Can Gynecomastia Come Back if I’m Still on TRT or Finasteride?Austin Gynecomastia Center

This is one of the most common — and reasonable — questions I hear from patients considering gynecomastia surgery, especially those on testosterone replacement therapy (TRT), finasteride, or other hormone-altering or “anti-aging” medications.

The short answer is this: recurrence is possible, but extraordinarily unlikely when the surgery is done correctly. In my own practice, with more than 7,000 gynecomastia cases, I have seen only two true recurrences. That makes the risk not zero, but very close to it.

Why does this matter? Because recurrence is almost always related to how much glandular tissue is left behind at the time of surgery.

Most surgeons are trained — often explicitly — to leave some breast tissue behind to avoid a depression or contour irregularity beneath the nipple. While well-intentioned, this approach leaves behind the most hormonally sensitive tissue. That residual tissue is exactly what responds to medications like TRT or finasteride, leading to the familiar complaint patients describe years later: “My nipples look puffy again.”

My surgical philosophy is different. I advocate for complete, aggressive removal of all gross gynecomastia tissue. This is not casual or careless removal — it is meticulous, deliberate, and experience-driven. When done properly, it avoids contour problems while eliminating the tissue that can respond to hormones.

I often explain this to patients with a simple analogy:

Gynecomastia tissue is the engine. Hormones are the fuel.
If I remove the engine, you can put whatever fuel you want in the car — it’s not going anywhere.

That is why I tell my patients they may continue TRT, finasteride, or other medications if they choose. Once the hormonally responsive tissue is gone, those medications no longer have a meaningful target.

To be clear, no surgery in medicine carries a zero percent risk. Biology always has exceptions. But with comprehensive tissue removal, recurrence is extraordinarily rare, even in patients who remain on hormone-altering therapies.

If you are considering gynecomastia surgery and are concerned about recurrence, the most important question is not what medications you take, but how completely the tissue will be removed. Experience, technique, and surgical philosophy matter — enormously.