Testosterone Levels After Miscarriage
Testosterone levels can be low after a miscarriage, particularly in women with recurrent miscarriage, though this represents an abnormal hormonal pattern rather than an expected physiological response.
Evidence for Low Testosterone After Miscarriage
In Women with Threatened or Recurrent Miscarriage
- Women experiencing threatened miscarriage demonstrate significantly lower serum testosterone levels compared to women with normal pregnancies 1
- In women with recurrent miscarriage who subsequently miscarried again, higher baseline testosterone levels were actually associated with continuing pregnancy success, while those who miscarried had lower total testosterone, free testosterone, and DHEA-S levels 2
- At 8 weeks gestation, women with a history of recurrent miscarriage show reduced total testosterone and free androgen index compared to women with polycystic ovary syndrome, along with elevated SHBG 3
Hormonal Context
- The low testosterone observed in threatened abortion appears linked to deficiency in DHEA and abnormal sex hormone metabolite levels, which may reduce overall estrogen activity 1
- Androgen precursors (DHEA, androstenedione) are also significantly lower in women with threatened miscarriage, suggesting broader disruption of the steroid hormone pathway 1
- Approximately 14.6% of women with unexplained recurrent miscarriage have elevated free androgen index, though this represents a minority 4
Clinical Implications
When to Suspect Hormonal Abnormalities
- Endocrinological abnormalities are present in approximately 25% of women with unexplained recurrent miscarriage 4
- Testing should include early follicular phase (day 3-5) measurements of FSH, LH, prolactin, androgens, and thyroid function in women with recurrent pregnancy loss 4
- Mid-luteal phase progesterone levels below 30 nmol/L were found in 17.4% of women with recurrent miscarriage, often associated with delayed endometrial development 4
Important Caveats
- The presence of polycystic ovaries alone (found in 44% of recurrent miscarriage patients) does not predict subsequent miscarriage risk 2
- However, hyperandrogenism may be associated with repeated miscarriage when present 2
- Hyperprolactinemia and abnormal thyroid function are not typically associated with recurrent miscarriage 4
Distinguishing From Other Conditions
- In men with chronic liver disease or obesity, low testosterone results from hypogonadotropic hypogonadism and increased peripheral aromatization to estradiol 5
- Postpartum testosterone changes differ from miscarriage-related changes: one study found no association between testosterone levels late in pregnancy or postpartum drops with postpartum depression 5
The key clinical takeaway: Low testosterone after miscarriage represents a pathological finding rather than a normal physiological response, and warrants comprehensive endocrine evaluation in women with recurrent pregnancy loss 1, 4, 2.