Can Testosterone Cause Snoring?

aging aromatase aromatase inhibitors estrogen heart disease hormone pellet therapy hormone replacement therapy sex hormones sex steroid hormones sleep sleep apnea sleep-disordered breathing snoring soy elimination diet soy-free diet testosterone testosterone replacement therapy May 13, 2023

Testosterone is a sex steroid hormone in males and females. It is produced by males' testicles and females' ovaries. However, testosterone levels in adult men are around seven to eight times greater than the hormone's levels in adult women.¹ Testosterone is responsible for the development of the male reproductive system. It also promotes secondary sexual characteristics. Examples of the latter are increased muscle and bone mass, body hair growth, and higher sex drive. Moreover, testosterone affects mood, mental processes, metabolism, and heart and blood vessel health in both genders.² In this article, we'll cover the following topics to see whether testosterone plays a role in snoring too:

The relationship between testosterone and sleep
The risks of testosterone replacement therapy (TRT)
The testosterone-estrogen connection
The role of estrogen in snoring

Let's begin by describing what testosterone levels are like in men with sleep-related issues.

The relationship between testosterone and sleep

Sleep-disordered breathing (SDB) refers to a group of conditions in which people breathe abnormally while they are sleeping. SDB affects around 25 percent of adult males. The usual symptoms are snoring, sleep apnea, excessive daytime sleepiness, and fatigue.³

Regarding sleep apnea, it comes in different forms. The most common one is obstructive sleep apnea (OSA). In OSA, breathing repeatedly stops and starts during sleep. This happens when the smooth muscle in the throat and neck is too relaxed and loses its tone (i.e., its ability to stay partially contracted). As a result, the soft tissue in the back of the throat collapses, and the airway becomes partially or completely blocked. Air then stops flowing into the lungs, thus lowering blood oxygen levels. When the brain senses this drop in oxygen, the person gets awakened for a short time. People with OSA tend to snore loudly. They also feel tired because of poor sleep quality at night.^4,5

Testosterone levels have been found to be lower in men with SDB and OSA. This is likely why both disorders have also been linked to sexual dysfunction, mainly erectile dysfunction and decreased sex drive.^4,6

The risks of testosterone replacement therapy (TRT)

TRT is a popular way of improving the symptoms of testosterone deficiency.⁷ TRT delivers testosterone to the body via skin or gum patches, or through topical gels or solutions. It can also be administered through intramuscular injections, under-the-skin pellets, and oral capsules. Each of these routes can come with side effects though. For example, patches and gels can cause irritation or inflammation of the body part on which they are applied. Injections can lead to unstable testosterone levels, which can then bring about mood and energy changes. Oral testosterone can cause liver damage. As for pellets, they allow for better absorption and are promising for long-term use. But their placement under the skin requires a minor surgical procedure, so they can only be received in a doctor's office. The procedure can have adverse effects, such as bleeding and site infections. ^8,9,10,11

TRT options differ not only in administration routes, but also in the forms of testosterone they use. In particular, synthetic forms like methyltestosterone and testosterone undecanoate are commonly used for patches, injections, and oral medication. However, both of them have different chemical structures from human testosterone; such differences are partly responsible for the health risks linked to TRT.

On the other hand, bioidentical testosterone comes from plants. It is structurally identical to the hormone produced by the human body. Thus, it is often advertised as a safer option compared to synthetic testosterone. It should be noted though that the bioidentical version still undergoes chemical processing in the laboratory to reach its final form. Bioidentical testosterone is available as patches, creams or gels, and capsules or tablets. It is commonly administered as pellet implants too.¹²

As a whole and regardless of delivery and form, TRT has been linked to an increased risk of various health problems. These include heart disease, prostate enlargement and cancer, and high red blood cell count. It may worsen the symptoms of OSA too.¹⁰

The testosterone-estrogen connection

Aromatase inhibition is an alternative to TRT for addressing low testosterone. Aromatase is an enzyme that converts testosterone to estrogen. The conversion takes place mostly in fat tissue. The process occurs in the brain, bone, breasts, liver, blood vessels, and testes as well.² Aromatase increases with aging. So, as men and women get older, their testosterone levels naturally decline, while estrogen gets higher. These changes account for the symptoms of testosterone deficiency, including an increase in body fat and a decrease in muscle mass.¹³

Aromatase inhibitors prevent testosterone from getting converted to estrogen. These substances have been shown to raise testosterone considerably to youthful levels in older men. At the same time, they lower estrogen moderately and keep it within the normal range. Aromatase inhibitors can be either or synthetic (e.g., anastrozole) or natural (e.g., diindolylmethane).^14,15,16

The role of estrogen in snoring

As described earlier, smooth muscle makes up the human airway. This muscle has estrogen receptors that, when activated, decrease the entry of calcium ions across cell membranes. The drop in calcium levels within the cells then relaxes the smooth muscle.⁵ When there is too much estrogen, the airway smooth muscle becomes too relaxed and loses its tone. This is what happens in OSA. The same mechanism is behind snoring, in which the partially relaxed airway muscle vibrates as air flows through it.¹⁷

Aside from the natural conversion of testosterone to estrogen, substances called xenoestrogens and phytoestrogens raise estrogen in the body. Xenoestrogens are synthetic chemicals widely found in the environment, while phytoestrogens are plant-derived substances present in a lot of foods today. Both xenoestrogens and phytoestrogens mimic the action of human estrogen.^18,19,20 For these reasons, it is easy for people to have excess estrogen, especially as they age.

Conclusion

Testosterone by itself does not cause snoring. However, the conversion of testosterone to estrogen via aromatase activity, along with the presence of xenoestrogens and phytoestrogens in the environment and in our diet, contributes to excess estrogen. Too much estrogen, through its effects on the airway smooth muscle, results in snoring.

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