Peyronie’s disease (PD) involves the build-up of plaque on the penis beneath the skin that can cause painful erections, erectile dysfunction (ED), and penile deformity. PD deformity is usually a distinct curve in the penis, but can have different shapes, such as an hourglass.
The U.S. Food and Drug Administration (FDA) has only approved one option for treating PD that does not involve surgery. An injection of collagenase clostridium histolyticum (CCH) is injected directly into the plaque on the penis. CCH then breaks down the plaque and reduces curvature.
Testosterone deficiency is common in PD patients, with a prevalence as high as 74%. Investigations into the effects of testosterone on CCH injections and PD suggest that testosterone may play a role in the response to CCH injections. As a result, researchers have investigated whether testosterone replacement therapy could improve the effectiveness of CCH treatment in men with both PD and testosterone deficiency.
The most recent study involved information from 778 men with PD around the age of 56 who were either:
- Testosterone deficient,
- Testosterone deficient and on testosterone therapy, or
- Within the normal range of testosterone (eugonadal).
The study compared the degree of penile curvature and pain severity before and after CCH.
- Testosterone-deficient men with no testosterone therapy had the poorest improvement in curvature at 17° of improvement
- Those receiving testosterone therapy improved by 19°
- Eugonadal men improved by 24°
Researchers suggest that testosterone does play a role in response to CCH. However, therapy may not be needed for success in testosterone-deficient men.
It appears that eugonadal men were in the least amount of pain. This was measured by likelihood of asking for pain medication. In this case, eugonadal men were less likely than testosterone-deficient men to ask. Researchers note that testosterone deficiency is associated with chronic inflammation. Speculatively, this inflammation response may increase pain severity in testosterone-deficient men.
This study aligns with others that suggest testosterone levels influence response to CCH.
- Eugonadal men had the best responses to CCH.
- Testosterone therapy does not appear to make a huge difference.
- Delaying CCH only to start testosterone therapy may not be necessary. Decisions about testosterone therapy should still be individualized to a patient's symptoms and testosterone levels.
Key Takeaways
- Peyronie’s disease causes penile deformity, erectile dysfunction, and penile pain.
- Testosterone deficiency has been associated with PD in a large number of patients.
- CCH injections are the only FDA-approved non-surgical treatment for PD.
- In one study, testosterone deficiency was associated with lower CCH treatment response for PD.
- More research is needed to clarify the role of testosterone therapy before starting CCH.
- If PD is evident or causing distress, it may be beneficial to speak with a healthcare provider.
Resources
Hernandez, B. S., Walia, A., Coady, P., Angulo-Llanos, L., Bernie, H. L., de Amorim, L. G., Dallmer, J. R., Moukhtar Hammad, M. A., Hsieh, T.-C., Hinojosa-Gonzalez, D. E., Kava, B., Masterson, T. A., Miller, J. A., Pereira, T. A., Saffati, G., Nguyen, V., Yaf, F. A., & Khera, M. (2026). Impact of testosterone therapy and hypogonadism on treatment outcomes in Peyronie’s disease: A multicenter retrospective analysis of collagenase clostridium histolyticum therapy. The Journal of Sexual Medicine, 23(7). https://doi.org/10.1093/jsxmed/qdag185
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