Written by: LowT Center Clinical Team
Medically reviewed by: Michael Seay, MSN, APRN, FNP-BC
Posted: Oct 5, 2026
Science has long shown that the quality of your sleep and testosterone levels go hand in hand. So, it’s no mystery that long periods of poor sleep can contribute to lower testosterone levels, hormone imbalances, reduced energy, and a hefty list of other long-term health concerns.
In fact, one small JAMA study found that healthy young men restricted to five hours of sleep per night for one week experienced a 10% to 15% decrease in daytime testosterone levels.
So what does that mean for those who suffer from sleep apnea? Does sleep apnea lower testosterone too? And if so, could treating sleep apnea help restore healthy testosterone levels?
Furthermore, where might testosterone replacement therapy fit for those feeling the effects of both poor sleep and low T?
Well, it turns out recent research reveals a key connection between sleep apnea and low testosterone, including a few surprises that challenge what you might expect.
In this article, we’ll examine what the latest research actually says, including:
The short answer: yes, sleep apnea can contribute to lower testosterone, but probably not in the way many people would expect.
Researchers believe several physiological changes caused by sleep apnea may help explain why it’s associated with lower testosterone levels.
Much of your body's testosterone production occurs while you sleep, particularly during deep and REM sleep. Because sleep apnea repeatedly interrupts these stages, your body has fewer opportunities to support healthy hormone production.
Every pause in breathing temporarily reduces the amount of oxygen reaching your body. Over time, these repeated drops in oxygen may interfere with normal hormone regulation and other recovery processes that occur during sleep.
Repeated sleep interruptions place your body under ongoing physical stress. This can increase cortisol, often called the “stress hormone,” which may suppress normal testosterone production while contributing to fatigue, poor recovery, and reduced energy.
Multiple studies have found that men with obstructive sleep apnea (OSA) were more likely to have lower testosterone levels than men without the condition. These same men also tended to report symptoms commonly associated with low testosterone, including fatigue, reduced libido, erectile dysfunction, brain fog, poor concentration, and decreased energy.
For years, researchers theorized that disrupted sleep interfered with testosterone production, so treating sleep apnea should naturally help restore healthy hormone levels.
However, as larger studies followed men before and after treatment, researchers noticed something they weren’t expecting. While sleep apnea and low testosterone clearly occurred together, treating sleep apnea didn’t consistently restore testosterone levels.
That forced researchers to ask a different question: What if sleep apnea wasn’t the main cause of low testosterone?
That’s when they began to look at another factor: obesity.
Across multiple studies, excess body weight emerged as a strong predictor of both obstructive sleep apnea and lower testosterone. Rather than a simple cause-and-effect relationship, researchers believe obesity may help explain why the two so often occur together.
However, that doesn’t make sleep apnea any less significant when it comes to testosterone. Instead, it suggests that it’s one part of a larger issue involving sleep quality, body weight, metabolism, and hormone health. Improving one doesn’t necessarily resolve the others.
For years, sleep apnea received most of the attention because it was the most obvious explanation for lower testosterone, given the large impact sleep can have on maintaining healthy hormone levels.
But as it turns out, once researchers began separating the effects of sleep apnea from the effects of obesity, the relationship became much more complicated.
One example is a 2025 analysis of 12,860 adults, which found that about 76% of adults with OSA were either overweight or living with obesity. People with obesity also had nearly five times the odds of having OSA compared with adults with a BMI below 25.
Weight categories among adults with obstructive sleep apnea in a 2025 analysis of 12,860 adults.
24.1%
44.4%
31.5%
BMI Below 25
Overweight
Obesity
75.9% COMBINED
About 3 in 4 adults with OSA were overweight or living with obesity.
2025 analysis of 12,860 adults with obstructive sleep apnea.
Another study initially showed that more severe sleep apnea was directly associated with lower testosterone. However, after researchers accounted for BMI, there was no longer a correlation, suggesting that instead of sleep apnea, obesity was actually a more influential factor in testosterone levels.
