Poor sleep reduces GH amplitude, impairing tendon and capsular recovery [161]; (iii) Cortisol, with its diurnal peak in the early morning, may become chronically elevated with sleep disruption, contributing to insulin resistance, immunosuppression, and estrogen resistance [162,163]; (iv) Melatonin, the principal chronobiotic hormone, modulates estrogen receptor expression and has anti-fibrotic, antioxidant, and immune-regulating properties [164,165]. Here, ESR1 is linked to Insulin resistance.