The complex relation between obstructive sleep apnoea syndrome, hypogonadism and testosterone replacement therapy

Area of Science:

• Endocrinology
• Sleep Medicine
• Men's Health

Background:

• Obstructive sleep apnoea syndrome (OSAS) is an under-recognized condition.
• Key risk factors for OSAS, including obesity and metabolic syndrome, are also linked to male hypogonadism (MH).
• OSAS can independently contribute to MH through hypoxia and sleep disturbances.

Purpose of the Study:

• To review the association between OSAS, MH, and testosterone replacement therapy (TRT).
• To discuss the implications of TRT in hypogonadal men with OSAS.
• To highlight the importance of personalized TRT strategies and polysomnography assessment.

Main Methods:

• Literature review of studies on OSAS, MH, and TRT.
• Analysis of the impact of TRT on OSAS symptoms and potential exacerbation of polycythaemia.
• Discussion of current guidelines and personalized treatment approaches.

Main Results:

• OSAS and MH share common risk factors like obesity.
• OSAS can cause or worsen MH, and MH may increase OSAS risk.
• TRT in severe OSAS is generally contraindicated, but personalized approaches considering dosage and duration are crucial.

Conclusions:

• TRT in hypogonadal men with OSAS requires careful consideration due to potential worsening of OSAS and polycythaemia.
• Long-term, lower-dose TRT might improve OSAS symptoms, while high-dose TRT could exacerbate them.
• Polysomnography assessment is recommended for patients on TRT who develop OSAS symptoms.