Central Serous Retinopathy/TRT - Input Requested

[daves52380]

There is little information out there about CSR and TRT. I was recently diagnosed with CRS two months ago after ignoring the symptoms for too long. I fit the general main demographics for candidates for this condition, white male, 37 years old, Type-A personality, overly stresses out and lacking proper sleep.

I inject 90mg 2x/weekly (180mg/week) and take .5mg anastrozole 2x weekly. T-levels at 1000mg and E2 at 27. I suffer from polycythemia while on TRT. All other numbers are great and I have started regular phlebotomy's to get those numbers down.

My CSR symptoms started beginning in November with routine headaches and blurred vision which I assumed was stress related. After labs revealed my HCT was above 55.7 an immediate bloodletting was in order that temporarily relieved the headaches and blurred vision. After about a month and a half the vision problems returned and progressively got worse over the course of the next few months. Symptoms were darkened blurred central vision, distorted objects, change in color saturation, and loss of magnification. I'm going on 4.5 months with no improvements. Even though the Ophthalmologist correlates this directly to cortical steroids he suggests that if symptoms do not improve in a few months to consider getting off TRT. This of course is my last resort as I already have been managing stress and resting more.

I am considering cutting my T-dosage in half and completely cutting out the anaztrozole, I want to try 45mg 2x/week (90mg) and see if symptoms improve or should I go cold turkey?

Any input from guys who have experience with this and/or suggestions would be appreciated.

 

[HarryCat]

Here is a report of someone on TRT who developed CSR which resolved after cutting back on the frequency of testosterone injections. Now the protocol he was on is absolutely horrible, 250mg injected every 2 weeks, and to cut the dose they made it even worse by dropping the injection frequency to 250mg every month (where do doctors come up with this stuff?), but the CSR resolved in the next 2 months, so as bad as the protocol was the end goal was achieved.

https://www.omicsonline.org/open-ac...-testosterone-treatment-2155-9570-1000509.pdf

I have chronic CSR which has been stable for several years, although the fluid has never been completely reabsorbed, and I have become a fan of Dr. Mark Gordon's approach to TRT. In his recent AMMG presentation he mentions "Male daily Testosterone production rates ranged from 4 to 11.8 mg per day. Ave = 28mg - 80mg/week. So why do we give 100mg, 200mg, 300mg a week?? Why are we treating everyone like a bodybuilder?" So this is one of the reasons I only inject 80mg/week, yielding about 55mg of actual testosterone per week.

 

[FeelingLost]

Hi daves, wow this sounds serious.
https://en.wikipedia.org/wiki/Central_serous_retinopathy

Why would you cut your T dose. wiki seems to think to fix this you need to reduce stress and eliminating all sources of corticosteroids.
I would think T injections would help you with stress management, improved mood, stronger body to help fight any illness.

 

[HarryCat]

BTW has your doctor suggested trying Eplerenone? Although I haven't tried it myself there are several reports of a positive response to it (re-absorption of fluid). There are also some low quality studies showing Meriva and low dose aspirin being effective.

 

[Nelson Vergel]

Here is a report linking CSR to DIM. I would decrease the T dose to 50 mg twice per week and stop anastrozole to see what happens.

Ophthalmic Surg Lasers Imaging Retina. 2014 Nov-Dec;45(6):589-91. doi: 10.3928/23258160-20141118-16.
Bilateral central serous chorioretinopathy associated with estrogen modulator diindolylmethane.
Bussel II, Lally DR, Waheed NK.
Abstract
Central serous chorioretinopathy (CSCR) is an idiopathic disease associated with states of hypercortisolism that causes fluid to collect under the retina resulting in visual impairment. The authors describe an otherwise healthy female patient who presented with headaches and blurry vision after a 2-month history of excessive daily consumption of diindolylmethane (DIM), an over-the-counter estrogen modulator medication used to treat facial acne. Imaging demonstrated asymmetric, bilateral CSCR with active leakage in the left eye. She was instructed to discontinue DIM and reported that visual improvement began 2 weeks after, with resolution to baseline after 8 weeks.

 

[Saul]

H In his recent AMMG presentation he mentions "Male daily Testosterone production rates ranged from 4 to 11.8 mg per day. Ave = 28mg - 80mg/week. So why do we give 200mg, 300mg a week?? So this is one of the reasons I only inject 80mg/week, yielding about 55mg of actual testosterone per week.

I don't know much about CSR, but agree with this statement. If you are at 1000 in the trough, you are outside normal range.

 

[madman]

Here is a report of someone on TRT who developed CSR which resolved after cutting back on the frequency of testosterone injections. Now the protocol he was on is absolutely horrible, 250mg injected every 2 weeks, and to cut the dose they made it even worse by dropping the injection frequency to 250mg every month (where do doctors come up with this stuff?), but the CSR resolved in the next 2 months, so as bad as the protocol was the end goal was achieved.

https://www.omicsonline.org/open-ac...-testosterone-treatment-2155-9570-1000509.pdf

I have chronic CSR which has been stable for several years, although the fluid has never been completely reabsorbed, and I have become a fan of Dr. Mark Gordon's approach to TRT. In his recent AMMG presentation he mentions "Male daily Testosterone production rates ranged from 4 to 11.8 mg per day. Ave = 28mg - 80mg/week. So why do we give 100mg, 200mg, 300mg a week?? Why are we treating everyone like a bodybuilder?" So this is one of the reasons I only inject 80mg/week, yielding about 55mg of actual testosterone per week.

