ASRS 2025: Associations between androgen exposure, PCOS, and transmasculine individuals with central serous chorioretinopathy

Danny A. Mammo, MD, a vitreoretinal surgeon and uveitis specialist at the Cole Eye Institute at Cleveland Clinic, presented research on the association between androgen exposure and central serous chorioretinopathy (CSCR) at the 2025 scientific meeting of the American Society of Retina Specialists, which was held in Long Beach, California from July 30 through August 2, 2025.

He explained that while CSCR was known to be associated with increased cortisol levels, the relationship with testosterone supplementation had been suggested in small case series but remained unclear due to conflicting evidence from larger studies. To address this uncertainty, Mammo and his team analyzed the TriNetX database, which contained over 89 million patients, to investigate whether individuals with exogenous androgen therapy, polycystic ovarian syndrome (PCOS), or female-to-male transgender patients had an increased risk of developing CSCR. The researchers used previously established ICD-10, CPT, and RxNorm codes to identify relevant patients.

The analysis identified just over 21,000 patients with CSCR. The results revealed that patients with a history of exogenous androgen therapy, female-to-male transgender surgery, and sex discordant hormone therapy had significant odds ratios with appropriate confidence intervals, indicating an increased risk of CSCR. PCOS patients also showed an increased risk, though the odds ratio was lower than other groups, which Mammo attributed to the fact that only 60-80% of PCOS patients have elevated testosterone levels. The study excluded patients with histories of exogenous steroid use, anxiety disorders, and Flonase use.

However, Mammo acknowledged limitations in the study design, as they could not exclude patients with histories of corticosteroid injections or alcohol use from the TriNetX database. Dr. Mammo concluded that the findings would be valuable for clinical practice, adding to the list of risk factors clinicians routinely assess when evaluating patients with suspected CSCR. He noted that since many patients require continued androgen therapy for medical reasons, photodynamic therapy (PDT) could be considered as a treatment option to reduce leaking spots in these higher-risk patients who cannot discontinue their hormone treatments.