TRT (Testosterone Replacement Therapy) can occasionally contribute to the development or worsening of sleep apnea. This can occur due to several factors:

• One key reason is the potential increase in muscle mass, particularly in the neck and shoulder areas, which can lead to a narrowing of the airway.
• Additionally, testosterone can increase the retention of glycogen and fluid in the muscles, further exacerbating this narrowing.
• Increased upper airway resistance, combined with the hormonal effects of testosterone on respiratory control, can lead to disrupted breathing patterns during sleep, contributing to or worsening sleep apnea.

Indicators of sleep apnea

Snoring - Can indicate OSA - ask patient if his partner comments on snoring

Waking up during the night - can indicate OSA if patient is waking frequently throughout the night

Poor symptom relief - If testosterone replacement therapy (TRT) does not fully resolve symptoms, untreated sleep apnea may be present

Hematocrit (HCT) or Haemoglobin (HB)

If either or both of these markers are borderline, or elevated

Why does this happen:

Poor oxygen supply during sleep (from apnea events) results in red blood cell production increasing, resulting in ‘thicker’ blood.

What else can cause elevated levels:

HCT and HB elevation can also come if Free T supraphysiological (900 pmol/L +) OR if patient is very dehydrated at time of blood test