Re: Sleep Apnea and Testosterone

[Guest guest]

On Sun, 13 Mar 2005 04:39:06 -0000, you wrote:

>Now, I have been mulling this around for a while, but does/can Sleep

>Apnea cause low test, or visa versa?

There's evidence that both are true.

- - - -

Just another albino black sheep

[Guest guest]

Tallen,

I have both. My sleep apnea was discovered before my low T, but even

after over 2 years on cpap, my T came back in the 100s. In my case

I'm guessing low T may have contributed to sleep apnea, but i'm not

sure. The one study you posted about sleep apnea in men possibly

being caused by disruption in the HPT axis is very interesting to me...

Mark

[Guest guest]

Hi Tallen I have got a letter from my Union Rep telling us to be careful going

to sleep clinics. It seams that they rely tell you you don't have a problem.

Sounds like seeing a shrink they all ways find something wrong with you. My

wife went to one and they had her on a machine that drove her nuts she got less

sleep that off the dam thing. She tried using a noise strip and lost weight and

sleep much better. If you are on meds some times that will do this to you our

if you have a drink. I know if I take more then on .25 Xanax I do it and snore

very bad. But this is not Apnea it is the Xanax. Try doing things first to see

if that is the problem. My wife went to a Dr. to have the surgery and took the

test result with her because she could not ware the machine. He looked at the

test and told her she is not that bad to lose weight and try the nose stripe.

Phil

tallen2_34 <no_reply > wrote:

Hey Guys,

It has been a while since I frequented this group. However, I wanted

everyone's opinion on this to see if I may be onto something.

I have been on TRT for about a year and a half. My baseline T before

starting TRT was in the 250-300 range. I have recently been diagnosed

with hypertension. Lately my SO has noticed that I have some trouble

breathing at night. SO, I went to my local doc who prescribed a sleep

study. I am going to have one in the next couple of weeks.

Now, I have been mulling this around for a while, but does/can Sleep

Apnea cause low test, or visa versa?

Most of the abstracts that I have read do not really take a position,

some say that TRT will exacerbate an already existing Sleep Apnea

conditions, other says that Sleep Apnea will lower test....

I am wondering if there is a group of us low T suffers who really have

sleep apnea.

Any ideas?

Pituitary-gonadal function in men with obstructive sleep apnea. The

effect of continuous positive airways pressure treatment.

Luboshitzky R, Lavie L, Shen-Orr Z, Lavie P.

Endocrine Institute, Haemek Medical Center, Afula 18101, Israel.

luboshitzky-r@...

OBJECTIVES: Decreased libido and a decline in morning serum

testosterone levels were reported in men with obstructive sleep apnea

(OSA). Our study aimed to evaluate the pituitary-gonadal axis in

middle age men with OSA before and after treatment with nasal

continuous positive airway pressure (CPAP). MATERIAL AND METHODS:

Measurement of the nocturnal serum luteinizing hormone (LH) and

testosterone levels and sleep recordings before and after nine months

of CPAP treatment in five men with OSA aged 49.5+/-5.2 years. Patients

were evaluated during nocturnal sleep at base line and during CPAP

treatment. Serum LH and testosterone levels were determined at 20

minutes interval between 1900h and 0700h with concomitant

determination of sleep quality, respiration and oxygen saturation.

RESULTS: At base line, patients had higher RDI and PaO2<90%, lower

mean and integrated (AUC) values of LH and testosterone. During CPAP

treatment, RDI and PaO2<90% were normal. Mean and AUC values of

testosterone and LH increased. CONCLUSIONS: OSA in men is associated

with dysfunction of the pituitary-gonadal axis. The central

suppression of nocturnal testosterone in these patients is partially

corrected during chronic CPAP treatment.

Neuroendocrine changes in sleep apnea.

Yee B, Liu P, Philips C, Grunstein R.

Woolcock Institute of Medical Research, Royal Prince Alfred Hospital,

Sydney, NSW, Australia. brendony@...

PURPOSE OF REVIEW: To review recent investigations examining the

effects of neuroendocrine changes in obstructive sleep apnea. RECENT

FINDINGS: Gonadal hormones have long been implicated in the

pathogenesis of obstructive sleep apnea. Recently, exogenous

testosterone has been shown to exacerbate obstructive sleep apnea,

whereas hormone replacement therapy in menopausal women may be

protective in obstructive sleep apnea. Effective treatment of

obstructive sleep apnea with nasal continuous positive airway pressure

has been associated with improved insulin sensitivity and testicular

function in individuals with obstructive sleep apnea. SUMMARY: It is

important to consider the potential development of sleep apnea in any

patient who has an endocrine disorder or is receiving certain hormonal

therapies. Effective assessment and management of obstructive sleep

apnea with nasal continuous positive airway pressure may lead to a

reduction in insulin resistance and hypertension as well as other

markers of vascular risk in patients with metabolic syndrome.

ARTICLES

Neuroendocrine dysfunction in sleep apnea: reversal by continuous

positive airways pressure therapy

RR Grunstein, DJ Handelsman, SJ Lawrence, C Blackwell, ID Caterson and

CE Sullivan

Sleep Unit, Royal Prince Alfred Hospital, Sydney, Australia.

