Increased Risk of Hypogonadal Symptoms in Shift Workers with Shift Work Sleep Disorder - Beyond the Abstract

Shift workers comprise more than 15% of the U.S. workforce, with 10% demonstrating shift work sleep disorder (SWSD). SWSD is a circadian rhythm disorder caused by a reduction of total sleep time due to a work schedule and has been found to be associated with hypogonadism in men.1 Pastuszak et al. had previously provided the foundation for this research, identifying that non-standard shift workers with poor sleep quality were at increased risk for hypogonadal symptoms and sexual dysfunction.2

In this present study, Balasubramanian et al. surveyed men presenting to a single academic men’s health clinic between July 2014 and June 2017. The administered research instruments included questionnaires about work schedules, a validated SWSD screening questionnaire and validated questionnaires such as the Androgen Deficiency in Aging Males (ADAM) and non-validated quantitative Androgen Deficiency in Aging Males (qADAM) questionnaires. Ultimately, the authors found that males working non-standard shifts with a high risk for SWSD had worse hypogonadal symptoms and lower testosterone levels compared to daytime workers and non-standard shift workers with low risk for SWSD.
The authors provide important insights into the emerging relationship between sleep quality and hypogonadism. Separate studies assessing the impact of obstructive sleep apnea and sleep restriction on testosterone levels have been performed, similarly concluding that poor sleep quality is associated with hypogonadal symptoms.3,4 While the mechanism between sleep quality and hypogonadism is not completely understood, it is evident that further research into this relationship is critical for optimizing the care for patients with SWSD and hypogonadal symptoms. As sleep is increasingly recognized as a determinant of overall health, future work will continue to define the role of sleep habit modification in the management of men with hypogonadal symptoms, particularly amongst those who may be considered ineligible for testosterone therapy based on current American Urological Association (AUA) guidelines.

Written by: Eric M. Lo, Adithya Balasubramanian, Larry I. Lipshultz, Baylor College of Medicine, Houston, Texas, USA.


  1. Cho, Jae Wook, and Jeanne F. Duffy. "Sleep, sleep disorders, and sexual dysfunction." The world journal of men's health 37, no. 3 (2019): 261-275.
  2. Pastuszak, Alexander W., Young M. Moon, Jason Scovell, Justin Badal, Dolores J. Lamb, Richard E. Link, and Larry I. Lipshultz. "Poor sleep quality predicts hypogonadal symptoms and sexual dysfunction in male nonstandard shift workers." Urology 102 (2017): 121-125.
  3. Hammoud, Ahmad O., James M. Walker, Mark Gibson, Tom V. Cloward, Steven C. Hunt, Ronette L. Kolotkin, Ted D. Adams, and A. Wayne Meikle. "Sleep apnea, reproductive hormones and quality of sexual life in severely obese men." Obesity 19, no. 6 (2011): 1118-1123.
  4. Schmid, Sebastian M., Manfred Hallschmid, Kamila Jauch‐Chara, Hendrik Lehnert, and Bernd Schultes. "Sleep timing may modulate the effect of sleep loss on testosterone." Clinical endocrinology 77, no. 5 (2012): 749-754.
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