Abstract / Summary
To evaluate retinal microvascular and structural parameters in individuals with gender dysphoria receiving testosterone therapy and patients with polycystic ovary syndrome (PCOS) using optical coherence tomography angiography (OCTA). This cross-sectional study was conducted between 2020 and 2021 at Istanbul University-Cerrahpaşa and included 39 individuals with gender dysphoria receiving testosterone therapy, 24 patients with PCOS, and 34 age-matched healthy controls. Macular superficial and deep capillary vessel density (SCVD and DCVD), foveal avascular zone (FAZ) area, radial peripapillary capillary (RPC) vessel density, and retinal nerve fiber layer (RNFL) thickness were assessed using OCTA. SCVD and DCVD values in the whole image, parafoveal, and perifoveal regions were significantly lower in the dysphoria group than in the PCOS group (all p < 0.05), whereas foveal measurements were comparable. Compared with healthy controls, the dysphoria group demonstrated significantly reduced macular vessel density and lower RPC vessel density across all peripapillary regions (all p < 0.05). No significant differences in macular vessel density parameters were observed between the PCOS and control groups. Among peripapillary parameters, inferior RPC density was lower in the PCOS group than in healthy controls ( p = 0.032), whereas the remaining RPC parameters were comparable between the groups. RNFL thickness measurements were comparable among all study groups. Testosterone therapy was associated with lower retinal and peripapillary microvascular density, whereas vascular parameters were largely preserved in PCOS. RNFL thickness was comparable among the groups. These findings demonstrate differences in retinal microvascular parameters between two distinct hyperandrogenic endocrine settings, although these differences cannot be attributed solely to the source of androgen exposure.