Testosterone: is it safe? When should I use it? How should I use it? Who can prescribe it?

Hormones, Testosterone & Dry Eye Disease: What Every Patient Should Know

Dry Eye Disease (DED): which generally means meibomian gland dysfunction (Decrease/lack of oil) and or aqueous deficiency (Decrease water from the lacrimal glands), is far more than “not enough tears.” It is a hormone‑sensitive, inflammation‑driven, gland‑damaging disease—and one of the most underdiagnosed hormone‑related conditions in both men and women.

A growing body of research shows that sex hormones—especially testosterone—play a critical role in meibomian gland function, ocular surface inflammation, and tear film stability. When testosterone levels fall, the meibomian glands produce less oil, the tear film evaporates faster, and symptoms worsen.

This article explains:

• How hormones influence dry eye

• Why testosterone deficiency worsens symptoms

• How testosterone cream or drops may help

• How clinicians prescribe testosterone safely

• Risks and monitoring

• How patients can get hormone testing with trusted clinicians

• Verified PubMed‑indexed research supporting these findings

1. Hormones & Dry Eye: What the Research Shows

Hormone therapy and increased dry eye risk

The American Academy of Ophthalmology summarized a large population‑based study showing that hormone replacement therapy (HRT) increases the risk of Dry Eye Disease. Women on estrogen‑only therapy had the highest risk, and combined estrogen‑progesterone therapy also increased risk, though to a lesser degree.  PubMed

This aligns with decades of research showing that estrogen can suppress meibomian gland function, while testosterone supports it.

Androgen deficiency is strongly linked to meibomian gland dysfunction (MGD)

The AAO’s clinical review on androgen deficiency notes that:

• Meibomian glands are androgen‑dependent

• Androgen deficiency contributes to MGD, evaporative dry eye, and ocular surface inflammation

• Women—especially post‑menopausal—are disproportionately affected

Clinical trials show testosterone therapy improves dry eye

A randomized, placebo‑controlled trial of transdermal androgen patches in postmenopausal women and andropausal men demonstrated:

• Improved symptoms

• Improved tear stability

• Improved ocular surface staining

This is one of the strongest clinical trials showing that restoring androgen levels can directly improve dry eye signs and symptoms.

2. Why Testosterone Matters for the Eyes

Testosterone regulates:

• Meibomian gland oil production

• Lipid composition (quality of the oil)

• Anti‑inflammatory pathways

• Epithelial health of the ocular surface

When testosterone is low:

• Oil glands shrink and clog

• Tear evaporation increases

• Inflammation rises

• Symptoms worsen (burning, stinging, fluctuating vision, redness)

This is why many patients—especially women after menopause and men after age 50—experience worsening dry eye that does not respond to standard treatments.

3. How Testosterone Cream or Drops Help

Mechanisms

Topical testosterone (cream or compounded eye drops) can:

• Stimulate meibomian gland oil production

• Improve tear film stability

• Reduce ocular surface inflammation

• Improve symptoms in patients with MGD‑driven evaporative dry eye

Forms used clinically

• Testosterone 0.03–0.1% cream applied to eyelids

• Compounded testosterone eye drops (less common, but used in research settings)

• Transdermal patches (systemic effect)

Who benefits most

• Postmenopausal women

• Men with age‑related androgen decline

• Patients with severe MGD

• Patients who failed standard therapies (Xiidra, cyclosporine, steroids, IPL, thermal pulsation)

4. How Clinicians Prescribe Testosterone for Dry Eye

Step 1 — Hormone Testing

Before prescribing testosterone, patients should have:

• Total testosterone

• Free testosterone

• SHBG

• DHEA‑S

• Estradiol (women)

• Progesterone (women)

• LH/FSH (if needed)

Step 2 — Determine deficiency

Clinicians look for:

• Low free testosterone

• Symptoms consistent with androgen deficiency

• MGD or evaporative dry eye on exam

Step 3 — Start therapy

Typical ophthalmic approach:

• Testosterone 0.03–0.1% cream, applied to upper eyelids once daily or anywhere on body. I’ve had many Patients, who have noticed the same affect whether it’s on their eyelids or on their body.

• Reassess symptoms and gland function at 6–8 weeks: This does not necessarily require a follow up with a Dr. If you do not feel any improvement to let your Dr. know to go onto the next step.

Step 4 — Monitor

• Hormone levels

• Ocular surface inflammation

• Meibomian gland function

• Side effects

5. Risks of Testosterone Therapy

While generally safe when monitored, testosterone therapy carries risks:

Local risks

• Eyelid skin irritation: very rare and it does not need to be put on the eyelid. It can be put anywhere on the body.

• Acne‑like eruptions: Also very rare

• Hair growth on application site: Very rare in my experience

Systemic risks (rare with low‑dose topical use)

• Hormonal imbalance

• Mood changes

• Acne

• Increased facial hair (women)

• Potential lipid profile changes

Contraindications

• Pregnancy

• Breast cancer or hormone‑sensitive cancers

• Uncontrolled cardiovascular disease

• High baseline testosterone

Patients should only use testosterone under medical supervision.

6. How Patients Can Get Hormone Testing

To ensure safe and appropriate treatment, patients should have hormone testing performed by a qualified clinician.

Recommended clinicians for hormone evaluation

Dr. Nicholas Kongosa: https://www.rhmgyn.com/make-an-appointment

📞 7704508677

Nurse Beth Sutton, RN

📞 +1 (703) 734‑8271

Please text her and tell her Dr. Cremers sent you.

Both can help men and women obtain comprehensive hormone panels before starting testosterone therapy for Dry Eye Disease.

7. Verified PubMed‑Indexed Research on Testosterone & Dry Eye

Below is a curated list of PubMed‑indexed, peer‑reviewed studies supporting the role of androgens in dry eye disease:

Key Clinical & Mechanistic Studies

1. Androgen deficiency and meibomian gland dysfunction

AAO Clinical Review summarizing multiple PubMed‑indexed studies.

American Aca...

2. Transdermal androgen therapy improves dry eye

Randomized, double‑masked, placebo‑controlled trial of androgen patches.

American Aca...

3. Hormone therapy increases dry eye risk

Large population‑based study showing increased DED risk with estrogen therapy.

PubMed

4. Hormonal influence on ocular tissues

AAO review on how hormones affect the eyes.

American Aca...

5. Dry Eye Disease epidemiology & pathophysiology

AAO overview summarizing decades of research.

American Aca...

8. Final Thoughts

Hormone imbalance—especially low testosterone—is one of the most overlooked drivers of Dry Eye Disease. For patients with persistent symptoms, meibomian gland dysfunction, or worsening dryness after menopause or with aging, hormone evaluation is essential.

Testosterone therapy is not a first‑line treatment, but for the right patient, it can be transformative—restoring gland function, reducing inflammation, and improving quality of life.

If you suspect hormones may be contributing to your dry eye, reach out to the clinicians above for testing and speak with your eye doctor about whether testosterone therapy may be appropriate.