Associations between Androgen Exposure, Polycystic Ovary Syndrome, and Transmasculine Individuals with Central Serous Chorioretinopathy

Purpose: The prevalence of central serous chorioretinopathy (CSCR) among transmasculine, polycystic ovary syndrome (PCOS), and androgen-exposed patients remains largely unexplored. Although these groups involve patients with elevated testosterone levels, previous literature is inconclusive on the influence of testosterone on CSCR. This study aimed to determine the relationship between CSCR and cohorts with exogenous androgen exposure, female-to-male (FTM) transgender individuals, and those diagnosed with PCOS.

Design: Cross sectional study.

Subjects: Patients with CSCR, receiving exogenous androgens, FTM transgender individuals (defined as gender identity disorder [GID], endocrine disorder not otherwise specified, sex-discordant hormone therapy, and FTM surgery), and patients with PCOS.

Methods: An electronic health records platform of >100 million patients was examined for this study. Patients were identified through 10th revision of the International Classification of Diseases and procedural codes. Patients with prior steroid prescriptions, anxiety disorders, and fluticasone use were excluded. Prevalence and prevalence odds ratios (ORs) of comorbid CSCR were calculated using RStudio and 95% confidence intervals (CIs) were calculated.

Main outcome measures: Prevalence, prevalence ORs, and 95% CIs of CSCR.

Results: Among 21 056 patients with CSCR, the mean age was 61 years (standard deviation ± 15), with 67.95% being male. The prevalence of CSCR was highest among those receiving exogenous androgen therapy (24.13 per 1000 patients with CSCR; OR: 5.84, 95% CI: 5.35-6.37). The FTM surgery (OR: 3.04) and sex-discordant hormone therapy (OR: 5.32) cohorts also showed significant associations with CSCR (P < 0.05). Patients with PCOS had a more limited but still significant association (OR: 1.23, 95% CI: 1.013-1.49). Gender identity disorder did not show a significant relationship with CSCR (P > 0.05).

Conclusions: This study, which investigated the associations between FTM transgender, patients with PCOS, and CSCR demonstrates that conditions linked with elevated androgens are associated with higher odds of CSCR. These findings emphasize the value of ophthalmic screenings in these populations, particularly within the transgender health care community.

Financial disclosure(s): Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.