Low Testosterone and Dry Eye: What Changed After Hormone Replacement in a 77-Man Study

Androgens, including testosterone, play a role in the glands that help keep the eye surface stable. A study published November 6, 2026, in International Ophthalmology looked at the ocular surface in men with androgen deficiency and at what changed after testosterone replacement.

Who was studied

The study included 77 men; only the right eye of each participant was evaluated. Thirty-seven men had testicular hypofunction, defined as a total testosterone level below 231 ng/dL. Forty eugonadal controls had testosterone above 346 ng/dL. Examinations included symptom scores (AMS and OSDI), meibomian gland grading, corneal staining, tear breakup time (TBUT), Schirmer I and II tests, tear osmolarity, and anterior-segment OCT of the inferior tear meniscus. The androgen-deficiency group received intramuscular testosterone (Sustanon 250 mg) every two weeks, and measurements were repeated at weeks 6 and 18.

What they found

• At baseline, men with low testosterone had higher AMS and OSDI scores, worse meibomian gland grades, more corneal staining, and higher tear osmolarity, and they had lower Schirmer values, shorter TBUT, and a smaller tear meniscus.
• After replacement therapy, testosterone levels rose, and AMS and OSDI scores, tear osmolarity, meibomian grades, and corneal staining improved. Schirmer tests and tear-meniscus measurements increased. TBUT also increased, but that change was not statistically significant.
• Testosterone levels correlated negatively with AMS, OSDI, and tear osmolarity, and more weakly with meibomian grade and staining, and positively with TBUT, Schirmer II, and tear-meniscus measures.

The authors concluded that androgen deficiency can affect the ocular surface, and that replacement was associated with favorable changes in several signs and symptoms in men who already needed treatment for androgen deficiency. This is not evidence that testosterone should be used as a dry-eye drug in men with normal hormone levels, and hormone therapy has its own risks that belong in a conversation with the prescribing physician. If you have known low testosterone and new dry-eye symptoms, mention both to your doctors.

Source: The effects of androgen replacement therapy on tear osmolarity and ocular surface parameters in androgen deficiency (International Ophthalmology (PubMed), 06/11/2026). This article is an educational summary written by Khanna Vision Institute and is not a substitute for medical advice.