Q&A: Danny A. Mammo, MD, on the associations between androgen exposure, PCOS, and transmasculine individuals with central serous chorioretinopathy

Danny A. Mammo, MD, at the 2025 ASRS meeting in Long Beach, California

Danny A. Mammo, MD, presented research analyzing the TriNetX database of over 89 million patients to investigate the association between androgen exposure and central serous chorioretinopathy (CSCR). Mammo gave this presentation at the 2025 scientific meeting of the American Society of Retina Specialists (ASRS), which was held in Long Beach, California from July 30, through August 2, 2025.

The study identified over 21,000 CSCR patients and found that individuals with exogenous androgen therapy, female-to-male transgender surgery, sex discordant hormone therapy, and PCOS had significantly increased odds ratios for developing CSCR. While the study excluded patients with certain steroid use and anxiety disorders, it couldn't exclude those with corticosteroid injections or alcohol use. Mammo concluded these findings would help clinicians assess CSCR risk factors and consider photodynamic therapy for high-risk patients requiring continued hormone treatments.

Note: The following conversation has been lightly edited for clarity.

Modern Retina: Can you share how this study was designed and conducted?

Danny A. Mammo, MD: We know that central serous chorioretinopathy, or CSCR, is associated with increased cortisol levels, whether it's endogenous or exogenous. And we also know that patients that have a history of using testosterone supplementation have been suggested to have an increased risk of CSCR. There are a few small case series out there suggesting there's an association. There are some larger studies with some conflicting evidence about whether there is a true association or not. So we wanted to use a large database, the TriNetX database, to look for an association between individuals with exogenous androgen therapy, PCOS, polycystic ovarian syndrome, or female-to-male transgender patients, and see if these patients have an increased risk of developing CSCR. So we performed analysis of the TriNetX database, and we used ICD-10, CPT, and RxNorm codes that had been previously established in other studies to identify these patients. In the TriNetX database, over 89 million patients were analyzed, and just over 21,000 patients with CSCR were identified.

MR: What did this data analysis show?

Mammo: Interestingly, patients with a history of exogenous androgen therapy, female-to-male, transgender surgery, sex discordant hormone therapy, were found to have significant odds ratios with appropriate confidence intervals suggestive of an increased risk of CSCR. PCOS patients were also found to have an increased risk, although this odds ratio was not as high as some of the others, and this might be due to the fact that about 60 to 80% of patients with PCOS have elevated testosterone levels, but not all of them do so. The association may have not been as strong. We excluded patients with a history of exogenous steroid use, anxiety disorders and Flonase use. We could not exclude patients with a history of corticosteroid injections or alcohol use based on the TriNetX database study design, so that is a limitation of the study. So overall, we found an increased risk of patients that undergo female-to-male transgender surgery, patients that receive exogenous androgen therapy, and patients with sex discordant hormone therapy, and PCOS with an increased risk of CSCR.

MR: How can this data be applied to clinics or in patient care?

Mammo: I think this data can help us in our clinics. Whenever we see a patient with suspected CSCR, we kind of have a list of questions that we ask patients for associated risk factors, so this study can add to that list. In addition, you know, some of these conditions, not much can be done. You know, some patients need exogenous androgen therapy. Some patients undergoing transition need exogenous hormone therapy, and PCOS patients have to have their condition managed as well. So sometimes these patients we might consider PDT as an option to help reduce leaking spots, if exogenous androgen therapy is going to be continued to be needed.