We studied the effects of sleep apnea on neuroendocrine function in a

cross-sectional study of 225 consecutive men undergoing sleep studies

and in a longitudinal study of 43 men with severe obstructive sleep

apnea before and after 3 months of successful treatment with nasal

continuous positive airways pressure to eliminate upper airways

obstruction. Blood samples were collected at 0600-0630 h on awakening

for measurement of plasma insulin-like growth factor I (IGF-I), total

and free testosterone, sex hormone-binding globulin (SHBG), LH, FSH,

PRL, T4, T4-binding globulin, and cortisol. The plasma hormone levels

were analyzed in relation to the severity of sleep apnea, as indicated

by the desaturation index (the hourly rate of episodes of arterial

oxygen desaturation greater than 4% of the stable baseline) and the

mean minimal oxygen saturation during the desaturation episodes. In

the cross-sectional study plasma IGF-I, free and total testosterone,

and SHBG levels were significantly lower in relation to the severity

of sleep apnea, whereas plasma LH, FSH, PRL, T4, T4-binding globulin,

and cortisol were not. The decreases in plasma IGF-I and total and

free testosterone were independent of the effects of aging and

adiposity by covariance analysis. In the longitudinal study plasma

IGF-I, total testosterone, and SHBG, but not free testosterone,

significantly increased after 3 months of nasal continuous positive

airways pressure treatment. We conclude that sleep apnea causes

reversible neuroendocrine dysfunction in men, which is manifested by

decreased plasma. IGF-I, testosterone, and SHBG levels. This

neuroendocrine dysfunction is related to the severity of the sleep

apnea, as indicated by the nadir levels of arterial oxygen

desaturation and the rate of desaturation episodes. These hormonal

measurements may provide biochemical markers for both the severity of

sleep apnea and its response to therapeutic intervention. In addition,

sleep apnea may be a previously unrecognized confounder of the

neuroendocrine correlates of aging.

1: Clin Endocrinol (Oxf). 1988 May;28(5):461-70. Related Articles, Links

Reversible reproductive dysfunction in men with obstructive sleep apnoea.

Santamaria JD, Prior JC, Fleetham JA.

Department of Medicine, University of British Columbia, Vancouver, Canada.

A central, reversible decrease in male sexual function appears related

to some aspect of obstructive sleep apnoea (OSA). Lower serum

testosterone (T) levels were documented in 15 men with OSA versus nine

snorers (no OSA), (9.18 +/- 0.92 vs 11.55 +/- 0.90 nmol/l, mean +/-

SEM), P less than 0.05 in a consecutive case series of 24 men referred

for diagnostic overnight sleep studies. Gonadotrophins did not differ

between the two groups. Although the men with OSA did not differ in

body mass index (BMI) or weight from the snorers, they were older (51

+/- 3.9 vs 44 +/- 3.1 years), P less than 0.02. Serum T did not

correlate with age, but was correlated with minimum nocturnal arterial

oxygen saturation (Min SaO2) (r = 0.589), P less than 0.02. A

prospective controlled trial of uvulopalatopharyngoplasty therapy

(UPP) for OSA in 12 subsequent subjects showed reproductive

improvement which was parallel with improved apnoea at 3 months

postsurgery. T increased (13.31 +/- 1.07 to 16.59 +/- 0.72 nmol/l), P

less than 0.02, without significant changes in BMI, serum PRL, LH or

FSH. All seven of the men who reported decreased sexual interest prior

to surgery felt their libido and sexual functioning had returned to

normal 3 months following UPP. Some aspect of OSA in men appears to

produce a reversible hypothalamic-pituitary reproductive dysfunction.

PMID: 3145819 [PubMed - indexed for MEDLINE]

Decreased Pituitary-Gonadal Secretion in Men with Obstructive Sleep Apnea

Luboshitzky, Ariel Aviv, Aya Hefetz, a Herer, Zila

Shen-Orr, Lena Lavie and Peretz Lavie

Endocrine Institute (R.L., A.A.), Haemek Medical Center, Afula 18101,

Israel; Unit of Anatomy and Cell Biology (A.H., L.L.), Endocrine

Laboratory, Rambam Medical Center, Haifa, Israel; and The Sleep

Research Center (P.H., P.L.), Technion, Israel Institute of

Technology, Haifa 32000, Israel

Address all correspondence and requests for reprints to: Prof. R.

Luboshitzky, Endocrine Institute, Haemek Medical Center, Afula 18101,

Israel. E-mail: . luboshitzky-r@...

