Does Prior Androgen Exposure Alter Outcomes After Gynecomastia Surgery? A Propensity-Matched Analysis

BackgroundGynecomastia is a benign condition associated with proliferation of male breast glandular tissue. Persistent symptoms that lead to psychological distress ultimately necessitate surgical treatment. Androgenic and anabolic steroids are a well-recognized contributor to the development of gynecomastia. With the increase in testosterone-supplementation over the past decades, surgeons are increasingly encountering documented androgen exposure presenting for gynecomastia reduction and correction.Materials and MethodsThis retrospective cohort study utilized data from the TriNetX Global Collaborative Network. Male patients who underwent surgical treatment for gynecomastia were identified using standardized diagnostic and procedural codes. Patients were stratified according to documented exposure to androgenic or anabolic agents within three years prior to surgery and were propensity score-matched in a 1:1 ratio to control patients without androgen exposure. Age-stratified analyses were additionally performed in patients younger than 50 years and those aged 50 years or older. The primary outcomes were short-term postoperative adverse events occurring within 30, 60, and 90 days after surgery. Secondary outcomes included revision surgery.ResultsAfter propensity-score matching, 6963 patients with documented androgen exposure were matched to 6963 controls. Androgen exposure was associated with increased risks of several early postoperative complications, including hematoma, wound dehiscence, wound debridement, and emergency department visits within 90 days of surgery. Age-stratified analyses demonstrated more pronounced increases in surgical complications among patients aged 50 years or older, whereas younger patients primarily demonstrated increased health care utilization. Despite higher rates of early postoperative morbidity, androgen exposure was associated with lower rates of revision surgery.ConclusionsIn this large propensity score-matched cohort study, documented androgen or anabolic-agent exposure was associated with increased early postoperative morbidity following gynecomastia surgery but fewer revision procedures. These findings identify prior androgen exposure as a clinically relevant risk marker that should be considered during preoperative assessment and counseling. However, the results do not establish a causal relationship or support a specific preoperative cessation interval.