My erections seem shorter than normal; the penis seems more slender and the head of the penis never gets hard or firm. I assumed I had Peyronie’s disease, but the doctor said there was no hard spot which apparently is typical. I am wondering if there could be another cause such as low testosterone.

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  • My erections seem shorter than normal; the penis seems more slender and the head of the penis never gets hard or firm. I assumed I had Peyronie's disease, but the doctor said there was no hard spot which apparently is typical. I am wondering if there could be another cause such as low testosterone.
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Dr. Levine answers:The scenario that you describe may be due to a diffuse scarring disorder involving the outer jacket of the penis, known as the tunica albuginea. Or it may involve the septum between the two erectile cylinders of the penis. Septal lesions are not so well appreciated and these scars involving the center portion of the penis are the ones that often times result in shortening and may interfere with blood flow beyond the area of the scar resulting in what is known as distal flaccidity or a softer shaft beyond the scar.

Your question as to whether testosterone may be a factor is also important, but a low testosterone is rarely the cause of erectile insufficiency and tends to be associated with a low libido as well. It would be reasonable to see another physician, possibly one who has greater experience with Peyronie’s disease or sexual dysfunction. Duplex ultrasound evaluation of the penis may reveal scarring within the tunica and/or septum as well as within the penile vascular tissue which may determine the cause of the problem. Typically the most common treatment for this type of problem, if the testosterone is normal, is to use a PDE5 inhibitor such as Viagra, Cialis or Levitra.