Instances of ocular findings in transgender patients undergoing hormonal therapy

Christian Nieves-Ríos; Jose S Pulido; Sarah Thornton; James P Dunn; Rebecca A Procopio; Armando L Oliver; Daniel Lee; Reginald Edwards; Robert C Sergott; Mark L Moster

doi:10.1016/j.ajoc.2023.101965

Instances of ocular findings in transgender patients undergoing hormonal therapy

Am J Ophthalmol Case Rep. 2023 Nov 28:32:101965. doi: 10.1016/j.ajoc.2023.101965. eCollection 2023 Dec.

Authors

Affiliations

¹ Glaucoma Research Center, Wills Eye Hospital, Philadelphia, PA, USA.
² University of Puerto Rico School of Medicine, Department of Ophthalmology, Medical Sciences Campus, San Juan, PR, USA.
³ Retina Service, Wills Eye Hospital, Philadelphia, PA, USA.
⁴ Neuro-Ophthalmology Service, Wills Eye Hospital, Philadelphia, PA, USA.
⁵ Ocular Genetics, Wills Eye Hospital, Philadelphia, PA, 19107, USA.

Abstract

Purpose: To describe the ophthalmological manifestations in transgender patients on gender-affirming hormone therapy.

Methods: A retrospective chart review study was conducted. Female-to-male (FTM) and male-to-female (MTF) transgenders on gender-affirming hormone therapy evaluated at a single center were included. Candidates were collected using a phrase-identifying search tool within the electronic medical record system. Descriptive analyses were conducted to report the demographics, hormonal therapies, clinical findings, and visual outcomes.

Results: A total of 17 patients were included, seven were FTM, and ten were MTF transgenders. The median age was 26.0 years (range; 20.0-30.0) in the FTM group and 35.0 years (range; 23.0-67.0) in the MTF group. Testosterone therapy in FTM patients comprised 30-60 mg of intramuscular injections weekly or 50 mg of transdermal gel daily. MTF patients used mainly 2-4 mg of estradiol and 100-300 mg of spironolactone tablets daily. A total of 27 eyes were affected, 12 in FTM and 15 in MTF patients. The median visual acuity was 20/25 in FTM (range; 20/20-20/60) and 20/25 in MTF (range; 20/20-20/400). The most common diagnoses in FTM patients were neurologic (71.4 %), particularly idiopathic intracranial hypertension, while MTF transgenders presented mainly with chorioretinal diseases (40.0 %). Compliance with medical recommendations and follow-up appointments was seen in 71.4 % of FTM and 50.0 % of MTF patients. At the last visit, the median visual acuity was 20/50 (range; 20/20-20/70) in FTM and 20/25 (range; 20/20-20/70) in MTF patients.

Conclusions and importance: Transgenders presented a variety of ocular findings. A cause-and-effect association cannot be stated, yet eye specialists must be cognizant of these findings to provide appropriate treatment.

Keywords: Female-to-male; Gender-affirming; Hormone; Male-to-female; Transgender.