AB196. SOH25_AB_268. Exploring the impact of testosterone supplementation on surgical outcomes in plastic and reconstructive surgery: a systematic review

Background: Testosterone replacement therapy (TRT) and anabolic androgenic steroid (AAS) use is common and appears to be increasing, particularly with regard to recreational use among bodybuilders and individuals seeking physique enhancement. Despite this, their impact on surgical outcomes in plastic and reconstructive surgery has never been systematically examined. This review synthesises current evidence on the effects of TRT and AAS on key surgical outcomes in plastic and reconstructive surgery.

Methods: A systematic review of 12 peer-reviewed studies was conducted, focusing on the impact of TRT and AAS use on fracture healing, upper-limb tendon injuries, burn recovery, and wound healing in clinical settings.

Results: Testosterone enhances fracture healing by improving bone mineral density and stimulating osteoblast activity and insulin-like growth factor 1 expression, while oxandrolone, a synthetic testosterone derivative, reduces donor graft healing times, improves lean muscle mass, and shortens hospital stays in burn patients. Conversely, TRT and AAS use results in impaired wound healing in non-burn patients by inducing a pro-inflammatory environment. TRT and AAS use was also associated with a significantly increased risk of tendon injuries, particularly in the upper limb (P<0.001). Additionally, TRT elevates venous thromboembolism risk due to increased haematocrit, posing significant peri-operative concerns.

Conclusions: TRT and AAS exhibit dichotomous effects, offering benefits in fracture healing and burn recovery but impairing wound healing, increasing tendon injury risks, and elevating thromboembolic complications. As their clinical and recreational use grows, further research is essential to optimise protocols for safe perioperative management in plastic and reconstructive surgery.

Keywords: Anabolic androgenic steroid (AAS); post-operative complications; plastic and reconstructive surgery; surgical outcomes; testosterone replacement therapy (TRT)