TRT and Sleep Apnoea

TRT and Sleep Apnoea: Understanding the Connection

At Omniya Clinic, we are dedicated to providing holistic and personalised healthcare solutions for men experiencing the complex symptoms of low testosterone (low-T), including Testosterone Replacement Therapy (TRT). Testosterone Replacement Therapy (TRT) has become an effective treatment for men experiencing low testosterone levels, but it's important to understand the relationship between TRT and obstructive sleep apnoea (OSA). Sleep apnoea is a condition in which breathing is interrupted during sleep, often leading to poor sleep quality and daytime fatigue. For men considering TRT at Omniya Clinic, understanding how it may impact or interact with sleep apnoea is key to achieving the best health outcomes.

Common symptoms of sleep apnoea include:

• Loud snoring
• Episodes of stopped breathing during sleep
• Waking up gasping for air
• Morning headaches
• Excessive daytime fatigue
• Irritability and difficulty concentrating

What are the risks of obstructive sleep apnoea?
As well as easily dozing off throughout the day, patients with obstructive sleep apnoea are at increased risk of developing high blood pressure, heart disease, stroke and diabetes.

Can TRT Cause Sleep Apnoea?

Research suggests that in some men, TRT may worsen or contribute to sleep apnoea symptoms, especially in those already predisposed to the condition. The exact mechanism by which this may occur remains unclear. One theory is that testosterone may affect the dilation and contraction of the airways; as testosterone levels fluctuate (particularly in patients using certain injectable formulations) so too does the degree of airway obstruction. A major confounding factor is that the primary risk factor for OSA is being overweight, and the study did not take into account the BMI/body fat of the patients enrolled, nor those of the control group. Nonetheless, if you have sleep apnoea or suspect you might, it’s crucial to discuss this with the specialists at Omniya Clinic before starting TRT.
According to a study published in the Journal of Clinical Endocrinology & Metabolism, sleep apnoea disrupts the normal sleep cycle, which is critical for testosterone production. The majority of testosterone is produced during REM (rapid eye movement) sleep, which is frequently interrupted in individuals with sleep apnoea. This reduction in testosterone production can lead to a range of symptoms such as fatigue, reduced libido, and muscle loss, which are also common in individuals with low-T. Studies looking at testosterone levels in patients with OSA have not however found that testosterone levels recover once the OSA is treated.

How does TRT affect OSA?

A study published in The American Journal of Respiratory and Critical Care Medicine found that TRT can potentially worsen obstructive sleep apnoea by increasing the number of apnoea episodes during sleep. The exact mechanisms are not entirely understood. The studies that have shown this correlation have either been small studies or a larger study with a significant confounding factor. We do know that one of the risks of TRT is that it can cause the blood count to rise, also known as polycythaemia. This is also a complication of OSA. Thus, patients with OSA starting TRT are at a greater risk of polycythaemia.

Whilst the research that looks to clarify the relationship between TRT and OSA is inconclusive and more large scale, robust studies will need to be conducted to further delineate this, it is widely agreed that TRT should be prescribed with caution in individuals with untreated sleep apnoea. If there is a suspicion of OSA, some doctors may ask for a sleep study to confirm the diagnosis and subsequent treatment of OSA with use of CPAP therapy at night, before starting TRT. Monitoring by a healthcare professional thereafter is critical to mitigate any risks associated with sleep apnoea and TRT.

TRT’s Benefits for Low Testosterone in Sleep Apnoea Patients

Despite concerns about TRT and sleep apnoea, men with low testosterone can experience a wide range of health improvements from TRT, especially when administered and monitored by a qualified medical professional. These benefits include:

• Reversing OSA: As being overweight is the most common reason to develop sleep apnoea and a very common symptom of low testosterone, treating the low testosterone with TRT alongside exercise and careful calorie intake will often result in weight loss. This weight loss is key to reversing sleep apnoea. Unfortunately some patients will have sleep apnoea for other reasons, e.g. genetic reasons, and in those patients TRT is unlikely to have this effect.
• Increased Energy and Reduced Fatigue: Low testosterone is associated with chronic fatigue, a symptom also prevalent in men with sleep apnoea. By restoring testosterone levels, TRT can help improve energy levels, allowing men to feel more active and alert throughout the day.
• Improved Mood and Cognitive Function: Men with low testosterone often experience mood swings, depression, and difficulty concentrating. TRT has been shown to improve cognitive function, mental clarity, and mood, helping individuals cope with the psychological effects of sleep apnoea.
• Enhanced Libido and Sexual Function: TRT is particularly effective in improving libido and sexual performance, which are commonly diminished in men with low testosterone. This improvement in sexual function can contribute to an overall increase in quality of life.
• Improved Muscle Mass and Physical Strength: Testosterone plays a key role in maintaining muscle mass and physical strength. Men undergoing TRT often report improvements in physical performance and a reduction in the muscle loss commonly associated with low testosterone and sleep apnoea.
• Reduced cardiovascular disease risk: Low testosterone levels have been linked to an increased risk of cardiovascular disease and by normalising this, that risk is also reduced.

Managing Sleep Apnoea and Low Testosterone

At Omniya Clinic, we prioritise a personalised approach. If you're experiencing symptoms of low testosterone, such as fatigue, low libido, or weight gain, while also dealing with sleep apnoea, our expert medical team will evaluate your specific needs. We ensure that any TRT treatment is carefully monitored to balance your testosterone levels without negatively affecting your sleep health.

