By Purnima S. Patel, MD
This retrospective case series found that exogenous testosterone may be an independent risk factor for the development of central serous chorioretinopathy (CSCR).
CSC has been typically associated with several risk factors that have elevated serum glucocorticoid levels in common. These include psychosocial stress, Type A personality, exogenous steroid treatment, Cushing syndrome, infection, tobacco, alcohol and pregnancy. Androgens may also play a role, and retinal pigment epithelial cells have been found to contain androgen receptors for 5α-reductase, the enzyme responsible for conversion of testosterone to the more potent molecule dihydrotestorsterone.
Recently, a greater awareness of serum testosterone decline with age has led to increased testing for testosterone levels. Combined with new delivery systems and increased consumer marketing, testosterone prescription sales have grown by 25 to 30% annually between 1993 and 2011. Exogenous testosterone is used in men with low testosterone to treat sarcopenia, depression, low libido and cognitive decline.
In this study, the authors reviewed the charts of nine patients who presented with CSCR after beginning exogenous testosterone therapy. They were all men over the age of 43 with a mean age of 51: a decade older than the average CSCR patient.
Six patients were using a gel preparation (Androgel), two were being treated with an underarm formulation (Axiron) and one patient was taking tablet supplements (Testopill). The duration of use prior to presentation ranged from three months to two years with a mean of 14 months. They were followed for an average of 17.3 months (range, 3 to 59 months).
All patients showed a significant presence of subretinal fluid typical of CSCR and increased choroidal thickness on spectral-domain OCT. Four patients had bilateral findings. The seven patients who continued testosterone therapy for the duration of follow-up continued to have subretinal fluid. Two patients discontinued treatment upon initial evaluation with resolution of symptoms and subretinal fluid and improved vision to 20/20.
The authors conclude that exogenous testosterone may increase choroidal blood flow and permeability. While this result is not likely in all cases of CSCR, inquiring about testosterone therapy in patients with CSCR is an appropriate consideration and may in some cases lead to adjustment or cessation of therapy.