The main reasons dosages vary on trt are it depends on what dosage is needed for one to attain relief of low t symptoms whether one needs to be in the mid/normal range of physiological levels or the high/normal range to experience relief.

On average most patients usually require any where from 100-150 mg/week......................sure 200 mg/week is not needed by most and would put most into the supra-physiological range (peak and trough) but there are some who require this higher dosage to reach high/normal levels (higher shbg men).

Ones shbg levels also play a role and of course ones sensitivity of the AR (androgen receptor).

As far as treating patients like body builders if you are talking 250+/week than maybe but I would not say prescribing a patient 200 mg/week is a body builder dose..........mind you it is hefty trt dose and most would not need that to attain healthy physiological testosterone levels.

You may be right in a sense that many people on trt tend to run higher testosterone levels than are truly needed. I would say the least amount of testosterone one needs to experience relief of low t symptoms should be the goal as excess is not needed and we do know
issues with excess e2 and hematocrit/hemoglobin can be problematic for many let alone negative effects on other health markers!

Sure these can be controlled with the use of aromatase inhibitors and phlebotomy but I would prefer to avoid those routes if possible.

I am with Nelson regarding the over use of a.i. and believe estrogen is critical to ones overall benefits regarding trt.

I think many suffer negatively because they manipulate there e2 too much whether too low/high especially when they are not experiencing any side effects and are just chasing a number.

 

[crash1270]

This happened to me in 2014. I was on TRT and my doctor would give me double doses when I would travel and was not able to come to his office every week. I was on 140 mg a week. He would give me 250mg doses. After doing this twice I had an occurrence of CSR. I had also just started Anastrozole. That is when I found this site. Thanks Nelson and everyone else who contributes.
See my post here https://www.excelmale.com/forum/showthread.php?2744&p=11938#post11938

I stopped trt for over a year. I found a retina specialist that gave me a shot of Avastin in my eyeball every six weeks. That was not fun but it worked. Within 4 months my vision was back to normal. Within a year no real signs of the fluid.

I went back on TRT self administered 2x week at 70mg. So far everything is okay. I do not use an AI. I use DIM instead and that seems to work for me. I also give blood when I can.

 

[daves52380]

Hi daves, wow this sounds serious.
https://en.wikipedia.org/wiki/Central_serous_retinopathy

Why would you cut your T dose. wiki seems to think to fix this you need to reduce stress and eliminating all sources of corticosteroids.
I would think T injections would help you with stress management, improved mood, stronger body to help fight any illness.

I am only contemplating cutting dosage because I think the current dosage could be a contributing factor to no relief as research from some others who have experienced this and I do not take any corticosteroids to my knowledge. My TRT is not the silver bullet to relieve all of life's perils although, since treatment I feel like a new man. Increased energy, strength, libido and mood but stress is a real part of everyday life that must be managed because no hormone therapy will do that alone, at least for me.

BTW has your doctor suggested trying Eplerenone? Although I haven't tried it myself there are several reports of a positive response to it (re-absorption of fluid). There are also some low quality studies showing Meriva and low dose aspirin being effective.

I have not been recommended any medication yet, that was my first visit to the eye doc I was told the natural course for this condition is 90% of the time it will go away on its own within 3-6 months.

This happened to me in 2014. I was on TRT and my doctor would give me double doses when I would travel and was not able to come to his office every week. I was on 140 mg a week. He would give me 250mg doses. After doing this twice I had an occurrence of CSR. I had also just started Anastrozole. That is when I found this site. Thanks Nelson and everyone else who contributes.

See my post here https://www.excelmale.com/forum/showthread.php?2744&p=11938#post11938

I stopped trt for over a year. I found a retina specialist that gave me a shot of Avastin in my eyeball every six weeks. That was not fun but it worked. Within 4 months my vision was back to normal. Within a year no real signs of the fluid.

I went back on TRT self administered 2x week at 70mg. So far everything is okay. I do not use an AI. I use DIM instead and that seems to work for me. I also give blood when I can.

Crash, if it wasn't for your post I would never have considered that my TRT treatment could be a factor as there was nothing on the web that suggested anything otherwise. It was only commonly linked to corticalsteroids, which led me to believe this had nothing to do with testosterone. Very little information on this out there so hopefully sharing our experinces can educate and help others. Thank you for sharing your experience, I read it in its entirely and it led me in a new direction to try something new for relief.

I thank everyone for their input and ideas. I'm going to try what Nelson recommended. I will cut T dose in half and cut out all other meds, anastrozole, caffeine, more rest and manage stress.

Some suggest my t-dose is too high. I started at 150mg/wk and I just wasn't feeling it, not much energy, weak erections etc. A big improvement but just wasnt all there. 200mg/wk was too much. 180mg/wk is my sweet spot and I have everything dialed in pretty good with the exception of having to donate regularly.