Testosterone, Too Little or Too Much

Androgens (including testosterone, the male sex hormone that both men and women have in different quantities and ratios) are important in the production of sebum and meibum. When androgens are low, skin may be dry, and meibum production may be low. Too much testosterone can lead to breakouts on the skin or inflammation and blockage in meibomian glands. Both too little and too much testosterone can lead to meibomian gland dysfunction (MGD) and evaporative dry eye. An imbalance in the ratio of testosterone and estrogen can also lead to MGD, because a high estrogen to testosterone ratio can block testosterone function.

There is some evidence suggesting that testosterone is an important component of the blink feedback loop that produces aqueous tears. As we age, our sex hormone levels fluctuate, and both women and men experience forms of menopause. (“Manopause” is sometimes used to describe testosterone levels dropping in men). When the level of testosterone relative to the level of estrogen drops, testosterone receptors do not work as efficiently because the higher relative estrogen level blocks testosterone. Consequently, the feedback loop that signals the lacrimal gland to produce tears during blinking is interrupted or becomes inefficient, resulting in Dry Eye.

Reference

The International Workshop on Meibomian Gland Dysfunction: report of the Subcommittee on Anatomy, Physiology, and Pathophysiology of the meibomian gland
Knop E, Knop N, Millar T, Obata H, Sullivan DA.
Investigative Ophthalmology and Visual Science
2011 Mar 30;52(4):1938-78. doi: 10.1167/iovs.10-6997c. Print 2011 Mar.
PMID:21450915
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