TRT and pregnancy: can testosterone therapy actually cause twins?

What did @teatimewithtawa actually say?

She said she thinks she might be carrying twins, citing two data points: an hCG of 173 at 12 DPO and 3,023 at 19 DPO. Her reasoning is that both numbers fall "well into the twin pregnancy category" and that twins run in her family. She's careful about it, though. She adds it "could easily be just a singleton" with a strong rise, and she's waiting on her first ultrasound at 11 weeks to know for sure. That's a reasonable, appropriately hedged position, not a viral overreach.

The framing here is personal and anecdotal, which is worth noting. She's not telling viewers their hCG means they're having twins. She's sharing her own numbers and her own reasoning. That matters when evaluating the accuracy of what she's actually claiming.

Does the science back this up?

Partially. hCG does tend to run higher in twin pregnancies, but the overlap with singleton ranges is significant enough that hCG alone cannot reliably predict multiples. The short answer: elevated hCG is a soft signal, not a diagnostic one.

A study by Heshmat et al. (2011, Reproductive Biology and Endocrinology) found that median hCG levels were meaningfully higher in twin pregnancies compared to singletons in early gestation, but the distributions overlapped considerably. Another analysis published in Fertility and Sterility (Seifer et al., 1995) noted that while twin pregnancies showed higher hCG at equivalent gestational ages, individual variation was wide enough to make prediction unreliable at the individual level. Her 3,023 at 19 DPO is a strong number, and the doubling time from 173 to 3,023 over seven days is faster than average, but fast-doubling singleton pregnancies exist and are well documented. hCG alone has poor positive predictive value for twins. Only ultrasound confirms chorionicity and number of gestational sacs.

What did they get wrong (or right)?

She got the general direction right: higher hCG can be associated with twin pregnancies. She got the caveats right, too. She explicitly says it "could easily be just a singleton." That kind of epistemic honesty is rare on TikTok health content.

Where the framing gets a little shaky is the phrase "well into the twin pregnancy category." There isn't a clean, validated cutoff that places a given hCG reading into a "twin category" versus a "singleton category" at these early DPO windows. Reference ranges vary by lab, by assay, and by individual. Presenting a specific number as categorically belonging to twin territory implies more precision than the data supports. That said, she doesn't claim certainty, so this is a framing issue more than a factual error. The bigger risk is that viewers with high hCG readings might read into her video and assume the same logic applies to them, which it doesn't without clinical context.

What should you actually know?

hCG is a blunt instrument for predicting multiples. It rises fast in healthy pregnancies, it rises faster on average in twin pregnancies, and it rises at wildly different rates across individuals. None of that adds up to a diagnostic tool.

The only reliable way to confirm twins is transvaginal or transabdominal ultrasound, ideally between 6 and 10 weeks when two gestational sacs or two embryos with cardiac activity can be visualized. Before that window, hCG trends tell you something about pregnancy viability, not about fetal number. For anyone using assisted reproductive technology, monitoring protocols differ and your clinic's thresholds apply, not social media benchmarks. If you're in an infertility journey and parsing your own hCG numbers against TikTok content, talk to your reproductive endocrinologist before drawing conclusions. The creator is doing exactly what she should be doing: waiting for the ultrasound.