Peyronie's Disease and Testosterone: A Narrative Review

Abstract

The pathophysiology of Peyronie's disease (PD) remains incompletely understood; current hypotheses point to a combination of predetermined genetic factors and tissue ischemia. Testosterone has been shown in pre-clinical studies to have anti-inflammatory properties and influence collagen metabolism, prompting various clinical studies examining its effect on disease development and impact on the severity of PD. We seek to review these studies to determine if testosterone levels are associated with PD. A comprehensive literature search of PubMed, Scopus, CENTRAL, Embase, and Web of Science was conducted with the search terms “Testosterone AND (Peyronie OR Peyronie's OR Peyronies).” Titles and abstracts were screened for relevance, and included studies were then manually reviewed. A narrative review was chosen due to the low number of available studies. A total of 381 studies were identified, of which 202 were duplicates, leaving 179 that underwent title and abstract screen. Full-text review was conducted for 52 studies, and a total of 15 studies were identified that examined or compared the relationship between testosterone levels and either the prevalence or severity of PD; some studies examined both. Three of the 12 studies examining the development of PD with relation to testosterone support an association between hypogonadism and PD, while another four possibly support an association and five do not support such an association. Of the nine studies that examine the severity of PD, three studies support a statistically significant association between PD severity and hypogonadism, while six do not support such an association. After a comprehensive review of the literature, no definitive statement can be made regarding a relationship between PD and testosterone deficiency. Studies examining such a link suffer from significant heterogeneity and retrospective bias. There is a need for more prospective randomized studies to further elucidate a possible relationship.