Can Testosterone Cause Retinopathy?

[Tom14]

I have been diagnosed with CSR in my left eye for 6 months and in the right eye for 1 month, I have been on trt test cyp 30mg every two days for 10 years. I have stopped taking testosterone for a month. How long after stopping will CSR go away?

 

[Nelson Vergel]

I hope this helps:

Yes, stopping testosterone replacement therapy (TRT) can potentially reverse central serous chorioretinopathy (CSCR) in some cases. Several studies and case reports provide evidence supporting this:

Resolution of CSCR After Discontinuing TRT

1. In a case series of nine patients who developed CSCR while on exogenous testosterone therapy, two patients discontinued treatment, which led to resolution of symptoms, subretinal fluid, and improved vision to 20/20[4].

2. A case report described a patient with CSCR who experienced recurring symptoms shortly after receiving intramuscular testosterone injections. When the patient's treatment was changed from injections to a daily topical testosterone gel, the symptoms did not recur in the following months[1].

Mechanism and Timeframe

The resolution of CSCR after stopping TRT is likely due to:

- Decreased choroidal blood flow and permeability
- Reduced interaction with androgen receptors in retinal pigment epithelial cells

The timeframe for improvement can vary, but some cases show:

- Resolution of subretinal fluid within 7-8 weeks after stopping TRT[1]
- Complete resolution of symptoms and OCT findings within a few months[4]

Considerations

It's important to note that:

- Not all cases of CSCR associated with TRT may resolve completely upon discontinuation
- The natural history of CSCR includes periods of waxing and waning, so controlled studies are necessary to definitively attribute improvement to TRT cessation[3]
- The decision to discontinue TRT should be made in consultation with the prescribing physician, weighing the benefits and risks for each individual patient

While stopping TRT can lead to CSCR resolution in some cases, it's crucial to consider each patient's overall health and the reason for TRT when making treatment decisions. Close monitoring by both an ophthalmologist and the prescribing physician is recommended for patients with CSCR who are on testosterone therapy.

Citations:
[1] Central serous chorioretinopathy secondary to intramuscular testosterone therapy - PMC
[2] Advances in the treatment of central serous chorioretinopathy - PMC
[3] Risk of Central Serous Chorioretinopathy in Male Androgen Abusers - Ophthalmology and Therapy
[4] https://www.aao.org/education/editors-choice/exogenous-testosterone-therapy-linked-to-central-s
[5] Central serous chorioretinopathy in patients receiving exogenous testosterone therapy.
[6] Testosterone replacement and its association with central serous chorioretinopathy | IOVS | ARVO Journals
[7] The potential role of testosterone in central serous chorioretinopathy - PMC

 

[Tom14]

thanks for your reply, should i also stop working out at the gym until crs goes away from my eyes? can growth hormone also cause csr?

 

[Nelson Vergel]

I found no reports on GH and CSR, but there seem to a few on exercise:

Based on the available evidence, both resistance exercise and growth hormone may potentially worsen or contribute to the development of central serous chorioretinopathy (CSCR). Here's a breakdown of the relationship between these factors and CSCR:

## Resistance Exercise and CSCR

Vigorous physical activity, including resistance training, has been associated with an increased risk of CSCR:

- A study found that moderate to high vigorous physical activity was observed in 63.5% of CSCR patients compared to 26% of controls[7].
- The potential risk of CSCR associated with moderate/high vigorous physical activity was 5.58 times higher[7].
- Weight lifting, which involves isometric muscle contraction, was more frequently performed by CSCR patients compared to controls[2].
- Intense resistance training can lead to sharp elevations in both systolic and diastolic blood pressure, potentially affecting choroidal circulation[2].

The mechanisms behind this association may include:

- Exercise-induced hypertension, which can affect choroidal blood flow[2].
- Increased sympathetic activity during intense exercise, which has been linked to CSCR[10].
- Elevated cortisol levels following periods of intense exercise[1].

## Growth Hormone and CSCR

While there is no direct evidence linking growth hormone to CSCR, some related factors suggest a potential connection:

- Testosterone, which is often associated with growth hormone, has been implicated in CSCR:
- A study found significantly higher serum testosterone levels in CSCR patients compared to controls (357 ± 10.4 ng/ml vs. 255.94 ± 7.43 ng/ml)[4].
- Another case report described CSCR development following testosterone therapy[5].

- The relationship between growth hormone and CSCR is not well-established, but it's worth noting that:
- Growth hormone can influence testosterone levels.
- Both hormones are involved in stress responses and metabolic regulation, which have been associated with CSCR[10].

## Recommendations

Given these associations, individuals with CSCR or at risk for the condition should consider the following:

1. Moderation in exercise: Avoid excessive or intense resistance training, particularly if you have active CSCR[3].
2. Low-intensity alternatives: Opt for low-intensity exercises for 20-30 minutes, as recommended by some practitioners[3].
3. Monitor hormone levels: If undergoing hormone therapy, including testosterone or growth hormone, consult with an ophthalmologist to monitor for potential CSCR development[5].
4. Stress management: Since stress and elevated cortisol levels are associated with CSCR, incorporate stress-reduction techniques into your routine[1][10].

It's important to note that while these associations exist, individual responses may vary. Always consult with an ophthalmologist and endocrinologist for personalized advice, especially if you have a history of CSCR or are at risk for the condition.

Citations:
[1] A "Workout" for Central Serous Chorioretinopathy
[2] https://iris.unito.it/retrieve/215a...c5dd78a15b/Vigorous activity_CRSC_AJO2022.pdf
[3]

https://www.reddit.com/r/Ophthalmology/comments/8w8v4x/central_serous_retinopathy_and_exercise

[4] The relationship between the central serous chorioretinopathy, choroidal thickness, and serum hormone levels - PubMed
[5] Central serous chorioretinopathy associated with testosterone therapy - Eye
[6] Central serous chorioretinopathy: updates in the pathogenesis, diagnosis and therapeutic strategies - Eye and Vision
[7] Vigorous Physical Activity Potential Risk Factor for CSCR
[8] Vigorous Physical Activity as a Risk Factor for Central Serous Chorioretinopathy
[9] Central serous chorioretinopathy: an update on pathogenesis and treatment - Eye
[10] Central Serous Chorioretinopathy - EyeWiki

 

[Tom14]

Thank you. One more question, long calorie deficit can affect csr. I have been keeping my calorie intake low for 6 years, my fat level is 7%. Can this also affect my csr?