The sleep-testosterone link

Low testosterone levels can make you feel tired, and sleep affects your hormone levels

By Heidi Borst | Mar. 26, 2024 Medically reviewed by Nicolle Melendez, PA-C

Key takeaways

Lack of sleep impacts testosterone levels, which are linked to sleep quality.
You can naturally improve testosterone levels by improving sleep hygiene, maintaining a healthy weight, exercising regularly, and eating a balanced diet.
TRT may be considered in individuals with low testosterone levels who don’t improve with lifestyle changes.
While the specific ways TRT impacts sleep varies by the individual, high-dose testosterone replacement therapy might exacerbate sleep problems.

Testosterone replacement therapy (TRT) is a buzzing topic in men’s health. If you have low testosterone levels—also known as hypogonadism—TRT may balance your hormones and improve your overall well-being. But experts say TRT does not come without risks. First-line treatment of low testosterone should always be lifestyle modifications. Changes like consuming a healthy diet, getting regular exercise, practicing stress-reduction techniques, and logging sufficient sleep can raise testosterone levels naturally (and significantly!).

The time you spend asleep, in particular, can have a profound effect on testosterone production and vice versa. Read on to learn about the link between testosterone and sleep, how to improve your sleep quality for better testosterone production, and the effect of TRT on sleep.

The relationship between sleep and testosterone

Getting a good night’s sleep is very important for maintaining healthy testosterone levels, says Raj Dasgupta, MD, the chief medical adviser for Sleep Advisor. Testosterone levels are typically highest in the morning and decline throughout the day.

Sleep cycle impacts testosterone production

To understand the circadian rhythm of testosterone, it’s important to address the various sleep stages. Sleep can be broken into two parts: non-rapid eye movement (non-REM or NREM) sleep and rapid eye movement (REM) sleep. It’s typical to cycle through these stages of sleep four to six times each night. There are three stages of non-REM sleep and one stage of REM sleep:

Stage 1 NREM: This is the lightest stage of sleep, lasting about five minutes after you fall asleep. It constitutes about 5% of your total sleep time.
Stage 2 NREM: You spend the most time (about 45%) in this phase. It’s still considered a lighter stage of sleep, but your brain waves slow down. Experts believe the brain organizes and stores information from the day during stage 2 NREM sleep.
Stage 3 NREM: The deepest stage of sleep, stage 3 NREM, makes up approximately 25% of your total sleep time. During this time, your body repairs injuries and restores the immune system.
REM sleep: The dream phase of sleep, REM sleep is a more active form of sleep. Brain activity is operating at a level similar to when you’re awake. REM sleep constitutes about 25% of your total sleep.

“The deepest stage of sleep is called slow-wave sleep. This stage—along with REM sleep—plays a role in the production of testosterone,” Dr. Dasgupta says. He explains that your testosterone levels could drop if you consistently miss out on high-quality sleep (including deep sleep and REM cycles).

One study examined how sleep impacts testosterone levels in young, healthy men. It found that testosterone levels began to rise as they fell asleep, peaking during their first period of REM sleep and remaining at that level until they woke up. “The longer it took to get to REM sleep, the slower their rise in testosterone was,” says Ramkishen Narayanan, MD, board-certified urologist and Director of the Center for Urologic Health at The Roy and Patricia Disney Family Cancer Center at Providence Saint Joseph Medical Center in Burbank, California.

Because research is limited, the specific mechanism by which sleep affects testosterone has yet to be established, says Dr. Narayanan. However, he points out that both REM sleep and testosterone play an important role in cognitive function. “We know that men who are depleted in testosterone have higher risks of poor cognition and dementia,” he says, adding that because testosterone is so vital to cognition, it makes sense that testosterone peaks during REM sleep.

Sleep duration affects testosterone levels

“Low sleep duration is associated with lower morning, afternoon, and total testosterone levels,” agrees Dr. Narayanan. In other words, getting less than the recommended seven to nine hours of sleep nightly results in lower testosterone levels during the day, he says. A study found that healthy young men who underwent sleep restriction (five hours nightly) experienced a 10% to 15% decrease in daytime serum testosterone levels.

Low T impairs sleep

Just as not getting enough sleep can lower testosterone, having low testosterone levels can impair sleep, says Dr. Dasgupta. “Low testosterone (low T) can make you feel more tired and fatigued and disrupt your sleep by making it hard to stay asleep, resulting in multiple awakenings throughout the night,” he says.

