PURPOSE: Chest masculinization surgery (CMS) can lead to hypertrophic scarring with reduced quality-of-life and need for revision. Given our clinical observations and prior animal studies suggesting testosterone(T) has negative effects on wound healing, we hypothesized T is associated with worse scarring after CMS. METHODS: 152 patients undergoing either double incision mastectomy or keyhole/circumareolar mastectomy were enrolled in an IRB-approved prospective registry at JHU from 2017-2022. Data regarding patient demographics, hormone regimen, scarring co-morbidities, procedural details and complications were collected. Scars were assessed by four blinded clinicians using Manchester Scar Scale and SCARS-scale using photos taken at early, mid, and late post-op timepoints. T-tests and Pearson correlations were used to look for association between scarring and T dose/level. RESULTS: 66% of patients were white and 90% were on T. MSS contour and SCAR palpability were positively correlated with increasing weekly dose of T (r=0.2/p=0.034 and r=0.234/p=0.013,respectively). Patients with high preop T-level (>500ng/dl) and high weekly T-dose (>50ng/dl) had a higher mean score on SCAR palpability subscale and SCAR overall impression subscale compared to patients in low preop T (<500ng/dl) and low weekly T-dose (<50ng/dl) group (p=0.038,p=0.047). CONCLUSION: Exogenous testosterone appears to be correlated with hypertrophic scarring after CMS. Current T-dosing regimens focus largely on subjective patient response and may lead to supratherapeutic doses. Recent trends towards continuation of hormones throughout perioperative period may warrant further evaluation of risks and benefits.
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