Peyronies treatment using ultrasound therapy along with hydrocortisone

Hello Dr,

I have read that ultrasound using hydrocortisone as the conductor is an effective Peyronies treatment. Are you familiar with this protocol?

I saw my local urologist today who basically gave me little hope via conventional methods, and told me to continue my own self-administered regimen of supplements, topical solutions, and traction.

Ultrasound seems promising. Do full instructions come with the ultrasound device and what conductor do you recommend–DMSO?

I have DMSO but would also like to try hydrocortisone if you think that would work.

With thanks in advance,


Greetings Mike,

Yes, I am familiar with the protocol of using ultrasound to drive in a drug; this technique is called phonophoresis.   The problem you face doing ultrasound with the hydrocortisone cream you have is that it is likely not a good sound conductor; you cannot use just any kind of cream or contact medium for ultrasound and expect it to work. This is the beauty of using the PMD DMSO gel or the Dusa-Sal DMSO gel that is available from PDI with your ultrasound machine; they both are excellent conductors of ultrasound energy.

With the PMD DMSO gel or the Dusa-Sal DMSO gel products, it is not the DMSO that is the sound conductor but it is the gel component of the product that conducts the sound. It has enough water in it to make it an excellent sound carrier.   

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I think it would be an interesting experiment to try your cortisone cream to treat your Peyronie's disease.  I can see nothing wrong with it, but I suggest you talk to your doctor first about it for confirmation.  Here is how I would do it: 

1. Get the ultrasound machine ready. 

2. Apply a moderate layer of cortisone cream on the shaft over the known area of the Peyronie's scar.

3. Apply a generous layer of either PMD DMSO gel or Dusa-Sal Gel over the cortisone cream.

4. Turn on the machine and treat as instructed in the information you will receive with the machine from PDI. We have an excellent 3MHz ultrasound machine available through the PDI store that comes with full instructions how to use it specifically for the problem of Peyronie's disease.

Please keep in mind that this methodology should only be used as one of many different therapies against your Peyronie's disease, and not as a stand-alone or solo therapy.  Never attempt to get rid of PD using only one therapy, or you are sure to be disappointed. 

Please let me know the results of your idea when a little time has passed.   TRH


Will my Peyronie's disease continue to get progressively worse if I do not have an operation?

Dear Dr. Herazy,

Since November 2012 I know that I suffer from Peyronies Disease. In the first weeks after I got the diagnostic finding, it was not such a big problem for me. But now i get more and more fear. Because I am afraid, that I could lose my whole ability to erection and I have suicidal thoughts. Sex has such a big quality of life for me.

Since now, I have no zigzag of my penis, because it seems that the plaque is around the penis, short behind the glans. In former times my penis was 19-20 cm, and now I have still 14,5. This is not such a big problem for me until now, but I want to keep these 14,5 cm. I can also observe, that my ability to have an orgasm is lower. I have informed myself on German websites, but all these information are confusing and sometimes are contradictory. The German Urologic Center in Darmstadt says, if you don´t get an operation, the Peyronies Disease will progress and progress due to the fact that with every erection at the edge of the plaque, there will occur new cracks which will lead to new scars. The inevitable end is the impotence. I am so desperate about this point.

In the past I had problems with erectile dysfunction and my libido. Other disorders were bad sleep, oscillation of my mood and so on. My testosterone value was very low. But nobody wanted to substitute my testosterone. On a German website I read, that its significantly that Peyronies disease correlates with a low value of testosterone and erectile dysfunction. In any case, the mainstream on German websites is, that medical treatment will affect the disease only marginal. And now I read your article about vitamin E. My question is, can I, in my role as a patient do anything with medical treatment which has chances of success to improve the disease a little bit. Please help me, I am so desperate, please, please help me. I feel so alone.

Alexander S.

Greetings Alexander,

Your fear is built on your feeling of helplessness that nothing can be done to help your condition; many men with Peyronie's disease share your thoughts and feelings of desperation.

I have a feeling that you did not spend much time reading and learning from the PDI website about self-treatment of Peyronie's disease before you wrote your question to me.  If you had spent a little time reading a few of the more than one thousand different pages of information on the PDI website you would know there is much you can do to try to support the natural healing ability of Peyronie's disease. I suggest that you read the PDI home page and a few of the links that are found there. From the standpoint of Alternative Medicine treatment all your effort must be directed toward increasing your natural ability to heal Peyronie's disease, as it happens in about half of the men who develop this problem. 

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You mention my article about vitamin E treatment of Peyronie's disease.  You must realize that by itself no one vitamin or natural therapy is going to be effective against a problem as difficult as PD.  Success requires a wide variety of different approaches used aggressively, and used at the same time, to help your body recover from Peyronie's disease – even then no results are guaranteed. 