Obesity’s relationship to low testosterone levels contributes to changes in metabolism, inflammation, insulin resistance, and hormone regulation. And today, obesity is also recognized as one of the strongest risk factors for obstructive sleep apnea.
In other words, obesity doesn’t just increase your risk of sleep apnea. In many cases, it may be a primary factor contributing to both sleep apnea and low testosterone.
So, rather than asking whether sleep apnea is causing low testosterone, researchers have begun asking if obesity could actually be the true influencer behind both sleep apnea and lower testosterone levels. Identifying that underlying factor can help determine what actually needs to be treated.
Knowing what we know now, the main question becomes, if obesity is often a primary factor contributing to sleep apnea and low testosterone, “Can losing weight help sleep apnea?”
The good news is that research suggests that, for many people with obesity, it can indeed.
Losing weight is a great way to address some of the physical and metabolic factors that can influence obstructive sleep apnea. This connection has become so important that weight management is now part of the medical conversation surrounding OSA.
So much so that the FDA approved tirzepatide to treat moderate to severe OSA in adults with obesity after clinical trials found significant reductions in sleep apnea events alongside substantial weight loss.
Now, it should be noted that this does not mean sleep apnea always goes away with weight loss. Sleep apnea can have several other causes, so losing weight doesn’t guarantee that OSA will go away. But for people whose obesity is contributing to their sleep apnea, weight loss can significantly improve its severity.
To double down on this concept, research has also found that weight loss in men with obesity can be associated with increases in testosterone.
If you’ve been diagnosed with obstructive sleep apnea, there’s a good chance your provider recommended a continuous positive airway pressure (CPAP) machine. CPAP works by delivering a steady stream of air through a mask to keep your airway open while you sleep, reducing breathing interruptions and helping you achieve more consistent, restorative sleep.
Once again, when larger clinical studies began comparing testosterone levels before and after CPAP treatment, more unexpected findings began to emerge.
A large meta-analysis reviewing 12 clinical studies involving 388 men found that CPAP therapy did not significantly increase testosterone levels, even among men who already had clinically low testosterone.
An earlier meta-analysis of seven studies involving 232 men reached nearly the same conclusion, suggesting that while CPAP remains highly effective for treating sleep apnea, it shouldn’t be viewed as a treatment for testosterone deficiency.
The research simply reminds us that better breathing doesn’t automatically mean higher testosterone.
If symptoms such as fatigue, low libido, brain fog, poor recovery, or reduced motivation continue despite successful CPAP treatment, the next step may be to evaluate whether imbalanced hormone levels are a contributing factor.
Losing weight may improve sleep apnea and support healthier natural testosterone levels. CPAP can address breathing interruptions and improve sleep. But neither guarantees solutions for clinically low testosterone levels.
That’s where testosterone replacement therapy might be a more viable option for those who still have low testosterone.
For men who continue to experience symptoms and are diagnosed with testosterone deficiency, TRT can be another way to restore testosterone levels and improve low T symptoms, including low energy, low libido, sexual function, and overall well-being. TRT can also reduce fat mass and increase lean mass, although it should support, not replace, weight management.
Ultimately, the research doesn’t point toward one treatment that fixes everything. It points toward understanding what’s actually contributing to the problem.
For one person, obesity may be a major factor driving both sleep apnea and lower testosterone. For another, severe sleep apnea may independently contribute to lower T. And for someone with clinically diagnosed testosterone deficiency, treating the sleep apnea or losing weight may still not completely resolve their hormone levels or symptoms.
That’s why addressing your weight, sleep, and hormone health with a more holistic approach can provide a much better solution than assuming one condition is responsible for everything.
Disclaimer: This article is made available for general, entertainment and educational purposes only. The opinions expressed herein do not necessarily reflect those of Low T Center. You should always seek the advice of a licensed healthcare professional.
