In recent years, Underwater Acoustic Sensor Networks (UASNs) have gained considerable attention for their unique role in detecting and monitoring the underwater environment. However, due to the long propagation time, high bit error rate, and limited bandwidth of underwater acoustic systems, the design of media access control (MAC) protocols is extremely complex, especially for the power consumption of UASNs. Therefore, this paper proposes an energy-efficient MAC protocol for three-dimensional UASNs with time synchronization and power control (TDTSPC-MAC). The proposed protocol is a hybrid access scheme for three-dimensional UASN using techniques such as time synchronization, power control, clustering, layering, and sleep mechanisms. Moreover, the TDTSPC-MAC protocol uses the hierarchical concept and distributed clustering algorithm to divide the three-dimensional space, and combines time synchronization and power control strategies to avoid collisions. Besides, energy consumption is reduced through monitoring and sleep mode. Simulation results demonstrate that the proposed TDTSPC-MAC protocol has reasonable data transmission delay time, throughput, energy consumption, and other performance.