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IS IT LOW T?
The relationship between Peyronies and testosterone levels is still evolving
and often confused by conflicting study results. This issue is best divided
into 3 separate, but related questions:

  • Do low testosterone levels predispose men to develop Peyronies?
  • Is there a relationship between testosterone levels and the severity of the
    condition during the active phase ? (usually months 1-18 from diagnosis)
  • Can testosterone therapy be used to mitigate or reverse the progression
    of the disease during the active phase?

Peyronies is a result of a penile connective tissue disorder of the tunica
albuginea. The most widely accepted etiology for Peyronies is trauma or
repeated micro traumas to the erect penis, followed by aberrant wound
healing, resulting in scar tissue formation of the tunica albuginea. This can
lead to a number of symptoms including pain, erectile dysfunction and
penile curvature during erection. Testosterone has anti-inflammatory
properties and it is thought to accelerate wound healing.  Wounds are
sensitive to testosterone stimulation and therefore, it would be reasonable
to conclude that abnormally low levels of testosterone would result in
abnormal would healing.  As men age, their testosterone levels decrease
and they are more likely to develop Peyronies.  

The International Journal of Urology August 31, 2011, examined the
question "Does testosterone deficiency exaggerate the clinical symptoms of
Peyronies disease."  The medical records of 106 men with Peyronies were
examined and divided into 2 groups.  Seventy-six men had normal levels of
testosterone and the remainder (30) has below normal levels.  These men
were in the active stage of Peyronies - approximately 8 months since
diagnosis.     

  • The plaque size for men in the testosterone deficient group was
    approximately 33% greater than for men in the normal testosterone group

  • The mean curvature was approximately 32 degrees in the low T group vs.
    22 in the normal group

  • The greatest degree of curvature in the low T group was almost 60
    degrees vs 37 degrees for the normal group

This study would seem to show a definite relationship between low
testosterone levels and the severity of Peyronies symptoms.  The author
pointed to another study published in the Journal of Sexual Medicine that
demonstrated that low T was associated with the development of Peyronies.  
Almost 75% of men in this other study had abnormally low levels of
testosterone.  These 2 studies would appear to demonstrate that low
testosterone levels are associated with the development of Peyronies and with
increased severity of the disease.  Unfortunately, as with many factors related
to our illness, a definite conclusion can not be reached.  The author then
discussed 2 other studies, one rather large one with almost 1500 subjects, that
found no correlation between Peyronies and low testosterone levels.  

In light of his findings and some of the contradictory evidence the doctor is
prudent in his findings and concluded that low testosterone levels
may  
predispose men to the development of Peyronies and those with low T levels
may also develop a more severe case.  

The author raises another good issue.  The frequency and vigor of sexual
intercourse is usually greater in young men, so it is unclear why peak
Peyronies onset occurs in men in their 50s if trauma is the precipitating event.  
Maybe low T levels in older men fail to protect them from injuries resulting from
sexual activities.  

One ongoing study that is currently still recruiting men and may answer some
of these questions is being conducted in Boston, Massachusetts.  This small
study of approximately 75 men is recruiting men with Peyronies.  Some of the
men in the control group will receive Vitamins D & E and the treatment group
will receive these Vitamins along with testosterone pellets.  The study will treat
men whether or not they have testosterone deficiency as long as they have not
been treated for this condition in the past with testosterone therapy.  All men
enrolled in the study will have to have been diagnosed within 18 months of
signing the informed consent agreement.  If you are interested in the study
Click Here.

My comments: This is another frustrating aspect of our disease.  When first
reading the study, it appeared that there was a positive correlation between low
T and the development and severity of Peyronies symptoms.  Then the author
points out 2 additional and larger studies that show no relationship between
Peyronies and testosterone levels.  Although logically, testosterone and
Peyronies levels should be related, some studies show they are not.  Basically,
we do not have enough evidence for a definitive conclusion.  

The study in Boston is rather interesting.  It will accept men who have been
diagnosed within the previous 18 months.  At the 18 month level men are
finishing their active phase of Peyronies and entering the chronic phase.  If I
were designing the study, I would have either significantly decreased or
significantly increased the monthly duration for inclusion in order to see
treatment results for different phases of our disease.  Another concern is that
the study has been running for almost 1 year and is still recruiting.  It would
appear that men, especially those with Peyronies, are reluctant to sign up for
testosterone supplementation.  With all these limitation it still should be
interesting to see if testosterone therapy can lead to a lessening or reversal of
the symptoms.  

For what it is worth, I had my testosterone levels checked and they are in the
high normal range.  So, no testosterone deficiency here, but still have a severe
case of Peyronies.    

Previously, I wrote about an interesting study in Brazil that used testosterone
and heat therapy as a possible mechanism to reverse Peyronies symptoms.  I
wrote the doctor to follow up on the study results, but never heard from him or
the study again.
 

There have been other articles in this site about this topic.  If you want to read
them, click on the icons at the left side of the page.  
Testosterone
Testosterone, Peyronies Disease