Anabolic-androgenic Steroid Use Among Gynecomastia Patients

Abstract

Background Anabolic-androgenic steroids (AAS) are widely implicated in gynecomastia development. Surgery is the definitive treatment for cases persisting after cessation of AAS use. Currently, the relevance of AAS use to the surgical approach of gynecomastia has not been well explored. This study aims to compare patient characteristics, surgical outcomes, and surgical management of gynecomastia correction in AAS users versus nonusers. Methods A retrospective cohort study was performed with patients who underwent bilateral gynecomastia reduction surgery between January 2005 and August 2015 by a single surgeon at an academic hospital. Demographic data, AAS usage details, operative documentation, and follow-up outcomes were reviewed. Results A total of 964 cases were reviewed. Eleven percent (n = 105) of the patients had a history of AAS use. Compared with non-AAS users, AAS users were older at time of gynecomastia onset (15 years vs 13 years, P < 0.001) and surgery (28 years vs 25 years, P < 0.001). The AAS users had higher body mass index (27.3 kg/m2 vs 25.7 kg/m2, P < 0.001) and a greater proportion of patients self-identified as bodybuilders (40.0% vs 22.4%, P = 0.002). Although no difference was found in the excised bilateral mastectomy volume (92.1 cm3 vs 76.4 cm3, P = 0.20), The AAS users had significantly less lipoaspirate fat volume (250 mL vs 300 mL, P = 0.005). No difference was found in total complication rates. However, AAS users had significantly more revision mastectomy surgeries (3.8% vs 1.1%; P = 0.02). Conclusions The unique breast composition of AAS users necessitates a surgical approach with meticulous intraoperative hemostasis and careful glandular excision to minimize recurrence and achieve comparable low complication rates.

Complication rates among women undergoing preventive mastectomy: An Austrian registry

“…To prevent major bleeding and prevent revisions, meticulous intraoperative hemostasis is necessary. 24 In our hospital, we often increase the blood pressure of the patient to a high-normal level for exact hemostasis. Furthermore, drains and compression can also help.…”

Harm Reduction in Male Patients Actively Using Anabolic Androgenic Steroids (AAS) and Performance-Enhancing Drugs (PEDs): a Review

“…2,23 Estrogenic side effects are common due to the aromatization of exogenous androgens, causing issues such as gynecomastia. 33 Exogenous testosterone is also shown to accelerate the growth of existing metastatic prostate cancer. 34 A wide range of behavioral effects are reported with AAS use including impulsivity, hypomanic/manic symptoms, aggression, and anxiety.…”

Anabolic-androgenic steroids are linked to depression and anxiety in male bodybuilders: the hidden psychogenic side of anabolic androgenic steroids

“…In the study conducted by Vojvodic et al. it was found that 11% of the patients with gynecomastia used AAS, and the patients who needed reconstructive surgery were statistically significantly more likely to be athletes using AAS [ 34 ]. These consequences, attributed to the use of AAS and its impact on physical appearance, may elucidate the observed elevated levels of depression that were associated with the estradiol levels of participants in our study.…”