Central serous chorioretinopathy risk with PDE5 inhibitors androgen therapy and alpha blockers in men

This study evaluated whether α-blockers, phosphodiesterase-5 inhibitors (PDE-5Is), and exogenous androgens are associated with incident central serous chorioretinopathy (CSCR) in adult men. We conducted a retrospective, propensity score-matched, new-user cohort study using the TriNetX global network, in which three independent cohorts of men initiating these medications were each compared 1:1 with matched controls. The primary outcome was incident CSCR (ICD-10-CM H35.71/H35.72), analyzed using Cox proportional hazards models over a 5-year follow-up, with a stricter H35.71-only definition as a sensitivity analysis. The analysis included 478,074 matched pairs (214,510 for α-blockers, 195,161 for PDE-5Is, and 68,403 for androgens). No statistically significant association with CSCR was observed for any medication class; the 5-year hazard ratios were 1.080 (95% CI 0.752–1.551; P = 0.676) for α-blockers, 0.917 (95% CI 0.649–1.296; P = 0.625) for PDE-5Is, and 1.171 (95% CI 0.634–2.161; P = 0.614) for androgens. For tadalafil, an early signal was observed that did not persist over longer follow-up. We did not observe a consistent or sustained population-level increase in diagnosed CSCR risk, although residual confounding and rare short-term risk in susceptible patients cannot be excluded.