Impact of testosterone therapy and hypogonadism on treatment outcomes in Peyronie's disease: a multicenter retrospective analysis of collagenase clostridium histolyticum therapy.

BACKGROUND

Peyronie's disease (PD) is an acquired connective tissue disorder characterized by fibrous plaque formation within the penile tunica albuginea that may be influenced by androgen status.

AIM: To evaluate whether baseline testosterone levels and testosterone therapy (TTh) during collagenase clostridium histolyticum (CCH) treatment affect curvature severity and treatment outcomes in men with PD.

METHODS

This multi-center retrospective study included men with PD treated with CCH who had no curvature progression in the preceding three months and documented baseline testosterone levels. Demographics, baseline and post-treatment curvature, pain, plaque calcification, adverse events, TTh use, and surgical conversion were analyzed. Testosterone deficiency was defined as testosterone <300 ng/dL and concurrent signs or symptoms of low testosterone. Multivariable analyzes assessed predictors of curvature improvement.

OUTCOMES: Primary outcomes included change in penile curvature following CCH therapy and secondary outcomes included adverse events and surgical conversion rates.

RESULTS

Among 790 men, 778 met inclusion criteria (mean age 56.6 ± 9.1 years), with a median of eight CCH injections. Testosterone deficiency was present in 21% (n = 166), of whom 54% (n = 90) received TTh. Baseline curvature was similar among eugonadal men, testosterone deficient men on TTh, and testosterone deficient men not receiving therapy (45° vs. 44° vs. 48°, P = .392), as were pain symptoms and disease duration, though plaque calcification was more common in testosterone deficient men (P = .039). Mean curvature improvement was greatest in eugonadal men (24°), followed by testosterone deficient men on TTh (19°) and testosterone deficient men without therapy (17°). On multivariable analysis adjusting for age, baseline erectile dysfunction, baseline curvature severity, plaque calcification and post procedure modeling, both testosterone deficient groups remained independently associated with less curvature improvement compared with eugonadal men, with no significant difference between testosterone deficient men receiving versus not receiving TTh. Testosterone deficient men experienced higher rates of pain requiring medication (P < .05). Other adverse events and surgical conversion rates were similar across groups.

CLINICAL IMPLICATIONS: Baseline androgen status may influence response to CCH therapy and should be considered during counseling and treatment planning.

STRENGTHS AND LIMITATIONS: Strengths include a large multi-center cohort and multivariable analysis, while limitations include retrospective design, variability in TTh regimens, and potential unmeasured confounders.

CONCLUSION

Testosterone deficiency is associated with reduced curvature improvement following CCH therapy regardless of testosterone treatment, with eugonadal men demonstrating the greatest therapeutic benefit.