When an individual’s testosterone levels are low, their doctor may prescribe medication, recommend supplementation, or even start them on testosterone replacement therapy. But sometimes, the Rx they really need is Zzz’s.
Not getting enough sleep can seriously throw off T levels. And, to make matters worse, low testosterone levels can also throw off sleep, making it hard to get the quality rest needed to boost your levels back into healthy territory, according to Dr. Raj Dasgupta M.D., F.A.C.P., F.C.C.P., F.A.A.S.M., a physician quadruple-board certified in pulmonary, sleep, internal, and critical care medicine, and the chief medical advisor with Sleepopolis. Talk about a vicious cycle.
All is not lost, though. Ahead, a closer look at the relationship between testosterone and sleep, plus tips on how to support both.
- ABOUT OUR EXPERTS: Dr. Raj Dasgupta M.D., F.A.C.P., F.C.C.P., F.A.A.S.M., is a physician quadruple-board certified in pulmonary, sleep, internal, and critical care medicine, and the chief medical advisor with Sleepopolis. Kevin Huffman, D.O., is a doctor of osteopathic medicine and licensed wellness specialist. Nathan Starke, M.D., is the director of the Men’s Health Clinic at Houston Methodist and an advisor to Marius Pharmaceutical, a health organization helping people achieve healthy testosterone levels.
Quick Refresher: What Is Testosterone?
Testosterone is an androgenic hormone primarily produced in the gonads (testicles or ovaries). While men and women both produce testosterone, it’s referred to as the male sex hormone because higher levels of testosterone are responsible for the primary and secondary sex characteristics associated with traditional masculinity, such as body hair, facial hair, an Adam’s apple, a deeper voice, and greater muscle mass, says doctor of osteopathic medicine and licensed wellness specialist Kevin Huffman, D.O.
Aesthetics aside, testosterone also plays a vital role in overall physical, reproductive, sexual, emotional, and mental health for both men and women, according to Huffman. Testosterone modulates muscle growth and repair, supports red blood cell creation, aids in bone mass maintenance, and modulates mood and energy levels, he says. It also plays an essential role in a healthy libido and fertility. “In men, it supports sperm production, while in women it supports regular menstrual cycles and ovulation,” Huffman explains.
Read More: 4 Signs You Have Low Testosterone
As such, when testosterone levels dip below healthy levels—generally between 300 and 1,000 nanograms per deciliter of blood (ng/dL) for men and 15 and 70 ng/dL for women—an individual may experience symptoms of low testosterone. According to Huffman, these commonly include: generalized fatigue, reduced strength, weakened bones, diminished libido, sexual dysfunction, poor mood, and, yes, disrupted sleep.
Why Sleep Is Important For Healthy Testosterone Levels
Sleep and testosterone have a direct relationship, according to Dasgupta. This means that when sleep quality decreases, testosterone levels do, too.
Mainly, that’s because testosterone production is closely linked to your circadian rhythm, or your natural sleep-wake cycle. “Testosterone levels decline throughout the day, then begin to rise again as you sleep and reach peak levels upon awakening,” explains Nathan Starke, M.D., Director of the Men’s Health Clinic at Houston Methodist and advisor to Marius Pharmaceutical, a health organization helping people achieve healthy testosterone levels. Translation: The body produces the majority of its overall daily testosterone when we are asleep.
More specifically, the body produces the bulk of its testosterone when we are in certain stages of sleep called REM and deep-stage non-REM sleep, says Dasgupta. (Deep-stage non-REM sleep is also referred to as delta sleep or slow-wave sleep.) One study published in the Journal of Andrology found that an individual’s testosterone levels spike at the time of the first REM cycle (most people have four to six REM cycles per night) and remain that high until waking. Meanwhile, another study published in the journal Current Medical Research and Opinion found that testosterone levels are highest at eight in the morning (after a night of sleep).
Ultimately, “any disruptions to sound sleep can interfere with the natural production of testosterone, and thus lead to a smaller rise in testosterone during sleep and lower average daytime testosterone levels,” says Starke. Indeed, in one small study published JAMA, researchers compared men’s testosterone levels after one week of sleeping eight hours per night with their levels after a week of sleeping just five hours per night. After just that week, the men who only slept five hours per night had 10- to 15-percent lower testosterone levels than those who logged a full eight hours of shut-eye.
Given the impact of sleep on T, “sleep conditions are a significant cause of lower testosterone levels,” according to Starke. Sleep apnea— a condition marked by regular wakings due to lack of oxygen—is particularly notorious for its impact on testosterone levels. “The routinely disrupted REM cycles associated with sleep apnea can lead to decreased testosterone production over time, exacerbating and even causing symptoms of low T,” he explains.
