Low testosterone and erectile dysfunction get treated as the same problem, but they are usually not. One is a hormone issue that blunts desire; the other is a blood flow issue that affects the mechanics of an erection. Here is how to tell which one you are dealing with — and why testosterone therapy often disappoints men who expected it to fix their erections.
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Here’s how the Mayo Clinic defines Peyronie’s Disease (PD):
“Peyronie’s Disease (PD) involves formation of fibrous scar tissue (plaque) in the tunica albuginea of the penis, leading to curvature, pain, shortening, or other deformities during erection. The exact trigger is often unclear, but the process centers on injury followed by abnormal wound healing.”
https://www.mayoclinic.org/diseases-conditions/peyronies-disease/symptoms-causes/syc-20353468
In my experience in dealing with thousands of PD patients, here’s 4 key questions and discussions about this very challenging condition.
Let’s just get a bit of science out of the way: The core mechanism of PD is improper healing and susceptibility to scar formation. PD is fundamentally a disorder of disordered wound healing rather than simple injury. After trauma or microtrauma causes bleeding and inflammation in the tunica, genetically or biologically susceptible individuals (sometimes linked to conditions like Dupuytren’s contracture) produce excess collagen, persistent myofibroblast activity, and inelastic plaque instead of normal remodeling. In short, PD most often begins with penile trauma in a susceptible person, followed by faulty scar-tissue formation. Symptoms of PD are painful erections, curved erections, difficulty in penetration, indentations or hourglass shaping, palpable fibrotic anomalies, loss of length and girth, erectile dysfunction, anxiety & depression. Patients will experience one or more of these symptoms, and the disease progresses from an acute phase (< 12 months) to a chronic phase (> 12 months).
Most cases have no clear recalled trigger; 75% of my guys don’t know why or how their PD started. 25%, however, are certain; they injured it during sex or masturbation, they got a puck or a foot in the groin, or they snapped a branch off on the head of their cock when they were clearing some brush, or post unrelated surgery (catheter insertion or removal?).
Don’t worry bro – you aren’t alone.
In fact it happens a lot, to a lot of guys over the course of their lives – PD prevalence is estimated as high as 9%.
For comparison sake – Diabetes has a similar prevalence – and everyone knows what diabetes is.
Most people don’t know what the F&%# PD is. And it’s very likely to be underreported.
So 25% for sure know HOW it happened, but for the remaining 3/4 of men, who just WAKE UP one morning – and it’s curved, or in pain – they have no idea what caused their condition.
I have my own theory.
I estimate that most of these men, specifically those who, prior to their injury, had normal erectile function, simply turned over on their boners during sleep, and boom, there’s your trauma. If you are a guy with healthy erectile function, you may be having 3-5 nighttime erections (nocturnal penile tumescence) every night! Accidents happen when you have a boner!
Simple preventative solution? Sleep on your back as much as you can!!! DICK UP!
Ultimately, being the detective in this scenario isn’t really relevant to you.
The question becomes – HOW DO I FIX THIS?
I’ve heard from several patients that when presenting to a urologists with PD, often later during the acute phase (because how long does it take to get a urologist appointment?), the advice for the patient was to ‘just wait it out’.
Whoa – yeah, don’t do that.
“See ya in a year!” said one urologist, without even completing a physical exam. Patient complained to me: “I just waited 10 months to be told there’s nothing that can be done?” Brutal. BS.
PD is a disease – meaning it progresses and usually worsens without intervention – and you should do what you can to halt it in its tracks early.
I’m not saying you need to have surgery or start injections – but you should be considering non-pharmaceutical, natural, non-invasive solutions now. I understand why most doctors opt to do nothing. In about 10% of PD patients, they will see a return to relative normalcy WITHOUT any intervention.
Following the Voltaire logic (“the art of medicine consists of amusing the patient while nature cures the disease”)
It just heals. And I’m sure, for a very small number of people – it does.
But for most, it won’t. And so being proactive is really important.
My advice is to throw the kitchen sink at the problem.
Here’s your list – Do all of them if you can:
Focused Shockwave Therapy. It’s powerful and painless for most people. It is expensive and there is no guarantee for success. But the data is very promising.
Traction Device and/or a vacuum pump. I recommend the RestoreX, the Penimaster, and the Active 3 Medintim Electric Pump. But don’t just buy it to let it sit under your bathroom sink. USE IT.
Nightly massages and jelquing. 5 minutes in a warm shower is all you need. These are somewhat controversial but I believe they can be done safely. Be careful! You CAN hurt yourself.
Apply Castor Oil to fibrotic plaque area. Purchase the very highest quality organic castor oil for topical use you can find. There’s none that I can specifically recommend. Go to a local Health Food Store. The data on castor oil is generally poor, but the side effects are so low that it’s generally worth a shot.
Bang & Masturbate (Carefully). Don’t let the blood flow to the area stop. USE IT.
Don’t do one, and ‘see what happens’. If you CAN – do them all. Do you think when Aaron Rodgers’ achilles exploded, he did the surgery and then was like ‘ahhh, I’m not gonna use the walking boot?’
Of course not – Throw the Kitchen Sink at the Problem.
Unfortunately, PD is like the achilles heel injury of the cock. PD, like an achilles rupture, is very difficult to fix, even with the best of care. How can such a small injury cause such a giant, and difficult to fix problem?
Often times you will never fully heal exactly, and If you do, prepare for a long recovery. The healing process takes time.
But if you DO NOTHING – I think you set yourself up for long term failure.
It’s important to note that there is a strong association of PD with mental health disorders. Many men develop significant emotional distress, clinical depression (rates often cited around 48% or higher in clinic samples), anxiety, relationship strain, and reduced quality of life. This is totally understandable given the impact PD can have on sexual function and body image.
https://pubmed.ncbi.nlm.nih.gov/40684259/
PD can often result in erectile dysfunction. While many guys who come to see me report no issues with ‘getting’ the erection, over time, it’s well defined that PD can result in early onset ED. In a retrospective analysis of 309 men with active-phase PD, ED was present in 37.5% of cases; in ALL of these, ED occurred during the course of PD. https://pmc.ncbi.nlm.nih.gov/articles/PMC4958366/
Again – it’s a disease.
Do what you can to halt its progression.
Clinical Presentation of Peyronie’s Disease: A Retrospective Study of 564 Cases (2024) — Found ED in 39.8% of PD patients.
https://www.mdpi.com/2075-4418/14/11/1125
Peyronie’s disease in the United States: A real-world, 13-year nationwide analysis of demographics, clinical characteristics, and treatment trends (2025) — ED present at diagnosis in 28.2% of patients; additional de novo ED developed in 14.8% within one year of PD diagnosis.
https://onlinelibrary.wiley.com/doi/10.1111/andr.70029
