i don’t handle testosterone at my pharmacy, mostly peptides and secretagogues, but the HPG axis literature overlaps enough that this pattern is worth naming. at 2500 ng/dL on 300mg/week, aromatization load is substantial. elevated E2 is documented in the sleep architecture literature - it suppresses melatonin synthesis upstream and shortens REM duration. that’s not just “trouble sleeping”, that’s the melatonin pathway being actively competed against. supplemental melatonin can’t fix a suppressed synthesis signal, which is probably why that list of sleep aids reads like a graveyard. the second mechanism is hematocrit. exogenous test at supraphysiological doses is a well-documented risk factor for sleep apnea - elevated RBC viscosity, upper airway muscle changes - and the “frequent wakeups plus anxiety” pattern maps closer to OSA than primary insomnia. none of the things on that list touch either variable. if E2 and hematocrit haven’t been pulled recently, that’s the actual place to start. not because it’s guaranteed, but because the mechanism case is cleaner than “try more supplements.” anyway.
Does melatonin suppression hit at any elevated E2 level or is there a threshold? Peri shows wide variation (some fine at 50-60, others tanked), wondering if you’ve tracked the same pattern on the T side or if it’s more linear.
the wide peri variation you’re describing (fine at 50-60 vs tanked) is basically the answer to your own question - if it were a clean threshold you wouldn’t see that spread, so it’s individual sensitivity stacked on top of the level, not the level alone. i can’t speak to the T side from data, that’s outside what i handle, but mechanistically a fixed cutoff would surprise me more than a messy linear-ish curve with big interpersonal scatter. ymmv, and that’s a clinician question once it’s about an actual person’s numbers.
the ‘big scatter’ you’re describing might look less random if people separated follicular from luteal - E2 at 50 doesn’t hit the same across cycle phases because progesterone context shifts how it lands. if people tracked phase alongside numbers before seeing the clinician, that mess might actually resolve into pattern. mechanism could still be messier than a clean threshold, but some of that scatter is probably just apples-to-oranges.