Other sleep disorders such as insomnia and restless leg syndrome, which also prevent you from getting that deep, restful sleep your body needs, can result in lower testosterone, adds Dasgupta.
How Low T Can Lead To Worsened Sleep
While downturns in sleep quality or quantity may lead to lower testosterone, it’s also true that low testosterone levels can lead to worsened sleep quality, says Starke. In one study published in the Journal of Clinical Endocrinology & Metabolism, older men with lower (less than 250 ng/dl) testosterone levels had reduced sleep efficiency, increased nocturnal awakenings, and less time in slow wave sleep compared to those with testosterone higher than 250 ng/dl.
This link is thought to be due in large part because, as the entire endocrine system is interconnected, cortisol levels increase when testosterone levels drop. In one 2023 study published in Clinical Medicine Insights: Endocrinology and Diabetes, for example, researchers found that cortisol levels were significantly higher in patients with significantly lower testosterone levels.
Cortisol (dubbed the stress hormone) has a stimulating effect on the body, so increased levels can lead to feelings of alertness that naturally make it harder to fall asleep. Plus, heightened cortisol can also lead to a sense of increased stress and distress, notes Starke. Naturally, it is harder for someone fretting about work or family—or stressed for any other reason—to fall asleep when they put their head on the pillow.
Breaking The Cycle
It is possible to break the vicious cycle between lack of sleep and low testosterone. However, doing so will require a holistic approach that supports both sleep quality and overall hormonal balance, Starke says.
On the sleep front, “sleeping at least seven to eight hours a night is essential for supporting testosterone levels and overall hormone balance,” says Starke. To ensure those hours happen—and are filled with quality sleep—you’ll need to prioritize good sleep hygiene, maintain a consistent sleep schedule, and create a conducive sleep environment, says sleep specialist and neurologist, Dr. Chris Winter, M.D., author of The Rested Child and The Sleep Solution, and host of Sleep Unplugged. “Allotting more time to sleep and spending less time on your phone are good places to start,” he says.
Read More: Steal These Health Experts’ Bedtime Rituals For Better Sleep And Well-Being
Certain sleep supplements can also help here. “Melatonin can help support regular sleep-wake cycles and improve sleep onset and duration,” Starke says. Meanwhile, “herbal remedies like ashwagandha, valerian root, and chamomile may also promote relaxation and better sleep.” Talk to your healthcare provider ahead of supplementation if you take other medications, as supplements can interfere with their efficacy.
That said, “a cool, quiet, and dark room complete with a comfy mattress will not be sufficient for someone with an underlying sleep condition,” says Winter. Likely, neither will over-the-counter sleep supplements. If you have an underlying sleep disorder, such as sleep apnea or insomnia (or think you might), it’s important to talk to a sleep specialist “Sleep conditions need to be addressed through appropriate treatments like CPAP therapy or cognitive-behavioral therapy,” Starke says.
Beyond improving your sleep, a range of lifestyle edits can also help support testosterone production and healthy T levels. “Stress management is essential, as excess stress can disrupt sleep patterns and quality, as well as hormone levels,” says Starke. Again, that’s because stress is accompanied by increases in cortisol, which has an inverse relationship with testosterone and is associated with feelings of wakefulness.
The exact stress management protocols you implement will depend on your particular preferences. “It can be through relaxation techniques like mindfulness or meditation, or regular physical activity,” Starke suggests. Writing a list of things you’re grateful for, listening to inspiring music, laughing, and stretching can also help relieve stress, per the CDC.
Certain supplements—such as lemon balm, magnesium glycinate, and l-theanine—can also be supportive here.
In terms of nutrition, consuming a balanced diet rich in essential nutrients can support overall health and thus testosterone production, says Starke. In particular, he recommends prioritizing foods rich in zinc (like oysters and red meat), magnesium (like nuts and seeds), and vitamin D (like salmon and mushrooms), as these three nutrients have been shown to play important roles in testosterone production. Consider supplementing with these nutrients if you tend to fall short in the food department.
“You also want to avoid excessive alcohol consumption and processed foods,” Starke says. Both can be toxic for testosterone production and lead to decreased T levels.
And lastly, if lifestyle modifications alone do not sufficiently improve symptoms associated with lower testosterone levels, such as worsened sleep, Starke recommends a trip to your healthcare provider. After confirming low T through a blood test, they might suggest testosterone replacement therapy (TRT). “TRT can help restore testosterone levels to a healthy range and alleviate associated symptoms,” he says.
Providers will also be able to evaluate whether or not an underlying health condition may be causing the lower testosterone, adds Starke. Obesity, type 2 diabetes, and cardiovascular disease can all tank levels.