Peyronie’s disease and testosterone deficiency: Is there a link?

  • Ishan Aditya
  • Ethan D. Grober
  • Yonah KrakowskyEmail author
Topic Paper



Peyronie’s disease (PD) and testosterone deficiency (TD) impact men at the same stage of life and can ultimately contribute to erectile dysfunction. There is speculation that low levels of testosterone (T) may predispose men to penile fibrosis; however, there is no published, up-to-date review summarizing the current evidence. Therefore, we conducted a narrative review of the literature exploring the relationship between PD and TD.


A comprehensive systematic search of existing literature of five online databases from June 1990 to June 2018 examining the relationship between PD and TD was conducted. The Cochrane risk-of-bias tool for randomized trials and the risk-of-bias assessment tool for cohort studies were used to evaluate the quality of studies.


Six studies were identified (n = 675). Overall, five studies supported the link between PD and TD by demonstrating relationships in PD patients with low total T, free T, bioavailable T, greater penile curvature, and plaque development. However, one study demonstrated no connection between the conditions. The literature is restricted by small studies with methodological flaws.


There are a number of mechanisms to support the link between TD and PD. The literature on the topic is limited by small studies which are overall conflicting. The findings of this work suggest the need for larger, prospective studies to clarify the role of TD in the development, evaluation, and treatment of PD. Establishing such a relationship could change management of PD as a diagnosis of PD may encourage clinicians to evaluate a patient’s testosterone levels.


Peyronie’s disease Testosterone deficiency Penile curvature Penile fibrosis Penile plaque Andropause Low testosterone Androgens Erectile dysfunction 


Author contribution

Aditya was involved in project development, data collection, data analysis, manuscript writing, and editing. Grober was involved in project development, data collection, data analysis, manuscript writing, and editing. Krakowsky was involved in project development, data collection, data analysis, manuscript writing, and editing.

Compliance with ethical standards

Conflict of interest

There are no personal conflicts of interest.


