Peyronie's disease is a wound healing disorder in which a fibrotic plaque forms in the tunica albuginea layer of the penis. It clinically presents as any combination of penile pain, angulation, and impotence. This condition has prevalence of 3 to 8% in adult men.
   Peyronie's disease causes an uncommon sexual dysfunction that results from a bent penis during erection. The disease is characterized by a hard, fibrous layer of scar tissue (plaque) that usually develops under the skin on the upper or lower side of the penis. When the penis is erect, the scar tissue pulls the affected area off at an angle, causing a curved penis. The plaque, formed by thickened layers of erectile tissue, is noncancerous (benign).

Peyronie's Disease natural treatment
Acetylcarnitine is an option, use doses less than 300 mg since higher dosages can cause overstimulation and insomnia. I don't have clinical experience using acetylcarnitine for this condition, so I don't know whether it works or not. One study shows a benefit, another does not.

Acetyl L-carnitine vs tamoxifen in the oral therapy of Peyronie's disease: a preliminary report.
BJU Int. 2001. Andros-Italia, Perugia, Italy.
The study included 48 patients with Peyronie's disease (15 acute and 33 initial chronic), randomized equally into two groups. The first group used tamoxifen 20 mg twice daily for 3 months and the second acetyl-L-carnitine 1 g twice daily for 3 months. The disease and stages were diagnosed and identified using a history, objective examination, pharmacologically induced erection, autophotography during erection, and basic and dynamic colour Doppler ultrasonography. Penile curvature, plaque size, pain and disease progression were assessed. The differences between the groups or between the variables before and after therapy were compared using analysis of variance or the chi-squared test. Acetyl-L-carnitine was significantly more effective than tamoxifen in reducing pain and in inhibiting disease progression. Acetyl-L-carnitine reduced penile curvature significantly, while tamoxifen did not; both drugs significantly reduced plaque size. Tamoxifen induced significantly more side-effects. These results suggest that acetyl-L-carnitine is significantly more effective and safe than tamoxifen in the therapy of acute and early chronic Peyronie's disease.

Comparison of vitamin E and propionyl-L-carnitine, separately or in combination, in patients with early chronic Peyronie's disease: a double-blind, placebo controlled, randomized study.
J Urol. 2007. Urology and Nephrology Research Center, Faculty of Medicine, Shaheed Beheshti University of Medical Sciences, Tehran, Iran.
We compared the efficacy and safety of oral vitamin E and propionyl-L-carnitine, separately or in combination, for the treatment of Peyronie's disease. A total of 236 men (mean age 43 years) with Peyronie's disease were randomly assigned to 4 groups. Group 1 received 300 mg vitamin E orally twice daily. Group 2 received 1 gm propionyl-L-carnitine orally twice daily, and group 3 received 300 mg vitamin E and 1 gm propionyl-L-carnitine orally twice daily. Group 4 (control group) received a similar regimen of placebo during the 6-month treatment period. This study did not show significant improvement in pain, curvature or plaque size in patients with PD treated with vitamin E, propionyl-L-carnitine, or vitamin E plus propionyl-L-carnitine compared with those treated with placebo.

Nattokinase
Have you heard of anyone who has tried nattokinase for Peyronies disease? Do you think this it be reasonable to use this product to combat this disease?
    I have not come across any research or personal anecdotes regarding the use of the blood thinning enzyme for this condition.

Serrapeptase
Is there any research where serrapeptase enzyme has any effect on Peyronies disease?
    As of 2016 I have not seen such research.

Medical treatment
Although a multitude of oral agents have been proposed and evaluated in PD patients, results vary widely and a reproducible objective benefit has not yet been strongly established for any single oral agent. Well-designed, large-scale, randomized controlled trials evaluating oral agents in PD patients are lacking. Consistent objective benefit from injectable agents has been supported for years by various non-controlled trials. Recently, injectable collagenase Clostridium histolyticum became the first pharmacologic agent to obtain FDA approval for use in PD patients

Emails
Q. Regarding combining nattokinase and serrapeptase. There is a product out called Neprinol that combines them and one of the ailments is Peyronies disease. I injured myself and have a plaque buildup on the penis shaft. Would one of these single enzymes help dissolve the plaque? It is about the size of a quarter now and is causing some discomfort. I caught it in a Harley Davidson wheel.
   A. Few human studies are available with either nattokinase or serrapeptase and hence it is very difficult to know what kind of effect the combination formula would have. To be on the safe side, it is advisable to learn how each work alone for you before considering the combination. We have not seen any studies regarding the role of either enzyme in the treatment of Peyronie's disease.

