Exogenous Testosterone Use Increases the Risk of Central Serous Chorioretinopathy

Abstract

Objective: To evaluate the association between exogenous testosterone (ExoT) use and central serous chorioretinopathy (CSCR). Design: Retrospective observational cohort study using large-scale electronic health record data. Subjects/Participants: Patients receiving ExoT therapy, identified from the MarketScan and STARR databases. Methods: Data were accessed from two sources: Merative MarketScan Commercial Database and Stanford's Clinical Data Warehouse (STARR), which aggregates deidentified patient records from Stanford Health Care. Patients on testosterone therapy were included and categorized by CSCR status. Demographic factors such as sex (administrative field), race, and ethnicity were assessed. Laboratory values (testosterone, hematocrit, red blood cell counts count, cortisol) were compared in STARR, with limited availability in MarketScan. Logistic regression analyses were performed in MarketScan, adjusting for age and sex. A sensitivity analysis restricted to patients exposed to ExoT prior to CSCR diagnosis was also performed. Main Outcome Measures: The primary outcomes were CSCR prevalence and adjusted odds ratios for CSCR risk in patients on ExoT. Secondary outcomes included differences in laboratory values and treatment requirements (photodynamic therapy and intravitreal injections). Results: In STARR, individuals with CSCR on ExoT had significantly higher mean testosterone levels (P = .001), hematocrit (P = .022), and red blood cell counts (P = .005) compared to those without CSCR. In MarketScan, laboratory values trended in the same direction but were not statistically significant, likely reflecting limited sample sizes. Logistic regression in MarketScan showed that ExoT was significantly associated with increased CSCR risk (adjusted odds ratios: 8.05; 99% CI: 6.04-10.73). In both datasets, there were no significant differences in treatment rates (photodynamic therapy or intravitreal injections) between ExoT and non-ExoT users. In a sensitivity analysis restricted to patients who received ExoT prior to CSCR diagnosis, no significant laboratory differences were observed. Conclusions: This study demonstrates a significant association between ExoT use and increased CSCR risk, highlighting the importance of monitoring patients on testosterone therapy for potential ocular symptoms, especially among high-risk demographic groups.