I think you have misunderstood what the website of the German Urologic Center in Darmstadt might have said about the progression of Peyronie's disease.  Peyronie's disease does not progress indefinitely; many times the condition stops progression after a year or two, and then remains essentially stable unless it is aggravated by injury or drug intake.  Surgery is offered in cases of Peyronie's disease, at least by all reputable medical clinics, only  if extreme pain or extreme penile curvature makes sexual intercourse impossible.   I have never heard of Peyronies surgery offered as a way to halt the progression of the disease. 

Your low testosterone and distressed emotions are both capable of reducing your ability to develop an erection. There are many websites that discuss how a many can increase his testosterone naturally;  if this does not work for you, you are always able to get a prescription to help you.

You are not alone.  Read the stories of the many men who have overcome their Peyronie's problem. Go to the Peyronie's Disease Institute testimonial page.    Also, there are many helpful pages to get ideas about PD treatment.   To mention just a few posts: Does this Peyronie’s treatment really work?  and  Does anyone know the best treatment for Peyronie’s disease?  and  What type of Peyronie’s treatment should my husband try?   Read and learn how you can work to increase your ability to repair and remove the PD scar.  Please let me know if you have further questions about helping yourself.   TRH  


How long do we stay on the plan after the Peyronies scar or plaque is reduced?

My husband just got diagnosed with Peyronie's Disease. He has no pain, we have a healthy sex life and have

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found other ways to deal with the curve, but he would like to reduce the curve and stop the plaque in it's
tracks. He does take other supplements. I have ordered the Medium Plan, should we stop all of his other
supplements while he is taking your plan. And have there been any side effects with you supplements.
He takes Lipitor for cholesterol, will this effect anything. Please let us know. We are anxious to begin and
want to know if he gets results, how long do we stay on the plan, after the plaque is reduced.
I will await your reply.

Thank you so much

Greetings Marija,

It is good for a man to have a dedicated and loving woman to support him during this difficult time when he is treating himself for reduction of the Peyronie's scar or plaque.  You really should spend a little time reading some of the questions and answers in this area of the PDI site to learn how to go about treatment.  The more you know the better his results will become.

If he wishes to take the other supplements while he is following his PD treatment plan, I see no reason to discontinue using them.

The only side effect is occasional diarrhea that affects a small percent of men due to the detoxification effects of the systemic enzymes.  You have already received instructions how to handle this small problem if it arises. 

Lipitor is a member of the statin group of drugs that have been implicated in causing Peyronie's disease.  The official verdict has not been reached as of this time, but there is growing evidence that all of the statin drugs have the potential to start Peyronie's disease.  To learn more about this, please read My husband has a curved penis, is this normal?   I suggest that you read about his subject to educate yourself, as well as discuss this with the doctor who prescribed Lipitor for your husband.    You might want to discuss the possibility of getting off him Lipitor while you attempt to control his cholesterol in more conservative ways so as to avoid aggravating his Peyronie's disease.

I usually suggest that once the plaque or scar is gone to stay on the plan for at least six months to assure no return of the scar material.  TRH 


What is the maximum "safe" daily dosage of Vitamin E for treatment of Peyronie's disease?

What is the maximum “safe” daily dosage of Vitamin E (for example, Unique E) in IU that is recommended for treatment of Peyronie's disease. I have read that daily doses in excess of 1500 IU of d-alpha tocopherol can be potentially toxic. I am planning on taking Vitamin E, with Nattokinase 200mg 2x/day, and PABA 1000mg 3x/day. Any comments on this regimen are appreciated.

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Please search this website for many articles I have written about safety of taking vitamin E within a Peyronie's disease treatment plan.  For example: Peyronie's disease treatment and vitamin E  and  Peyronie's disease vitamin E therapy.

To answer your question directly, I usually recommend that a man takes 800-1200IU of Unique E daily in a Peyronies plan.

Concerning the brief plan that you have outlined, above, I suggest that you consider adding some external therapies to this plan (DMSO with related copper peptides and vitamin E as topical applications, gentle manual penis stretching, ultrasound, etc.).  Your plan as you describe it is not fully developed.  I suggest that you look at the small, medium or large PDI plans to get an idea of what a well rounded plan looks like.


Could ultrasound treatment help with some of the ED that is part of Peyrnie's disease?

I think that I got some positive results from taking Neprinol. I will continue to take at least six pills/day.

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My question is for the ultrasound machine that you have. I was wondering if this could help with some of the ED possibly.



Greetings John,

Taking any therapy by itself as a solo treatment is not a very effective protocol; usually Neprinol must be combined with other therapies for maximum effectiveness.

Having some degree of erectile dysfunction (ED) with Peyronie's disease is not uncommon.  It is due to the presence of the Peyronies scar preventing full closure of the veins that trap blood to create increased hydraulic pressure needed for an erection to occur.  The answer for this kind of ED is to reduce the size of the PD scar material, or get rid of it altogether, so the veins can close again as they did before you developed Peyronies. 

Here is some additional information about this subject: Should I use Neprinol as part of my Peyronie’s disease treatment?

The ultrasound machine is proving to be a good therapy to add to a basic PDI style treatment plan, based on the reports I am getting back from men who are using it in combination with broad therapy plans. 