According to Alex Dimitriu, MD, a double board-certified psychiatrist and sleep medicine specialist, and founder of Menlo Park Psychiatry & Sleep Medicine, symptoms of low testosterone include:

Decreased sex drive
Erectile dysfunction
Reduced muscle mass
Fatigue
Low motivation
Mood variability, including depression

How testosterone affects sleep quality

Both men and women have testosterone (an androgen, or sex hormone), says Dr. Dasgupta. The hormone is produced by endocrine glands—the testicles, ovaries, and adrenal glands. In women, it is converted to estrogen. Men and women with low testosterone have changes in their sleep quality and quantity, says Dr. Dimitriu.

According to research, older men with low testosterone had lower sleep efficiency, more awakenings, and less time in slow-wave sleep. The study found low testosterone was linked to a higher body mass index (BMI). A higher BMI is an indicator of obesity, and obesity is strongly associated with sleep apnea. Sleep disorders like obstructive sleep apnea (a form of sleep-disordered breathing) or chronic insomnia may lead to lower testosterone levels, says Dr. Dasgupta. “Having low testosterone might also contribute to the development or worsening of these disorders, possibly creating a reciprocal relationship between hormonal balance and the quality of your sleep,” he says.

Low testosterone affects sleep quality in women as well. After menopause, the level of testosterone in women may have decreased by half. Low testosterone in postmenopausal women can cause poor sleep, fatigue, vaginal dryness, and thinning hair.

Dr. Narayanan says that apart from unhealthy sleep habits, sleep disorders are the most significant clinical disruptors of sleep. What’s more, obstructive sleep apnea, obesity, and low testosterone frequently occur together, he says. So while low testosterone doesn’t directly cause obstructive sleep apnea, it can play a role in airway obstruction while you’re asleep, Dr. Dasgupta says.

How to promote healthy sleep hygiene

“Sleep loves silence, darkness, coolness, and rhythm,” says Dr. Dimitriu. This means having a regular bedtime and wake time and getting the recommended seven to nine hours of sleep in a cool, dark setting. Spending time outdoors, avoiding television before bedtime, and showering at night may also be helpful to improve sleep hygiene.

If you’re struggling with sleep, Dr. Narayanan recommends seeing a sleep specialist for a sleep study. That way, you can get tested for sleep disorders like sleep apnea. Sleep apnea is when your breathing stops repeatedly during sleep resulting in your body not receiving enough oxygen. Unfortunately, having sleep apnea doubles your risk of having a heart attack or a stroke. Treatment is essential for patients diagnosed with the condition—often, this means wearing a breathing device like a continuous positive airway pressure (CPAP) mask while sleeping. As a bonus, improving your sleep and avoiding sleep loss can help manage chronic health conditions like hypertension, Type 2 diabetes, obesity, cardiovascular disease, and depression.

Other important lifestyle changes include:

Weight loss and maintaining a healthy weight
Regular physical activity
Limiting alcohol and caffeine
Quitting smoking
Having good sleep hygiene

Once factors like weight and sleep apnea are addressed in individuals with low testosterone, they can consider testosterone replacement, says Dr. Narayanan.

Can Testosterone Replacement Therapy improve sleep?

The effect of testosterone replacement therapy (TRT) on sleep is understudied. TRT may help improve sleep for some people with testosterone deficiency, but it doesn’t work the same way for everyone, and more research is needed to confirm this effect, says Dr. Dasgupta.

Some research indicates that TRT benefits energy levels, mood, sexual function, lean body mass, muscle strength, bone mineral density (BMD), cognition, and cardiovascular health. This may result in healthier habits that translate to better sleep, Dr. Narayanan says.

However, some evidence indicates that high doses of TRT can cause insomnia and sleep fragmentation. Yet, Dr. Dasgupta reiterates that TRT can affect people differently, so it’s important to talk to your healthcare provider if you notice any significant changes in your sleep after starting TRT treatment.

The bottom line: Lifestyle changes can improve low T

Good sleep habits, stress-reduction techniques, regular exercise, eating a healthy diet, and maintaining a healthy weight can boost your endogenous (naturally produced) testosterone levels, says Dr. Narayanan. He emphasizes the importance of working on these habits and seeking treatment for sleep disorders before starting testosterone replacement treatment.

“Getting good sleep and having the right amount of testosterone is important to feel your best, physically and mentally,” Dr. Dasgupta adds. It’s very much a symbiotic relationship—good sleep helps testosterone levels, and having enough testosterone helps you stay healthy.