Testosterone and Breathing
What It Means for
Men and Women

How testosterone shapes breathing

Testosterone influences the respiratory system through several pathways. It stimulates the production of red blood cells, which carry oxygen, giving men with higher testosterone levels a greater oxygen-carrying capacity on average than women. It increases the size and strength of respiratory muscles, including the diaphragm, contributing to higher lung volumes and greater peak flow rates in men.

It also affects the anatomy of the upper airway. Under testosterone's influence during puberty, the larynx enlarges and the pharyngeal airway changes shape. These structural changes increase airway resistance in men relative to women, which is one of the reasons men are significantly more prone to snoring and obstructive sleep apnea than pre-menopausal women of similar age and weight. A larger airway is not necessarily a more stable airway, and the anatomy that testosterone creates is more susceptible to collapse during sleep.

The sleep apnea link

Men develop obstructive sleep apnea at roughly two to three times the rate of pre-menopausal women. Testosterone is a significant part of the explanation. Its structural effects on the airway increase susceptibility, while the absence of the airway-protective effects of oestrogen and progesterone compounds the risk further.

There is also a bidirectional relationship between testosterone and sleep apnea that is worth understanding. Testosterone levels are strongly influenced by sleep quality, most testosterone production in men occurs during deep sleep, and sleep apnea, which fragments and disrupts sleep architecture, suppresses testosterone production. Men with untreated sleep apnea often have measurably lower testosterone levels as a result. Treating the sleep apnea typically leads to recovery of testosterone levels, which highlights the extent to which sleep quality and hormonal health are intertwined.

Testosterone in women

Women produce testosterone in smaller amounts, primarily in the ovaries and adrenal glands. Its role in female physiology includes contributing to libido, energy, bone density, and mood. Its effects on breathing in women are less dramatic than in men but are not negligible.

During perimenopause and menopause, the ratio of testosterone to oestrogen and progesterone shifts as the female hormones decline faster than testosterone. This relative increase in androgenic influence can contribute to changes in body fat distribution, airway anatomy, and sleep-disordered breathing risk that begin to approximate male patterns. Post-menopausal women have significantly higher rates of sleep apnea than pre-menopausal women, and the shifting hormonal balance is one of the contributing factors.

Declining testosterone in men

Testosterone levels in men decline gradually from their mid-thirties onward. The symptoms associated with this decline, reduced energy, poorer sleep, increased anxiety, diminished recovery capacity, overlap substantially with the symptoms of burnout. This overlap is not coincidental. Chronic stress suppresses testosterone production directly, through the effects of cortisol on the hypothalamic-pituitary-gonadal axis. And poor sleep, which is both a symptom and a driver of burnout, suppresses it further.

Addressing sleep quality through better breathing such as nasal breathing, reduced sleep-disordered breathing, improved sleep architecture, is one of the most direct ways to support testosterone production in men dealing with burnout or chronic stress. It is not a testosterone treatment, but it removes one of the most consistent suppressors of testosterone: chronically fragmented, unrestorative sleep.