Why Low T is Plaguing the Fire Service

“Does sleep loss cause low testosterone?” I hear it asked by firefighters at almost every sleep deprivation training class I teach. Don’t hate the messenger, but the answer is yes. In this article, we will look at reasons why. More importantly, we will address how we can fix it amidst increasing call volume that occurs in the middle of the night.

First, we must understand what’s happening in the body.  For starters, the body primarily Screen Shot 2018-09-28 at 4.39.21 PMproduces testosterone while we sleep. So it’s a pretty obvious deduction that the longer you are awake, the less testosterone the body will make. This virility hormone is known not only for sex function but also bone density, muscular strength, and mental focus.  The University of Chicago performed a testosterone and sleep study on young healthy men that were published by the Journal of the American Medical Association in 2011. The study found that the testosterone levels of the male participants dropped by 10-15% when sleep was restricted to 5 hours per night, as soon as just one week. This drop was measured in comparison to the participants’ baseline T levels found in 7-8 hours of sleep per night. During the study, these sleep-deprived men unanimously resulted in progressive decreases in muscular strength, energy, concentration, and vigor; congruent to their testosterone drop. What does this equate to in terms of health? Through normal aging, men’s testosterone levels naturally lower approximately 1%- 2% annually, so after just one week of sleep deprivation, guys have the levels of testosterone of men 10 to 15 years their senior. Sleep deprivation quite literally accelerates the aging process.

In order to understand further reasons for low T in the fire service, we must look at rates of sleep apnea- which is a serious sleep disorder found to be associated with low testosterone. How many firefighters do you personally know that use a CPAP (continuous positive airway pressure) machine – or maybe should? Perhaps you are a firefighter reading this who uses a CPAP machine or has been recently diagnosed with this sleep disorder.


According to a study of 6993 firefighters that were screened for common sleep disorders, almost 40% of them were diagnosed positive with a sleep disorder; the majority were found to have sleep apnea followed by insomnia, and work shift disorder. Sadly, 80% of these firefighters who screened positive for a diagnosable sleep disorder had been unaware and untreated prior to the study (Dr. Barger, Harvard). Many firefighters I know tell me that getting diagnosed with sleep apnea and using a CPAP machine changed their life and their spouse’s life for the better. They sleep better, have more energy and have reclaimed their health.

What exactly is the disorder? Obstructive Sleep Apnea, the type of apnea most firefighters have, isScreen Shot 2018-09-28 at 4.35.42 PM associated with excessively heavy snoring, choking sounds or pauses in respiration during sleep. This disorder is appropriately named after the Greek word apnea which means “without breath.” There is a collapse to the airflow due to relaxed or weakened neck muscles, excess neck fat or a large tongue, resulting in a cessation of breathing which limits oxygen to the brain and body. It profoundly interferes with the circadian rhythm. Sleep apnea disrupts access to regenerative slow-wave Delta sleep and REM (rapid eye movement) sleep. Sometimes individuals never enter REM sleep at all, a critically restorative phase when dreaming occurs, and when testosterone levels peak and maintain. The overall impact prevents the cardiac, immune and metabolic systems to reset and function properly.  Breathing cessations can occur dozens, or even hundreds of times per night lasting for seconds to even minutes. If left untreated, the consequential risks couple the effects of low testosterone levels and the condition may lead to high blood pressure, irregular heartbeat, heart disease, stroke, type 2 diabetes and something we are all familiar with: daytime fatigue (Johns Hopkins Medicine).

But why?

Here’s the double whammy. As a direct response to sleep loss, the body releases a cascade of stress hormones which cause an increase to blood pressure, a lowering to the immune response, and an unleashing of a pitbull-like grip to hold on to body fat stores- specific in the mid region. Sleep deprivation and sleep apnea experienced either independently or combined, regardless, lead to excess weight. Dr. Eve Van Cauter, a leading sleep scientist with a team of researchers found that sleep-deprived individuals not only experience starkly elevated stress hormones like cortisol that cause fat retention, they also experience an increase in the hunger hormone (ghrelin) that profusely increases when an individual has reduced sleep resulting in impulsive eating. Their findings were impactful: individuals who sleep 6 hours or less, on average consume 70,000 extra calories annually, which translates to 10 to 15 pounds of weight.


While obesity and higher levels of fat in the neck area are often cited as a cause of sleep apnea, it is a true case of which came first, chicken or the egg. We know for a fact that circadian disruption, i.e. running calls in the night leads to weight gain. Regardless of which causes which, it’s an ugly downward cycle. And not all fat is made the same. aromataselowt2Different from subcutaneous fat, abdominal fat,  caused by sleep loss is visceral and it goes deep, enveloping the intestines, pancreas and liver organs in a dangerous way. It causes an expression of an enzyme called aromatase, which triggers the conversion of male hormone androgens to estrogen, massively lowering testosterone health. A cascade of physiologic effects ensue, causing a disruption to other hormones and health functions, “All of these factors eventually contribute to the CHAOS Complex: coronary disease, hypertension, adult-onset diabetes mellitus, obesity and/or stroke as permanent changes unfold. Other consequences of the chronic hypogonadal state include osteopenia, extreme fatigue, depression, insomnia, loss of aggressiveness and erectile dysfunction all of which develop over variable periods of time.” (Cohen; Aromatase, adiposity, aging, and disease.  US National Library of Medicine National Institutes of Health.)

This adage is true and false: “If a firefighter has excess fat all they need to do is work out more.” My theory is backed by research that proves in order to rid the body of visceral fat, yes, the body must work out, but equally with, if not of higher importance, the body must experience regular, routine stress relief and restorative, high-quality sleep. Stress reduction practices, done before bedtime actively reset hormones by engaging the parasympathetic nervous system. The parasympathetic nervous system resets and renews all systems of the body and it must be engaged in order to experience deep quality, restful sleep which in turn supports ideal weight, heart health, muscle mass, and healthy testosterone levels.

We have created a set of stress – reduction practices that activate the parasympathetic nervous system response and can be done simply in minutes at the firehouse. These practices have been studied and proven to lower blood pressure, reduce stress hormones like adrenaline and cortisol, calm and restore the nervous system and improve sleep patterns. The fire service should be doing everything possible to maximize quality of sleep to regain healthy testosterone levels, and reclaim healthy firefighter lives on and off the job. Every practice that we teach in our course, the First Responder Sleep Recovery Program has been influenced and developed through the support of my firefighter husband who works for the Denver Fire Department, as well as through test groups of career firefighters who have supported the evolution of our program design and approval. We are so honored to work with each and every fire department and firefighter partnering in the mission to support the health and wellness of those in the emergency services.  If your department would like to partner with us and bring this transformative, life-saving training and sleep education to your members please contact me, Jacqueline Toomey, founder of the First Responder Sleep Recovery Program:  720-347-0269 or firstrespondersleeprecovery@gmail.com.