  1. 1.
    Yafi FA, Pinsky MR, Sangkum P, Hellstrom WJ (2015) Therapeutic advances in the treatment of Peyronie’s disease. Andrology 3(4):650–660CrossRefPubMedGoogle Scholar
  2. 2.
    Lue TF, Giuliano F, Montorsi F, Rosen RC, Andersson KE, Althof S, Christ G, Hatzichristou D, Hirsch M, Kimoto Y, Lewis R (2004) Summary of the recommendations on sexual dysfunctions in men. J Sexual Med 1(1):6–23CrossRefGoogle Scholar
  3. 3.
    Stuntz M, Perlaky A, des Vignes F, Kyriakides T, Glass D (2016) The prevalence of Peyronie’s disease in the United States: a population-based study. PLoS ONE 11(2):e0150157CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Mulligan T, Frick MF, Zuraw QC, Stemhagen A, McWhirter C (2006) Prevalence of hypogonadism in males aged at least 45 years: the HIM study. Int J Clin Pract 60(7):762–769CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Bolona ER, Uraga MV, Haddad RM, Tracz MJ, Tracz MJ, Sideras K (2007) Testosterone use in men with sexual dysfunction: a systematic review and meta-analysis of randomized placebo-controlled trials. Mayo Clin Proc 82(1):20–28CrossRefPubMedGoogle Scholar
  6. 6.
    Wu FC, Tajar A, Pye SR, Silman AJ, Finn JD, O’neill TW, Bartfai G, Casanueva F, Forti G, Giwercman A, Huhtaniemi IT (2008) Hypothalamic-pituitary-testicular axis disruptions in older men are differentially linked to age and modifiable risk factors: the European Male Aging Study. J Clin Endocrinol Metab 93(7):2737–2745CrossRefPubMedGoogle Scholar
  7. 7.
    Corona G, Mannucci E, Fisher AD, Lotti F, Petrone L, Balercia G, Bandini E, Forti G, Maggi M (2008) Low levels of androgens in men with erectile dysfunction and obesity. J Sexual Med 5(10):2454–2463CrossRefGoogle Scholar
  8. 8.
    Snyder PJ, Bhasin S, Cunningham GR, Matsumoto AM, Stephens-Shields AJ, Cauley JA, Gill TM, Barrett-Connor E, Swerdloff RS, Wang C, Ensrud KE (2016) Effects of testosterone treatment in older men. N Engl J Med 374(7):611–624CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Shen ZJ, Zhou XL, Lu YL, Chen ZD (2003) Effect of androgen deprivation on penile ultrastructure. Asian J Androl 5(1):33–36PubMedGoogle Scholar
  10. 10.
    Traish AM, Park K, Dhir V, Kim NN, Moreland RB, Goldstein I (1999) Effects of castration and androgen replacement on erectile function in a rabbit model. Endocrinology 140(4):1861–1868CrossRefPubMedGoogle Scholar
  11. 11.
    Schwarzer U, Sommer F, Klotz T, Braun M, Reifenrath B, Engelmann U (2001) The prevalence of Peyronie’s disease: results of a large survey. BJU Int 88(7):727–730CrossRefPubMedGoogle Scholar
  12. 12. (2019) Cochrane risk of bias tool. Accessed 2 Jan 2019
  13. 13.
  14. 14.
    Moreno SA, Morgentaler A (2009) PEYRONIE’S DISEASE: testosterone deficiency and Peyronie’s disease: pilot data suggesting a significant relationship. J Sexual Med 6(6):1729–1735CrossRefGoogle Scholar
  15. 15.
    Nam HJ, Park HJ, Park NC (2011) Does testosterone deficiency exaggerate the clinical symptoms of Peyronie’s disease? Int J Urol 18(11):796–800CrossRefPubMedGoogle Scholar
  16. 16.
    Sturm R, Rumohr JA, Lipshultz LI, Mohamed O, Khera M (2009) Increased incidence of hypogonadism in patients with a novel diagnosis of Peyronie’s disease as compared to organic erectile dysfunction. J Urol 181(4):278–279CrossRefGoogle Scholar
  17. 17.
    Karavitakis M, Komninos C, Kontos S, Simaioforidis V, Kachrilas S, Politis V, Chatziplis E, Koritsiadis G, Doumanis G (2009) Altered collagen metabolism in Peyronie’s disease: is dehydroepiandrosterone sulfate the missing link?: po-07–015. J Sexual Med 6:455–456Google Scholar
  18. 18.
    Cavallini G, Biagiotti G, Giudice CL (2012) Association between Peyronie disease and low serum testosterone levels: detection and therapeutic considerations. J Androl 33(3):381–388CrossRefPubMedGoogle Scholar
  19. 19.
    Kirby EW, Verges D, Matthews J, Carson CC, Coward RM (2015) Low testosterone has a similar prevalence among men with sexual dysfunction due to either Peyronie’s disease or erectile dysfunction and does not correlate with Peyronie’s disease severity. J Sexual Med 12(3):690–696CrossRefGoogle Scholar
  20. 20.
    Al-Thakafi S, Al-Hathal N (2016) Peyronie’s disease: a literature review on epidemiology, genetics, pathophysiology, diagnosis and work-up. Transl Androl Urol 5(3):280CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Bilgutay AN, Pastuszak AW (2016) Peyronie’s disease: What’s around the bend? Indian J Urol 32(1):6CrossRefPubMedPubMedCentralGoogle Scholar
  22. 22.
    Rubin RS, Goldstein I (2016) Medical management of sexual dysfunction in the aging male. Top Geriatr Rehabilit 32(3):167–173CrossRefGoogle Scholar
  23. 23. (2018) Drugs@FDA: FDA approved drug products—Xiaflex. Accessed 10 July 2018
  24. 24.
    Shirazi M, Haghpanah AR, Badiee M, Afrasiabi MA, Haghpanah S (2009) Effect of intralesional verapamil for treatment of Peyronie’s disease: a randomized single-blind, placebo-controlled study. Int Urol Nephrol 41(3):467–471CrossRefPubMedGoogle Scholar
  25. 25.
    Wu FC, Tajar A, Beynon JM, Pye SR, Silman AJ, Finn JD, O’neill TW, Bartfai G, Casanueva FF, Forti G, Giwercman A (2010) Identification of late-onset hypogonadism in middle-aged and elderly men. N Engl J Med 363(2):123–135CrossRefPubMedGoogle Scholar
  26. 26.
    Bratland Å, Ragnhildstveit E, Bjørnland K, Andersen K, Mælandsmo GM, Fodstad Ø, Saatcioglu F, Ree AH (2003) The metalloproteinase inhibitor TIMP-2 is down-regulated by androgens in LNCaP prostate carcinoma cells. Clin Exp Metast 20(6):541CrossRefGoogle Scholar
  27. 27.
    Liao X, Thrasher JB, Pelling J, Holzbeierlein J, Sang QX, Li B (2003) Androgen stimulates matrix metalloproteinase-2 expression in human prostate cancer. Endocrinology 144(5):1656–1663CrossRefPubMedGoogle Scholar
  28. 28.
    Snyder P, Kopperdahl D, Stephens-Shields A, Ellenberg S, Cauley J, Ensrud K et al (2017) Effect of testosterone treatment on volumetric bone density and strength in older men with low testosterone. JAMA Intern Med 177(4):471CrossRefPubMedPubMedCentralGoogle Scholar
  29. 29.
    Roy C, Snyder P, Stephens-Shields A, Artz A, Bhasin S, Cohen H et al (2017) Association of testosterone levels with anemia in older men. JAMA Intern Med 177(4):480CrossRefPubMedPubMedCentralGoogle Scholar
  30. 30.
    Nehra A, Alterowitz R, Culkin DJ, Faraday MM, Hakim LS, Heidelbaugh JJ, Khera M, Kirkby E, McVary KT, Miner MM, Nelson CJ (2015) Peyronie’s disease: AUA guideline. J Urol 194(3):745–753CrossRefPubMedPubMedCentralGoogle Scholar
  31. 31.
    Bella AJ, Lee JC, Grober ED, Carrier S, Benard F, Brock GB (2018) 2018 Canadian urological association guideline for Peyronie’s disease and congenital penile curvature. Can Urol Assoc J 12(5):E197CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Ishan Aditya
    • 1
  • Ethan D. Grober
    • 2
  • Yonah Krakowsky
    • 2
    Email author
  1. 1.Faculty of MedicineUniversity of TorontoTorontoCanada
  2. 2.Division of Urology, Department of Surgery, Women’s College Hospital and Mount Sinai HospitalUniversity of TorontoTorontoCanada

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