From the Guidelines
Testosterone therapy should be approached with caution in patients with Central Serous Chorioretinopathy (CSCR) as androgens may potentially exacerbate the condition. The relationship between testosterone and CSCR is not fully understood, but it is thought to involve the hormone's effects on choroidal vasculature and retinal pigment epithelium permeability 1. For patients requiring testosterone replacement, consider using the lowest effective dose and closely monitoring retinal changes with regular ophthalmologic examinations every 3-6 months.
Some key considerations for managing CSCR include:
- Treating hyperfluorescent areas on indocyanine green angiography (ICGA) that correspond to the area of focal leakage on fluorescein angiography (FA) and sub-retinal fluid on optical coherence tomography (OCT) 1
- Using half-dose or half-fluence photodynamic therapy (PDT) as it appears to be the safest and most effective treatment for CSCR, although it may not be available in all countries 1
- Considering alternative delivery methods such as topical gels, which provide more stable hormone levels, instead of injectable formulations
- Monitoring patients with risk factors for CSCR, including stress, corticosteroid use, and type A personality, even more carefully when receiving testosterone therapy
If a patient develops CSCR while on testosterone therapy, temporary discontinuation or dose reduction should be considered while working with both an ophthalmologist and endocrinologist. Alternative approaches to managing hypogonadism, such as clomiphene citrate, which stimulates endogenous testosterone production rather than providing exogenous hormone, may be considered in appropriate candidates. Regular follow-up and monitoring of retinal changes are crucial in patients with CSCR receiving testosterone therapy.
From the Research
Considerations for Testosterone Therapy in CSCR Patients
- The relationship between Central Serous Chorioretinopathy (CSCR) and testosterone therapy is a significant consideration, as some studies suggest a potential link between exogenous testosterone therapy and the development of CSCR 2.
- A retrospective case series found that nine patients presented with CSCR after beginning exogenous testosterone therapy, and two patients experienced resolution of symptoms and subretinal fluid after stopping therapy 2.
- The use of testosterone replacement therapy (TRT) in patients with CSCR requires careful consideration of the potential risks and benefits, particularly in light of the possible association between exogenous testosterone and CSCR.
- Alternative treatments for hypogonadism, such as gonadotropins, clomiphene citrate, and tamoxifen, may be considered in patients with CSCR who require testosterone therapy 3.
- Clinicians should exercise caution when prescribing TRT to patients with CSCR, monitoring for potential adverse events and adjusting treatment as needed.
Potential Risks and Adverse Events
- Adverse events associated with TRT in hypogonadal men, including those with CSCR, may include gynecomastia, persistent pain at the injection site, local reactions to testosterone skin patches, and priapism 4.
- The risk of these adverse events should be carefully weighed against the potential benefits of TRT in patients with CSCR.
- Regular monitoring and follow-up are essential to minimize the risk of adverse events and optimize treatment outcomes.
Treatment Alternatives and Considerations
- Eplerenone, a mineralocorticoid receptor antagonist, has been shown to be effective in treating chronic CSCR refractory to photodynamic therapy 5.
- This treatment alternative may be considered in patients with CSCR who are at risk of adverse events from TRT or who have not responded to other treatments.
- The optimal treatment approach for patients with CSCR and hypogonadism will depend on individual factors, including the severity of symptoms, medical history, and treatment goals.