Testosterone Replacement Therapy and Visual Disturbances
Testosterone replacement therapy (TRT) can be associated with visual disturbances, including blurred vision and transient visual obscurations, based on case reports and small case series. [1], [2]
Evidence Supporting TRT-Associated Visual Disturbances
A case report described central serous chorioretinopathy (CSR) occurring shortly after intramuscular testosterone injection, with symptom resolution and recurrence after subsequent injection. [1]
A published case report and literature review of intracranial hypertension associated with exogenous testosterone reported ocular symptoms including transient visual obscurations and blurred vision. [2]
Mechanisms Relevant to Visual Symptoms
Visual symptoms from TRT may occur through mechanisms affecting retinal function and through mechanisms that increase intracranial pressure. [1], [2]
Clinical Presentation Patterns After TRT Initiation
TRT-associated intracranial hypertension commonly presents with headache plus ocular symptoms such as transient visual obscurations and blurred vision. [2]
TRT-associated CSR may present with blurred vision temporally related to testosterone dosing, with improvement after changing the testosterone regimen in a reported case. [1]
Evaluation of New Visual Disturbances in a TRT-Treated Patient With TBI
New or worsening visual symptoms after starting TRT or after a dose change should prompt urgent clinical assessment for neuro-ophthalmic and retinal causes. [1], [2]
Immediate Safety Actions When TRT-Related Visual Disturbances Are Suspected
TRT should be held and an urgent ophthalmology and/or neuro-ophthalmology evaluation should be pursued when visual disturbances occur in close temporal relation to treatment initiation or dose escalation, consistent with the reported approach in TRT-associated CSR. [1]
Targeted Diagnostic Considerations
Evaluation should include assessment for retinal disease consistent with CSR when blurred vision occurs after TRT dosing. [1]
Evaluation should include assessment for intracranial hypertension when blurred vision co-occurs with headache or other signs/symptoms consistent with increased intracranial pressure. [2]
Patient-Specific Risk Context in Traumatic Brain Injury
Traumatic brain injury increases baseline risk for neurologic sequelae, so new visual disturbances during TRT should be treated as potentially clinically significant until alternative causes are excluded. [2]