Sleep and Testosterone: How TRT Might Help You Get More Z’s

Of all the lifestyle changes that can improve testosterone levels—from losing weight to eating more healthy fats to lifting heavier—sleep may be the most powerful and most overlooked.

“If you have poor sleep, it doesn’t matter what else you do—you still won’t make sufficient testosterone,” says endocrinologist Steven Wise, M.D. “You don’t make testosterone while you’re exercising. You don’t make testosterone while you’re eating. You make testosterone while you’re sleeping.”

Here’s how sleep and testosterone affect each other—and what actually helps you optimize both.

About the Experts

Paul Gittens, M.D., is a urologist specializing in sexual medicine and male infertility. He’s the medical director at Rockwell Centers for Sexual Medicine & Wellness. 

Steven Wise, M.D., is a board-certified endocrinologist with over 25 years of experience and a Fellow of the American Association of Clinical Endocrinologists.

Testosterone’s Role in Sleep

Testosterone is primarily produced during sleep. Even short-term sleep deprivation can lower testosterone levels by 10–15 percent, including in younger men with otherwise healthy, near-peak hormone levels.¹

The relationship between testosterone levels and sleep runs both ways: 

• Low testosterone levels can negatively impact sleep.
• Consistently poor sleep can lower testosterone levels.

Because sleep and testosterone influence each other, improving one can reinforce the other: Better sleep supports healthier testosterone production, and restoring testosterone levels may help improve sleep quality.

How Low Testosterone Affects Your Sleep

Testosterone helps regulate sleep patterns, so low testosterone levels can make it harder to fall asleep, stay asleep, and feel rested the next day. 

Low testosterone doesn’t just reduce the total number of hours you sleep—it degrades sleep quality and efficiency, with more nighttime awakenings and less time spent in restorative stages, particularly deep sleep.

Studies show that men and women with lower testosterone wake more frequently during the night.^{2 3} Men with chronically low testosterone levels get less REM sleep and less deep, slow-wave sleep—the most restorative phase when muscle, bone, and tissue repair occur, Wise says.^{4 5}

Over time, sleep disruption can trigger a cascade of downstream health effects, says urologist Paul Gittens, M.D.

• Mood: Low testosterone contributes to poor sleep and chronic fatigue, which can worsen mood and increase depressive symptoms. 
• Weight: Sleep deprivation is also associated with higher body mass index (BMI)⁶ and increased abdominal fat⁷—a pattern strongly linked to further testosterone decline.⁸
• Metabolic dysfunction: Disrupted sleep and low testosterone both impair insulin sensitivity and glucose control, raising the risk of type 2 diabetes over time.⁹ 

The result is a vicious cycle of lower testosterone, worse sleep, more fat gain, and even lower hormone levels.

How Poor Sleep Can Harm Testosterone Production

Healthy testosterone levels depend on a good night’s sleep.

“You need about three hours of uninterrupted sleep (plus 7–9 hours total) to make a normal amount of testosterone,” Wise says. Testosterone production begins shortly after you fall asleep and peaks in the early morning. Levels are highest during the first REM cycle, and are then maintained through the night if sleep remains stable.¹⁰

Repeated awakenings—from light, noise, stress, or bathroom trips—can significantly lower both total and free testosterone levels (the amount that’s available to promote deeper sleep) by the time your alarm goes off.^{11 12} (11, 12) 

Even short-term sleep deprivation can cause a measurable drop in testosterone:

• In one small study of healthy young men, cutting sleep to five hours per night led to a 10–15 percent decline in morning testosterone levels within a week.¹³
• Another study found that restricting sleep to 4.5 hours caused testosterone levels to fall after a single night.¹⁴

The good news: This decline is reversible. When sleep time and quality improve, testosterone production rebounds to the highest levels your body can sustain based on your age, genetics, body composition, stress, and overall health. More sleep won’t push testosterone beyond its natural ceiling—but without enough of it, you won’t reach your personal max.

How much sleep do I need to increase or maintain testosterone levels?

There’s no “perfect” amount of rest, but studies suggest that most men can maintain healthy testosterone levels with 7–9 hours of sleep. 

If you have to skimp on sleep because of work, travel, or life, it may be less damaging for your testosterone to stay up later rather than wake up earlier, Wise says. In a study where participants were limited to 4.5 hours of sleep, men who delayed bedtime but woke at a normal hour had higher morning testosterone levels than those who went to bed early and woke up early.¹⁵ Although much of testosterone production occurs early in sleep, hormone levels also follow a circadian rhythm that peaks in the morning. Waking earlier than usual can cut off that peak, leading to lower measured testosterone—even if total sleep time is the same.

How To Improve Sleep Quality

To improve both sleep duration and quality and help maintain testosterone levels, Wise recommends focusing on a few high-impact habits:

• Limit caffeine to the first half of the day. You don’t have to give up coffee entirely, but cap intake at one to two servings and avoid caffeine in the afternoon. Late-day caffeine can delay the buildup of adenosine, the chemical that creates sleep pressure (your biological drive to sleep that builds the longer you stay awake) and helps you feel tired at night.¹⁶
  
• Kick your phone out of bed. Scrolling in bed can interfere with sleep onset, Wise says, because light exposure signals to your brain that it’s still daytime. In a small 2016 study, people who used an iPad for 30 minutes before bed felt less sleepy and took longer to fall asleep than those who read a physical book.¹⁷
  
• Lose weight. Shedding some pounds might reduce your risk of sleep apnea and increase testosterone levels.¹⁸ A study of 900 overweight men found that those who lost around 17 pounds increased their testosterone levels by an average of 15 percent.¹⁹
  
• Exercise regularly. Consistent movement—especially combining cardio with resistance training—helps preserve lean muscle, reduce body fat, and improve insulin sensitivity, all of which support healthy testosterone levels. It may also improve sleep quality, creating a positive feedback loop between movement, sleep, and hormone health.²⁰

Improve Your Sleep

10 Habits Practically Guaranteed To Help You Sleep Better Tonight

Ask a Sleep Doctor: Is Six Hours of Sleep Enough?

Low Testosterone and Sleep Apnea

Obstructive sleep apnea (OSA) has been linked to lower testosterone levels. OSA is a sleep disorder in which the airway repeatedly narrows or collapses during sleep, disrupting breathing and lowering blood oxygen levels.²¹ Recent research shows that the more severe the sleep apnea, the lower a man’s testosterone levels will be.²² 

If sleep apnea isn’t treated, testosterone therapy may not be appropriate—so it’s important to rule out or address OSA before starting hormone treatment.

Does TRT Help with Sleep?

Yes—testosterone replacement therapy (TRT) can improve sleep in men with clinically low testosterone, but the benefits depend on proper dosing and individual health factors, including sleep apnea risk.

In a 2017 study of 100 men with clinically low testosterone, one year of TRT was associated with improvements in sleep quality and overall well-being.²³ A 2015 study found that TRT reduced nocturia—frequent nighttime urination—in men with low testosterone, which helped improve sleep continuity and markers of prostate health.²⁴

TRT may also support sleep indirectly by improving metabolic health. Testosterone helps regulate body composition, and treatment can promote fat loss and lean muscle preservation. Because excess body fat increases the risk and severity of sleep apnea, these changes may further support healthier sleep patterns over the long term.

FAQs

About the reviewer

Marilyn Lajoie, M.D., is an internist who specializes in hormone therapy for men and women. She holds degrees in integrative medicine from Saba University School of Medicine and chiropractic medicine from Northeast College of Health Sciences.