Abstract

Decreased libido is frequently reported in male patients with

obstructive sleep apnea (OSA). The decline in morning serum

testosterone levels previously reported in these patients was within

the normal adult male range and does not explain the frequent

association of OSA and sexual dysfunction. We determined serum LH and

testosterone levels every 20 min between 2200–0700 h with simultaneous

sleep recordings in 10 men with sleep apnea and in 5 normal men free

of any breathing disorder in sleep. The mean levels and area under the

curve of LH and testosterone were significantly lower in OSA patients

compared with controls [LH, 24.9 ± 10.2 IU/liter·h vs. 43.4 ± 9.5 (P <

0.005); testosterone, 67.2 ± 11.5 nmol/liter·h vs. 113.3 ± 26.8 (P <

0.003)]. Four of 10 patients had hypogonadal morning (0700 h) serum

testosterone levels. Analysis of covariance (ANCOVA) revealed that the

2 groups differed significantly in the amount of LH and testosterone

secreted at night independent of age or degree of obesity. After

partialing out body mass index, there was a significant negative

correlation between the amounts of LH and testosterone secreted at

night and the respiratory distress index, but not with degree of hypoxia.

Our findings suggest that OSA in men is associated with dysfunction of

the pituitary-gonadal axis. The relation between LH-testosterone

profiles and the severity of OSA suggests that sleep fragmentation

and, to a lesser extent, hypoxia in addition to the degree of obesity

and aging may be responsible for the central suppression of

testosterone in these patients.

Check this as well:

http://jcem.endojournals.org/cgi/co...3994ec63a70f f

[Guest guest]

On Sun, 13 Mar 2005 17:37:56 -0000, you wrote:

>

>Tallen,

>

>I have both. My sleep apnea was discovered before my low T, but even

>after over 2 years on cpap, my T came back in the 100s. In my case

>I'm guessing low T may have contributed to sleep apnea, but i'm not

>sure. The one study you posted about sleep apnea in men possibly

>being caused by disruption in the HPT axis is very interesting to me...

There is a theory that low oxygen from sleep apnea can lead to

secondary hypo-g. The centers for each hormone in the pituitary are

really quite small and a little tissue death there can have profound

affects.

- - - -

Just another albino black sheep

[Guest guest]

Mark and Tallen,

I have both as well. But in my case I think the apnea came first, starting

about ten years before the low T symptoms (erectile problems) began. I've

been on CPAP for almost two years and I haven't seen any improvement in T

levels, but this is complicated by the fact that I was already on TRT. My

overall sexual performance and libido have improved since starting CPAP,

though.

Jay

Re: Sleep Apnea and Testosterone

Tallen,

I have both. My sleep apnea was discovered before my low T, but even

after over 2 years on cpap, my T came back in the 100s. In my case

I'm guessing low T may have contributed to sleep apnea, but i'm not

sure. The one study you posted about sleep apnea in men possibly

being caused by disruption in the HPT axis is very interesting to me...

Mark

[Guest guest]

Jay,

Yeah, according to what I've learned here, your natural production

shuts down after being on TRT for a short time. Might be possible to

recover natural production, but that would probably involve one of the

jump-start type experiments others have talked about. Might depend on

how long you've been on TRT as well. If you are primary, I would

imagine it wouldn't make a difference at all. If you are secondary,

maybe you'd have a shot, but I don't know for sure.

Mark

---

> levels, but this is complicated by the fact that I was already on TRT.

[Guest guest]

Mark,

I've been on TRT about four years. I've never found out if I'm primary

or secondary, but I've had no noticeable testicular atrophy. Currently

I do 100mg of Testosterone Cypionate weekly and take a 20mg Cialis

every 72 hours. I'm very happy with things as they are, especially

since starting CPAP. So if it ain't broke...

Jay

> Re: Sleep Apnea and Testosterone

>

>

>

> Jay,

>

> Yeah, according to what I've learned here, your natural production

> shuts down after being on TRT for a short time. Might be possible

to

> recover natural production, but that would probably involve one of

the

> jump-start type experiments others have talked about. Might depend

on

> how long you've been on TRT as well. If you are primary, I would

> imagine it wouldn't make a difference at all. If you are secondary,

> maybe you'd have a shot, but I don't know for sure.

>

> Mark

>

> ---

> > levels, but this is complicated by the fact that I was

> already on TRT.

>

>

>

>

>

>

[Guest guest]

Jay,

I agree. Unless fertility is really important to you, I would stick

with what you are doing. I hope to get to the point where you are

someday. Just gotta figure out this CFS/viral thing. Maybe someday...

Mark

> I do 100mg of Testosterone Cypionate weekly and take a 20mg Cialis

> every 72 hours. I'm very happy with things as they are, especially

> since starting CPAP. So if it ain't broke...

>

> Jay

[Guest guest]

Mark,

Fertility is the least of my concerns, fortunately. If I had a

child now it would be a disaster. I'm retired and I just turned

64. Between the two of us my lady and I have six grown children,

and that's quite enough.

Best of luck,

Jay

Re: Sleep Apnea and Testosterone

Jay,

I agree. Unless fertility is really important to you, I would

stick

with what you are doing. I hope to get to the point where you

are

someday. Just gotta figure out this CFS/viral thing. Maybe

someday...

Mark

> I do 100mg of Testosterone Cypionate weekly and take a 20mg

Cialis

> every 72 hours. I'm very happy with things as they are,

especially

> since starting CPAP. So if it ain't broke...

>

> Jay