What can we do for our sex life after Peyronies gave me a 90 degree curved penis?

I was diagnosed by Dr. Levine about 7 years ago with Peyronies disease when I was 51 years old. When I told him I did not want to be cut on he politely told me he could not do anything more for me. I have read way too many horror stories about Peyronie surgery. Like I think I read on your website it does not make sense to operate on something that has already shown it is going to heal with an abnormal amount of scar tissue.

What I want to know is what can we do for our sex life after Peyronies has left me this way? My wife and me have had to be very careful about our sex life because my upward curve is close to 90 degrees, so there is a lot we can't do any more. We have learned to be satisfied with limited contact because my bent penis prevents complete entry. I am a lucky guy to have a wife who has stayed with me in spite of all this.

Thanks for all that you do.


Greetings W.,

What I have written many times on the PDI website is that a man should be extremely careful and reluctant to undergo Peyronies surgery because of the increased risk of developing even more scar tissue and a worse case of Peyronie's disease after being cut on.  I have warned that before agreeing to undergo penis surgery it is very prudent to first use all of the possible non-surgical and non-drug options possible for at least a year before even thinking about being cut on to remove the PD scar tissue.  I am not against Peyronies surgery; I am against hasty and premature surgery as though it is the only option, and as though it is a simple and sure-fire cure for this terrible problem.  It is not. 

You ask for advice about your limited sex life, but I must back you up a bit and suggest that you might not have a limited sex life if your curve was improved or reduced.  This is a good place to start to help your sex life, by working to improve your Peyronie's disease.  It sounds like you have not tried to increase or support your ability to get rid of your PD on your own.   I suggest that you read How to start Peyronies treatment.

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The subject of sexual problems when Peyronies is in the bedroom is huge, and the subject of possible solutions is complicated.  There is so much to be said about improving sexual performance and compatibility in spite of a curved penis that must refer you to the book, “Peyronie's Disease and Sex.”   I wrote this book a few years back to address this problem that affects most couples who deal with Peyronies;  few couples are exempt; sex problems are common and just a matter of degree.  What I can tell you since writing this book is that almost all people who read it and follow the ideas in it will improve their sexual ability and regain either a small or large degree of their lost sexual pleasure.  As an outside observer in this area I can tell you that I have yet to find a couple whose sex life is not helped by using this book; some to a great degree and some to a small degree but everyone seems to gain something.   TRH      


How to help my Peyronies disease that started after using Propecia for 14 years?

Dr Herazy,  I appreciate the work with Peyronies disease you have done and are doing. I have read your newsletters with great interest over the past year or so. I would love to get your opinion when you have time.

I have Peyronie's disease or what has been diagnosed as Peyronies disease due to the upward curve. However, mine appeared rather spontaneously. I had no injury. I have no pain. The curve does not seem to be changing (for the better or worse).

I read somewhere on the internet there appears to be a link between Propecia & Peyronies. I suspect mine might be similarly related as I took Propecia daily from '97? (or whenever it was approved as a “hair loss” preventive measure) until 2012 when I read of the possible connection.

Have you heard of this? If so, would Peyronie's treatment be the same?

I can feel a mass about the size of a dime—it feels like it does not go very deep—I mentally picture something as thick as a nickle although that may not be correct.

Things I've done:
Called my Doc May/June 2011 (as soon as I noticed)—referred me to a urologist
Saw the urologist—referred me to a specialist in VA Beach
Saw the Peyronies specialist in Nov 2011—prescribed Potaba, Vitamin E, L-Carnitine, & Cialis

Still taking all but the Potaba

May/June 2012 –Saw a specialist @ Johns Hopkins—-had not heard of any connection between Propecia & Peyronie's disease — said to come back whenever it reached the point of preventing intercourse & they would be glad to do surgery

August 2012–Saw a Peyronies specialist @ Mayo (liked him much more)—he said there wasn't much that could be done differently than I was doing except maybe try a vacuum pump—-I've tried but w/ no success

Any suggestions for what I can do to help my Peyronie's disease would be appreciated.



Greetings Jim,

The Peyronie's disease specialist who was unaware of a connection between Propecia and Peyronies is either sadly unaware if what is going on in the world, or just did not want to spend the time to talk to you about the mounting evidence against Propecia in regard to Peyronie's disease and several other health problems.  For information that might be of interest to you please read Another case of Propecia and Peyronie’s disease.  In the absence of known trauma and known genetic predisposition, Propecia (finasteride) causation is an interesting possibility to consider.

If you do indeed have a case of Peyronies disease caused by Propecia the natural treatment would be essentially the same as for cases caused by trauma or other chemical causation. 

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I suggest that you consider trying to increase your natural ability to heal and correct the damage done to you that resulted in a Peyronies scar.  From my experience the more aggressive and consistent the treatment, when guided by the response of the scar structure to your therapy plan, the more likely you will help your body to heal.   A good place to start reading is How to start Peyronie's disease treatment.  TRH