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.
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