in men: a bidirectional mendelian randomization analysis. PLoS One 12:1–15

    Google Scholar 

  24. 24.

    Maneesh M, Dutta S, Chakrabarti A et al (2006) Alcohol abuse-duration dependent decrease in plasma testosterone and antioxidants in males. Indian J Physiol Pharmacol 50:291–296

    CAS  PubMed  Google Scholar 

  25. 25.

    Castilla-Garcia A, Santolaria-Fernandez F, Gonzalez-Reimers C et al (1987) Alcohol-induced hypogonadism: reversal after ethanol withdrawal. Drug Alcohol Depend 20:255–260

    Article  CAS  PubMed  Google Scholar 

  26. 26.

    Sierksma A, Sarkola T, Eriksson CJP et al (2004) Effect of moderate alcohol consumption on plasma dehydroepiandrosterone sulfate, testosterone, and estradiol levels in middle-aged men and postmenopausal women: a diet-controlled intervention study. Alcohol Clin Exp Res 28:780–785

    Article  CAS  PubMed  Google Scholar 

Download references

Author information




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

Corresponding author

Correspondence to Ranjith Ramasamy.

Ethics declarations

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.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Patel, P., Shiff, B., Kohn, T.P. et al. Impaired sleep is associated with low testosterone in US adult males: results from the National Health and Nutrition Examination Survey. World J Urol 37, 1449–1453 (2019).

Download citation


  • Sleep
  • Testosterone
  • National Health and Nutrition Examination Survey
  • Male
  • Hormones