Balancing TRT and Sleep Apnoea at Omniya Clinic

With our focus on individualised care, our experts will assess your hormonal health, review any underlying sleep disorders, and recommend a tailored TRT plan that suits your body’s unique needs. This ensures that men undergoing TRT can safely address low testosterone symptoms while minimising the risk of worsening sleep apnoea. Our doctors are committed to providing the highest standard of care for men suffering from low testosterone and related conditions such as sleep apnoea. Our approach is holistic, ensuring that each patient receives a treatment plan tailored to their unique health needs. While TRT can offer numerous benefits, particularly for men with low testosterone, it is essential to manage potential risks related to sleep apnoea.

If you are concerned about your testosterone levels or experiencing symptoms of sleep apnoea, we encourage you to book a consultation with our expert medical team.

We are here to help you achieve better health, improved sleep, and restored vitality.

Start your journey to better health today with Omniya Clinic.

For expert guidance and safe TRT treatments that consider your full health profile, including conditions like sleep apnoea, contact Omniya Clinic today.

What to Expect at Omniya Clinic:

Comprehensive Sleep and Hormone Testing:

We start by assessing your testosterone levels and conducting sleep assessments to determine whether you have sleep apnoea. If sleep apnoea is diagnosed or suspected, we may refer you for a sleep study to confirm the severity of the condition.

Tailored Treatment Plans:

Our doctors will work with you to develop a personalised treatment plan that addresses both low testosterone and sleep apnoea. In some cases, treating sleep apnoea first, through the use of CPAP machines or other sleep therapies, can significantly improve symptoms of low-T, reducing the need for TRT.

Close Monitoring During TRT:

For men who require TRT, we provide ongoing monitoring to ensure that testosterone levels remain within the healthy range and that sleep apnoea symptoms are not worsening. Regular follow-ups help us adjust the treatment as needed and ensure your overall health is prioritised.

Lifestyle Modifications:

Alongside TRT, we may recommend lifestyle changes such as weight loss, exercise, and dietary adjustments to help alleviate both sleep apnoea and low testosterone. Obesity is a known risk factor for both conditions, and even modest weight loss can dramatically improve sleep apnoea symptoms and hormone levels.

References:

Hoyos, C. M., Killick, R., Yee, B. J., Grunstein, R. R., & Liu, P. Y. (Year). Effects of testosterone therapy on sleep and breathing in obese men with severe obstructive sleep apnoea: A randomized placebo-controlled trial. Endocrine and Cardiometabolic Research Group, NHMRC Centre for Integrated Research and Understanding of Sleep (CIRUS), Woolcock Institute of Medical Research, Royal Prince Alfred Hospital, University of Sydney, Sydney, NSW, Australia.

According to a study by Hoyos et al., testosterone therapy in obese men with severe obstructive sleep apnoea had notable effects on sleep and breathing quality. This placebo-controlled trial, conducted by researchers at the University of Sydney’s CIRUS Woolcock Institute, highlights potential benefits and risks of testosterone therapy in sleep-related health.

Knapp, A., Myhill, P. C., Davis, W. A., Peters, K. E., Hillman, D., Hamilton, E. J., Lim, E. M., & Davis, T. M. E. (Year). Effect of continuous positive airway pressure therapy on sexual function and serum testosterone in males with type 2 diabetes and obstructive sleep apnoea. School of Medicine and Pharmacology, University of Western Australia, Fremantle; Department of Pulmonary Physiology and Sleep Medicine, Sir Charles Gairdner Hospital, Perth; Department of Biochemistry, PathWest Laboratory Medicine, Sir Charles Gairdner Hospital, Fremantle, WA, Australia.

Research by Knapp et al. explored how continuous positive airway pressure (CPAP) therapy impacts sexual function and testosterone levels in men with type 2 diabetes and obstructive sleep apnoea. This study, conducted at the University of Western Australia and Sir Charles Gairdner Hospital, suggests CPAP therapy may positively influence hormonal balance and sexual health in affected individuals.

Cole, A. P., Hanske, J., Jiang, W., Kwon, N. K., Lipsitz, S. R., Kathrins, M., Learn, P. A., Sun, M., Haider, A. H., Basaria, S., & Trinh, Q. D. (Year). Impact of testosterone replacement therapy on thromboembolism, heart disease and obstructive sleep apnoea in men. Center for Surgery and Public Health; Division of Urological Surgery; Section on Men’s Health, Aging, and Metabolism, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA; Department of Urology, Marien Hospital, Ruhr-University Bochum, Herne, Germany; Department of Surgery, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD, USA.

A study by Cole et al. examined the effects of testosterone replacement therapy (TRT) on the risk of thromboembolism, heart disease, and obstructive sleep apnoea in men. Conducted by researchers from Harvard Medical School, Ruhr-University Bochum, and Walter Reed Medical Center, the findings contribute to understanding TRT’s impact on cardiovascular and respiratory health.

Graziani, A., Grande, G., & Ferlin, A. (Year). The complex relation between obstructive sleep apnoea syndrome, hypogonadism, and testosterone replacement therapy. Unit of Andrology and Reproductive Medicine, Department of Medicine, University of Padova, Padova, Italy.

Graziani et al. explored the intricate relationship between obstructive sleep apnoea, hypogonadism, and testosterone replacement therapy (TRT) in men. Conducted at the University of Padova, this research highlights the potential interactions between TRT and respiratory conditions, shedding light on important considerations for treatment in men with sleep apnoea and low testosterone.