Sleeping through night but...

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Scoot2300

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Hello All,
It has been some time since I posted. I appreciate all the knowledge and feedback from everyone. I am 50 years old and have been on TRT since January 2021. My current protocol is 70mg per week with eod injections. No HCG, NO AI. When I first started TRT at 150mg per week, I had terrible insomnia which through what feels like hundreds of hours of reading and research, is a common occurrence. I slowly dropped my dose and eventually ended up here at 70 mg per week. My most recent trough blood work showed:
Total Test - 737
Free T - 224.8
SHBG - 10
Estradiol - 16
All other blood work markers are in normal range. I have been chasing "poor" sleep for almost 2 years now. I did have a triple spinal fusion 23 years ago that does cause a bit of jumpy leg and getting comfortable but I did not have this issue prior to TRT so I have ruled that out. I have genetic hypertension and cholesterol that I had under control via diet and exercise until recently, when my PCP decided it was finally worth it to start low dose meds for both of those. One being generic Lipitor and the other a calcium channel blocker which I am tolerating them both quite easily. My regular diet is healthy and I work out 6 days a week. My cardio exercise is also sound at 2-3 times per week. Everything about my TRT has been a success with the exception of not being able to get quality, deep sleep where I feel rested. I have been recently tracking my sleep with my IWatch and it shows zero deep sleep. I was sleeping for 8 hrs, had 4.5 hours of "quality" sleep with a heart rate of 68. I am looking at my blood work for cholesterol and BP right now (had blood work this morning) and my cholesterol dropped from 244 to 144 and everything else looks good (sugars, liver function, Thyroid TSH, T-3 and T-4 all tested and good). I have tried EVERY supplement combo known to man. You name it, I've tried it. Currently, my doctor prescribed me Mirtazapine which helps me get to sleep but its getting down into the deep sleep is where all my issue are.

I guess my question is, are there just some people, like me, that will just not sleep well while on TRT ever?
 
Defy Medical TRT clinic doctor
Yes, and you partially answered your question yourself.
I would try lowering your T dose further, just to check if it makes a difference regarding sleep.

There are many posts about sleep issues with other causes than testosterone: sleep apnea etc
 
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Many of us do find that excessive testosterone impairs sleep. Your calculated free testosterone is over-range, so you have a lot of leeway for a dose reduction. Do your best to ignore the more-is-better mentality that is so common in the forums and even among many doctors. With your numbers I would gradually reduce to ~50 mg TC per week. I'd give it at least a couple months at the lower level for a fair evaluation. If you cant find a happy medium with good sleep and adequate testosterone then you can also try using a T propionate/cypionate blend daily. The hypothesis is that the daily peak level of testosterone has some independent importance in the results we get, whereas side effects may be more driven by average and/or trough levels. I do well with this approach, using the equivalent of 44 mg TC per week.
 
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