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Dr Hayat
Dr Hayat, Specialty Dr Internal and Critical Care Medicine
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How do I know if I have Peyronie’s disease? I recently saw a

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How do I know if I have Peyronie’s disease? I recently saw a urologist who performed a doppler ultrasound on my penis to diagnose severe vascular ED, with a penis curvature of 30>40% the curve is downwards. He did say I had a lot of scar tissue in my penis which was restricting blood flow and recommended I do extracorporeal shockwave therapy. Does it sound like I have peyronie’s? Or could it just be a natural curvature?I have included a picture of my penis for reference.Thanks.
Dr Hayat
Hi. Dr Hayat here.  Welcome to JA.
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Have you got any underlying health issues?

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Its seems like peyronies disease. The erection seems to be good quality. With 30% you should be able to have vaginal penetration. Doppler USS is not a very reliable investigation to diagnose ED. It most of times shows venous leak which now is considered not very significant. ESWL is a treatment for peyronies disease ( recommended by NICE guidelines ). In my opinion  should use tab Cialis 5 mg OD or 20 mg Twice weekly and the ED would improve. Does not need any corrective surgery for 30% curvature. ESWL is optional.

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Anything else I can help with?

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Customer: replied 16 days ago.
I am currently using cialis 5mg daily dose, however I cannot achieve more than a semi erection that feels soft and like I could lose it at any time. I’m hoping that the shockwave therapy improves the effectiveness of the cialis. The Doppler showed a lot of white bits which was explained to me by the specialist to be scar tissue. Would the shockwave therapy dissipate the scar tissue? Is that how it works?Also lastly is there anything you can recommend I do as well as the EWSL to improve my condition? Anything diet specific or anything else at all.Thanks doc.
Customer: replied 16 days ago.
In regards ***** ***** question about underlying health issues, I recently got my blood work done and my testosterone is low, I will upload a screenshot of my blood work for you to look at
Customer: replied 16 days ago.
File attached (151124P)
Customer: replied 16 days ago.
Could the low testosterone be causing my ED? I was told it was Vasculogenic that’s why I want to do the EWSL, I’m hoping to get testosterone replacement. Is that something you think I need based on my testosterone levels for my age? ( 38 )

How's your libido

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Hello

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Customer: replied 15 days ago.
In terms of wanting sex it’s non existent. Masturbation is around every day, or every other day, usually always to porn.

I don't think testosterone is the cause . Its low but not that low low to cause these symptoms. However you can take a shot if testosterone depot preparation given intramuscular and effective for a month and see the response  to it. It will need a prescription from the GP.  If you find that it has worked then can continue it.

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Anything else I can help with please?
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Customer: replied 15 days ago.
The thing is my GP said that I need an initial prescription for testosterone to come from a urologist, then they (gp) will be able to issue it thereafter.In your opinion does it sound like a vascular issue that is causing my ED?I should mention that I never experience erections during the night or wake up with them.

It sounds multifactorial...Vascular, peyronies, testo to some extent and psychological

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Best wishes.  Please feel free to contact me if you have any further queries or need to follow up.  I will be happy to help and guide. Have a nice day
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Customer: replied 12 days ago.
Thank you
Pleasure
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