Gynecomastia: androgen risk signal

Before surgery to reduce an enlarged male breast, the relevant history can extend beyond medicines taken on the day of consultation. The practical question is whether earlier androgen or anabolic-agent use also carries information about recovery. The American Society of Plastic Surgeons’ preparation guidance places medical assessment and medication review within planning for gynecomastia surgery.

A study published on 16 October 2026 examines that history using records from the TriNetX Global Collaborative Network.

A large comparison with two different signals

The researchers identified patients with recorded androgenic or anabolic-agent exposure during the three years before surgery. They matched 6,963 of them to 6,963 controls without documented exposure, producing a comparison of 13,926 patients. Propensity-score matching aims to balance measured characteristics; it does not randomly assign treatment histories.

Exposure was associated with more early postoperative problems, including hematoma, wound separation, wound debridement and emergency-department visits within 90 days. The study assessed outcomes at 30, 60 and 90 days. In patients aged 50 or older, the association with surgical complications was more pronounced; among younger patients, increased healthcare use was the main signal.

Yet the exposed group had fewer revision operations. That does not establish a better cosmetic result or greater durability. Revision is a separate outcome from early wound problems, and the accessible abstract does not explain why its direction differed. Both findings need to remain visible when interpreting the study.

A risk marker is not an individual prediction

The central limitation is the retrospective, observational design. A large sample and matching cannot exclude unmeasured differences or incomplete coding. The abstract also supplies no absolute event rates, effect estimates or confidence intervals. It therefore cannot tell a reader how many additional complications occurred per hundred patients.

The exposure category should not be treated as proof of illicit steroid use or athletic status. Nor does the public summary allow a clear separation of prescribed treatment from nonmedical use, or provide the dose and duration needed to interpret individual histories.

Most importantly, the authors explicitly state that the analysis neither establishes causality nor supports a specific preoperative cessation interval. It is not a reason to stop prescribed treatment without the treating clinician. Its useful contribution is to make earlier exposure part of a factual medication discussion, with uncertainty acknowledged. This article uses the original abstract and verified metadata; funding and conflict-of-interest statements could not be checked in the inaccessible full text.