HRT Experts - your input?

[CraigWatts]

Would like the input of you guys who have been at this awhile. Not getting any help from doctors. My main question is - do I have any indication what is causing my low testosterone , and do I have any hope of restoring it without supplementation? I wont load you up with lab results. They've already been analyzed by a neuroendocrinologist who is very HRT friendly. I couldn't get a clear answer from him. Maybe someone here will have some insights/brainstorms. So Ill summarize:

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Pre any treatment: Testosterone 296. Estradiol 6 (insanely low). DHT extremely low. However: LH and FSH - normal.
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Plan 1: Clomid 12.5mg daily: Testosterone 880. Estradiol 8 (still low). DHT still low. However: LH and FSH - far too high.
Sex drive returned, depression lifted, sleep & energy restored - followed by total loss of libido.
I theorized that I felt like crap because my LH and FSH were too high.
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Plan 2: Clomid 6mg daily: Testosterone 730. Estradiol 12 (still low). DHT still low. However: LH and FSH - back in range. Good.
Sex drive back. Felt much better. Followed by bouts of severe afternoon depression.
I theorized that I needed my Estrogen to be pulled up in range. So I added DHEA.
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Plan 3: Clomid 6mg + 5mg DHEA: Testosterone 550.
Felt for the most part perfect again. Sex drive still somewhat blah. But for some reason, this combination was my "sweet spot".

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Notes:
* I clearly didn't have low LH and FSH when I started. Probably shouldn't have gone the Clomid route.
* I got insane results from a very small dose (12mg) but this pushed my LH out of range and i felt like crap despite 880 testosterone.
* Lowering the dose got me back in range, but pushed my testosterone down to 550 which is lower than I'd like.
* My estrogen and DHT are still too low. And not moving.

This tells me that the source of my (entire) endocrine system being "low" is not an LH / FSH problem. Its something else.

I'm not sure how to proceed at this point.

* I want my estrogen at about 26. Not 8.
* I want my DHT at a slightly higher level just for overall health.
* I want my Testosterone at about 750 ongoing.
* I do not want to take testosterone to accomplish this
* I prefer to find the true cause and address that.

Any thoughts at all?

* I can't keep taking Clomid forever. And if I start Androgel that's just going to "undo" any endegenous production I may have kickstarted with the Clomid.
* I've been on clomid now for almost 6 months
* Granted its only 6mg a day, but still... this can't be a smart approach.
* I have extreme propensity towards heart attacks / stroke / heart disease in my family.
* I got my 23andMe results back and my genetic markers put me at very high risk for all three as well.
* I don't want to mess with Androgel or injections.

Thanks.

[kelkel]

So, you have normal LH values which shows a functioning pituitary yet low test. Normally this points to primary (testical) issues but you respond well to clomid.
Makes me wonder, normal LH values are not enough yet hyper-stimulated values while on clomid elicit a good response.
My initial thought is to obtain an ultra-sound on your testicals to look for issues, varicoceles, etc. based on info given.

[CraigWatts]

Had an ultrasound done exactly two years ago and they noted:

"Trace right hydrocele, not of clinical significance. There may be trace of left hydrocele, also not of significance".

Aside from that, I am stumped.

At this point I was thinking of upping my Clomid again to 12mg. Not taking any androgel . And getting myself back to that 880 testosterone level. My LH and FSH will go "high" again I know. And I will probably feel like crap again. But maybe I can stop after awhile and enjoy ongoing natural production from then forward. I know Clomid "restarts" people.

Thoughts?

[kelkel]

It's worth a shot Craig. I'd also consider a second opinion ultrasound.