2022
DOI: 10.1097/prs.0000000000009858
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Perioperative Hormone Management in Gender-Affirming Mastectomy: Is Stopping Testosterone before Top Surgery Really Necessary?

Abstract: Background: Gender-affirming mastectomy, or “top surgery,” has become one of the most frequently performed procedures for transgender and nonbinary patients. However, management of perioperative testosterone therapy remains controversial. Despite a lack of supporting evidence, many surgeons require cessation of testosterone before top surgery. This is the first study to compare complication rates in patients undergoing gender-affirming mastectomy with and without discontinuation of perioperative testosterone. … Show more

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Cited by 8 publications
(8 citation statements)
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References 33 publications
(54 reference statements)
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“…16 A recently published study comparing complication profiles in patients who discontinued testosterone versus patients who maintained on HRT found that there was no difference in postoperative complication rates including hematoma, seroma, VTE, and overall complications. 17 Boskey et al 4 synthesized all the surgical risks of exogenous hormones in transgender and gender-diverse patients and concluded that the current evidence does not support routine discontinuation of HRT before GAS. Despite the evidence, some surgeons remain concerned about continuing HRT, and our study demonstrated a wide variation of perioperative HRT usage among surgeons.…”
Section: Discussionmentioning
confidence: 99%
See 1 more Smart Citation
“…16 A recently published study comparing complication profiles in patients who discontinued testosterone versus patients who maintained on HRT found that there was no difference in postoperative complication rates including hematoma, seroma, VTE, and overall complications. 17 Boskey et al 4 synthesized all the surgical risks of exogenous hormones in transgender and gender-diverse patients and concluded that the current evidence does not support routine discontinuation of HRT before GAS. Despite the evidence, some surgeons remain concerned about continuing HRT, and our study demonstrated a wide variation of perioperative HRT usage among surgeons.…”
Section: Discussionmentioning
confidence: 99%
“…Rather, the strongest risk factor of developing a hematoma is due to the surgical technique of limited incision such as periareolar or circumareolar approaches 16 . A recently published study comparing complication profiles in patients who discontinued testosterone versus patients who maintained on HRT found that there was no difference in postoperative complication rates including hematoma, seroma, VTE, and overall complications 17 . Boskey et al 4 synthesized all the surgical risks of exogenous hormones in transgender and gender-diverse patients and concluded that the current evidence does not support routine discontinuation of HRT before GAS.…”
Section: Discussionmentioning
confidence: 99%
“…The development of topical antiandrogens that competitively bind to androgen receptors represents a promising area of future research as a novel approach to controlling the tissue repair cascade through the sex hormone axis. 38…”
Section: Discussionmentioning
confidence: 99%
“…The development of topical antiandrogens that competitively bind to androgen receptors represents a promising area of future research as a novel approach to controlling the tissue repair cascade through the sex hormone axis. 32…”
Section: Discussionmentioning
confidence: 99%
“…Traditional practices of stopping testosterone perioperatively were based on concerns about thrombocytosis, hypertension and thromboembolic events, but recent studies suggest these concerns are largely theoretical. 28 Because hormone therapy provides TGD patients with psychological benefits, patients may experience distress if asked to pause an important aspect of gender-affirming care, and cessation is less common now. 29 However, these newer studies do not address scar results, potentially resulting in perioperative use of a medication that delays WH and increases scar hypertrophy.…”
Section: Discussionmentioning
confidence: 99%