Test Replacement Isn’t a Cure for Apnea
One might think that giving testosterone to sleep apnea patients would result in lifestyle enhancement, but testosterone itself has been linked to sleep apnea. Testosterone is the only androgen that has been attributed to control of breathing, although its role is unclear.
In a study of seven obese men, all but the hypogonadal man had nocturnal hypoxemia or sleep-disordered breathing.34 In relation to sleep-disordered breathing, two randomized, placebo-controlled studies in older men are available and document that high-dose testosterone administration worsens sleep and breathing, although lower dose, steady-state testosterone delivery may be less likely to do so.30 Testosterone alters neurochemical control of breathing and administration of testosterone to hypogonadal men results in disturbed breathing patterns.21 Older men given high doses of testosterone resulted in reduced sleep time (approximately one hour) and disrupted breathing during sleep. So how is this happening? The author concluded that even though testosterone increased lean muscle mass and reduced fat mass, the disruption in sleep could have been attributed to the fact that testosterone administration changes nocturnal metabolism, potentially impairing sleep quality. In addition, the large rapid increases in lean mass reflect changes in tissue hydration, which could cause edema in the airways, disturbing breathing.30 Another possible cause of the increased number of sleep disturbances, which can occur with testosterone administration, is that testosterone decreases melatonin production. Patients with GnRH deficiency who have low levels of testosterone have higher levels of melatonin than normal controls. The administration of testosterone enanthate to GnRH patients resulted in a reduction in melatonin to the levels appropriate for age-matched controls.33 What’s interesting is that the pineal gland where melatonin is secreted has the ability to take up and metabolize estradiol and testosterone.32

Similarly to men, administration of testosterone to women results in sleep-disordered breathing. For example, when women were administered testosterone for 12 days via a transdermal patch, (giving them physiological levels of testosterone similar to a man’s) this caused disturbances in ventilation during sleep. These changes couldn’t be explained by changes in airway mechanics, because the short duration of the study.23 In addition, women with polycystic ovary disease who have high serum androgen levels also have similar sleep-disordered breathing.22 It’s also of interest that the risk of developing sleep apnea related syndromes declines with age, which may be related to decreased testosterone levels.