Gender Differences in the Relationship between Sex Hormone Deficiency and Soft Drusen

To investigate the association between sex hormone deficiency and soft drusen in women and men.

We retrospectively reviewed the medical records and fundus photographs of subjects who underwent a health screening for additional examination of climacterium and age-related changes including sex hormone status. In women, sex hormone deficiency was defined as cessation of menstruation that had lasted for at least 12 months and follicular stimulating hormone (FSH) levels ≥ 25 mIU/mL; in men, it was defined as testosterone levels ≤ 3.5 ng/mL. The subjects were divided into two groups-the soft drusen and control groups-based on the presence of soft drusen in the fundus photographs. The total drusen area was measured using ImageJ™ software.

Of total 2036 subjects, 638 (271 women; 367 men) were included. Two hundred thirteen subjects (33.4%) had soft drusen (97/271 women, 116/367 men). In women, sex hormone deficiency was more common in the soft drusen group than in the control group (P < 0.001); this was not the case in men. Multivariate logistic regression analysis revealed that sex hormone deficiency was an independent risk factor for soft drusen in women (P < 0.001; odds ratio [OR] = 3.494), as was age (P < 0.001; OR = 1.092). A long post-menopausal period was a risk factor for large soft drusen (≥ 125 μm). (P < 0.001; OR = 1.220). Age was significantly associated with total drusen area in both women (P = 0.022; β = 0.406) and men (P = 0.015; β = 0.246).

Sex hormone deficiency and its duration were significantly associated with the development and progression of soft drusen in women but not in men. It may be necessary to assess and manage the sex hormone deficiency in women with age-related macular degeneration.