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I recently took a Panorama Fertility test from Mira, and it said my free testosterone levels were really high. I’m curious what data there is on high testosterone levels and infertility. How likely is it that this might be a reason why we haven’t conceived yet? It’s been about six months of trying.
—Looking for Answers
There’s a possibility that a high free testosterone level is a reason that you haven’t been able to conceive yet because it can be indicative of having polycystic ovarian syndrome, or PCOS. However, just because you have a high free testosterone level does not mean you necessarily have PCOS.
PCOS impacts fertility, as most who have it do not ovulate regularly, and to become pregnant, an egg needs to be released.
Most of the research on testosterone levels and infertility focuses on the PCOS population. There was a study that looked at patients with unexplained infertility who were pursuing fertility treatment with intrauterine insemination (IUI), and no differences were found in pregnancy rates in those with higher or lower testosterone levels.
There are two levels of testosterone that can be measured in the blood: the total and free. Many hormones, like testosterone, can be bound to proteins in the blood. A certain proportion of that hormone can be unbound, or in the blood “freely,” and that is what was measured on your test. To give a more “real-world” analogy, think of your blood like a bank where you have both a savings and a checking account. The total testosterone would be all the money you have in the bank, whereas the free testosterone is the money in your checking account that you could spend. Of note, free testosterone is best measured by a technique called equilibrium dialysis or by calculating the amount of the binding protein in the blood to help you determine the true level of free testosterone. It would be worth understanding what type of test was used to calculate your result to understand how accurate it might be; you may have to contact the company directly for this information.
If a patient were to come to me with a scenario like yours, I would want to know about their menstrual cycle history, be able to perform a physical exam and ultrasound, and repeat some blood tests, including the total and free testosterone. If you did have regular menstrual cycles, I would be curious to know where you were in your cycle, as testosterone levels vary throughout a cycle in normal, menstruating women.
So, to answer your specific question, if you are having regular menstrual cycles and ovulating on your own, the high testosterone should not be impacting your ability to conceive. If you are not, then your results could be due to having PCOS. Either way, I’d talk to your OB-GYN or see a fertility specialist for further discussion and testing if needed.
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