Abstract
Purpose
Testosterone deficiency has been linked to several adverse health outcomes and recent data have suggested that abnormal sleep quality may result in lower testosterone levels. We assessed the effect of self-reported sleep patterns on serum testosterone while controlling for co-morbidities, and baseline demographics.
Materials and methods
Using data collected from the 2011–2012 National Health and Nutrition Examination Survey (NHANES), we extracted serum total testosterone level, sleep duration, demographic, and co-morbidities for men aged 16 years and older. Univariate and multivariate linear regression was used to estimate the association of number of hours slept, co-morbidities, and demographics with serum testosterone.
Results
Among the 9756 individuals in the NHANES dataset, 2295 (23.5%) were males 16 years and older with a median (interquartile range) age of 46 years (29–62) who also had serum testosterone levels drawn. Median serum testosterone level was 377 ng/dL (IQR: 279–492 ng/dL). Median number of hours slept was 7 h (IQR: 6–8 h). On multivariate linear regression, we found serum testosterone decreased by 0.49 ng/dL per year of age (p = 0.04), 5.85 ng/dL per hour loss of sleep (p < 0.01) and 6.18 ng/dL per unit of body mass index (BMI) increase (p < 0.01).
Conclusions
Among men aged 16–80 in the United States, we found increasing age, impaired sleep and elevated BMI is associated with low testosterone. It is important, therefore, that evaluation and treatment of reduced serum testosterone should also include improving sleep duration in combination with weight management.
Similar content being viewed by others
References
Watson NF, Badr MS, Belenky G et al (2015) Joint consensus statement of the american academy of sleep medicine and sleep research society on the recommended amount of sleep for a healthy adult: methodology and discussion. Sleep 11:931–952
Short Sleep Duration Among US Adults. https://www.cdc.gov/sleep/data_statistics.html. Published 2017. Accessed 7 Mar 2018
Ford ES, Cunningham TJ, Croft JB (2015) Trends in self-reported sleep duration among US adults from 1985 to 2012. Sleep 38:829–883
Reutrakul S, Van Cauter E (2018) Sleep influences on obesity, insulin resistance, and risk of type 2 diabetes. Elsevier Inc
Cappuccio FP, Cooper D, Delia L et al (2011) Sleep duration predicts cardiovascular outcomes: a systematic review and meta-analysis of prospective studies. Eur Heart J 32:1484–1492
Cappuccio FP, D’Elia L, Strazzullo P et al (2010) Sleep duration and all-cause mortality: a systematic review and meta-analysis of prospective studies. Sleep 33:585–592
Dray F, Reinberg A, Sebaoun J (1965) Biological rhythm of plasma free testosterone in healthy adult males: existence of a circadian variation. C R Hebd Seances Acad Sci 261:573–576
Evans J, MacLean A, Ismail A et al (1971) Concentrations of plasma testosterone in normal men during sleep. Nature 229:261–262
Leproult R, Van Cauter E (2011) Effect of 1 week of sleep restriction on testosterone levels in young healthy men. JAMA 305:2173–2174
Schmid SM, Hallschmid M, Jauch-Chara K et al (2012) Sleep timing may modulate the effect of sleep loss on testosterone. Clin Endocrinol (Oxf) 77:749–754
Arnal PJ, Drogou C, Sauvet F et al (2016) Effect of sleep extension on the subsequent testosterone, cortisol and prolactin responses to total sleep deprivation and recovery. J Neuroendocrinol 28:12346
Abu-samak MS, Mohammad BA, Abu-taha MI et al (2018) Associations between sleep deprivation and salivary testosterone levels in Male University students : a prospective cohort study. Am J Mens Health. 12:411–419
McQuillan GM, McLean JE, Chiappa M et al (2015) National Health and Nutrition Examination Survey Biospecimen Program: nHANES III (1988–1994) and NHANES 1999–2014. Vital Health Stat 2(170):1–14
Ritchey J, Zhang H, Karmaus et al (2014) Linearity asssessment methods for sex steroid hormones and carrier proteins among men in the National Health and Nutritional Examination Survey (NHANES III). Steroids 82:23–28
R Core Team (2014). R: A language and environment for statistical computing. R Foundation for Statistical Computing, Vienna Austria. http://www.R-project.org. Accessed 1 Sep 2017
Cooke RR, McIntosh JE, McIntosh RP (1993) Circadian variation in serum free and non-SHBG-bound testosterone in normal men: measurements, and simulation using a mass action model. Clin Endocrinol 39:163–171
Luboshitzky R, Herer P, Levi M et al (1999) Relationship between rapid eye movement sleep and testosterone secretion in normal men. J Androl 20:731–737
Luboshitzky R, Zabari Z, Shen-Orr Z et al (2001) Disruption of the nocturnal testosterone rhythm by sleep fragmentation in normal men. J Clin Endocrinol Metab 86:1134–1139
Harman SM, Metter EJ, Tobin JD et al (2001) Longitudinal effects of aging on serum total and free testosterone levels in healthy men. J Clin Endocrinol Metab 86:724–731
Feldman HA, Longcope C, Derby CA et al (2002) Age trends in the level of serum testosterone and other hormones in middle-aged men: longitudinal results from the Massachusetts male aging study. J Clin Endocrinol Metab 87:589–598
Wu FCW, Tajar A, Pye SR et al (2008) Hypothalamic-pituitary-testicular axis disruptions in older men are differentially linked to age and modifiable risk factors: the European male aging study. J Clin Endocrinol Metab 93:2737–2745
Yeap BB, Knuiman MW, Divitini ML et al (2014) Differential associations of testosterone, dihydrotestosterone and oestradiol with physical, metabolic and health-related factors in community-dwelling men aged 17–97 years from the Busselton Health Survey. Clin Endocrinol (Oxf) 81:100–108
Eriksson J, Haring R, Grarup N et al (2017) Causal relationship between obesity and serum testosterone status in men: a bidirectional mendelian randomization analysis. PLoS One 12:1–15
Maneesh M, Dutta S, Chakrabarti A et al (2006) Alcohol abuse-duration dependent decrease in plasma testosterone and antioxidants in males. Indian J Physiol Pharmacol 50:291–296
Castilla-Garcia A, Santolaria-Fernandez F, Gonzalez-Reimers C et al (1987) Alcohol-induced hypogonadism: reversal after ethanol withdrawal. Drug Alcohol Depend 20:255–260
Sierksma A, Sarkola T, Eriksson CJP et al (2004) Effect of moderate alcohol consumption on plasma dehydroepiandrosterone sulfate, testosterone, and estradiol levels in middle-aged men and postmenopausal women: a diet-controlled intervention study. Alcohol Clin Exp Res 28:780–785
Author information
Authors and Affiliations
Contributions
Protocol/project development: PP, TK, RR. Data collection or management: PP, TK. Data analysis: PP, TK. Manuscript writing/editing: PP, BS, TK, RR.
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that they have no conflict of interest.
Ethical approval
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Informed consent
Informed consent was obtained from all individual participants included in the study.
Rights and permissions
About this article
Cite this article
Patel, P., Shiff, B., Kohn, T.P. et al. Impaired sleep is associated with low testosterone in US adult males: results from the National Health and Nutrition Examination Survey. World J Urol 37, 1449–1453 (2019). https://doi.org/10.1007/s00345-018-2485-2
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00345-018-2485-2