I am 65 and was diagnosed with PD 18 months ago. I have a 50-degree upward curvature and some associated erectile dysfunction, but with Viagra I am still able to be sexually active. I plan to purchase the Fastsize Extender and use it in conjunction with L-arginine in hopes of reducing the degree of curvature. Is there a problem using L-argenine and Viagra together?

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Dr. Levine answers: As you know, erectile dysfunction (ED) frequently accompanies Peyronie’s disease and in fact up to 90% of patients have been reported some reduction of rigidity. The use of all three of the PDE-5 inhibitors (i.e. Viagra, Levitra, and Cialis) have been used successfully to improve rigidity in Peyronie’s disease patients. It should be recognized though that a much stronger erection with curvature may have a greater risk of being reinjured during sex and make the deformity worse. But this has not been reported. The use of the L-arginine is as an anti-fibrotic (i.e. anti-scarring) agent. It should be taken daily and the recommended dose is 1000 mg twice per day. Viagra, Levitra, and Cialis are taken on an as-needed basis, but can be taken up to once per day. There is experimental evidence to suggest that Viagra as well as the other two PDE-5 inhibitors can have some anti-scarring effects as well, but these have not been demonstrated in proper trials.

Previous I am 45, Peyronie’s for 5 years, stable, curve about 75 degrees. I am able to have sexual intercourse, but I worry about getting worse over time. My urologist suggests I take 2 Pentox a day, Is this OK or should I take 3? I also worry about being on the Pentox for years, if I quit after one year will I experience any worsening? Will using Pentox mess with my Immune system? I suffer from lower than normal testosterone, so I get sick easily. Should vitamin D be taken with Pentox to help in immunity?
Next I am looking for the best medical therapy for a moderate Peyronie’s case (no ED, age 30, healthy) and have questions about a combination Dr. Levine once proposed (PDE5 e.g. Sildenafil 25mg daily, L-arginine 500 mg twice daily, pentoxyfiline 400 mg thrice daily). 1. L-Arginine is known to be a precursor to nitric oxide. Why is that not contraindicated with Sildenafil (“no nitrics”) 2. Pentox says it should not be combined with substances that lower the blood pressure. Any problem with Sildenafil?
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