Testimonial
I have been taking your serrapeptase for about 3 months and have noticed an improvement in my peyronies. I have had it for six years and the disease was (is) 100% unfortunately. Have you have any other reports or suggestions?
   This is the first report we have had.

Treatment of Peyronie's disease
Medical therapy plays a pivotal role in the management of this disease and should be performed prior to any surgery. Intraplaque collagenase, intraplaque verapamil, intraplaque interferon, oral acetyl-L-carnitine, oral propionyl-L-carnitine and oral colchicine have proved effective in Peyronie's disease. With the exception of collagenase, these drugs have displayed a number of activities whose final result is to improve immune response, to inhibit inflammation and to inhibit fibroblast metabolism and replication.

Res Rep Urol. Jan 14 2013. Current and emerging treatment options for Peyronie's disease. PD is a condition of the penis, characterized by the presence of localized fibrotic plaque in the tunica albuginea. PD is not an uncommon disorder, with recent epidemiologic studies documenting a prevalence of 3-9% of adult men affected. The actual prevalence of PD may be even higher. It is often associated with penile pain, anatomical deformities in the erect penis, and difficulty with intromission. As the definitive pathophysiology of PD has not been completely elucidated, further basic research is required to make progress in the understanding of this enigmatic condition. Similarly, research on effective therapies is limited. Currently, nonsurgical treatments are used for those men who are in the acute stage of PD, whereas surgical options are reserved for men with established PD who cannot successfully penetrate. Intralesional treatments are growing in clinical popularity as a minimally invasive approach in the initial treatment of PD. A surgical approach should be considered when men with PD do not respond to conservative, medical, or minimally invasive therapies for approximately 1 year and cannot have satisfactory sexual intercourse.

December 2013 - Xiaflex (collagenase clostridium histolyticum) has been approved by the U.S. Food and Drug Administration. This medication was first sanctioned three years ago to treat a hand deformity called Dupuytren's contracture.

Medical Management of Peyronie's Disease.
J Androl. 2008.
Peyronie's disease likely results from a predisposing genetic susceptibility combined with an inciting event such as microtrauma during intercourse. During the initial acute phase (6-18 months), the condition may progress, stabilize, or regress. For this reason authorities recommend a more conservative treatment approach with a trial of oral and/or intralesional pharmacotherapy before surgical reconstruction is considered. Oral therapies most commonly employed include tocopherol (vitamin E), and para-aminobenzoate (Potaba), with colchicine, tamoxifen, propoleum and acetyl-L-carnitine being used less often. There are a limited number of long-term placebo- controlled studies with these oral agents and for the most part, studies have failed to show a consistent beneficial effect. Intralesional injection therapy for Peyronie's disease is more commonly being used as a first line therapy. The current standard of care includes injection with interferon-alpha-2b, verapamil, or collagenase. Interferon-alpha-2b, in particular may decrease penile curvature, plaque size, penile pain, and plaque density. However, intralesional interferon is associated with post treatment flu-like symptoms unless premedicated with a non-steroid anti-inflammatory agent. Other available therapies that have not consistently shown efficacy in placebo-controlled studies include corticosteroids, orgotein, radiation, and extracorporeal shockwave therapy. Surgery is considered when men do not respond to conservative or medical therapy for approximately 1 year and cannot perform satisfactory sexual intercourse.

Research studies
Potassium paraaminobenzoate (POTABA) in the treatment of Peyronie's disease: a prospective, placebo-controlled, randomized study.
Eur Urol. 2005; 
The aim of this study was to investigate the effect of potassium paraaminobenzoate (Potaba) in Peyronie's disease in a prospective, randomized, double-blind, placebo-controlled, multicentre study during a 12-months period of treatment. 103 patients with Peyronie's disease and a history <12 months, non-calcified plaques and without pre-treatment were included. 51 were randomized to potassium paraaminobenzoate, 52 to placebo receiving 4 x 3g/day for 12 months.  The results of this study indicate a significant plaque-related effect of potassium paraaminobenzoate. There was no relevant difference with regard to improvement of pre-existing penile deviation. However, under potassium paraaminobenzoate a significant protective effect on deterioration of penile curvature could be demonstrated. Potassium paraaminobenzoate appears to be useful to stabilize the disorder and prevent progression of penile curvature.

Peyronie's disease: a silent consequence of diabetes mellitus.
Asian J Androl. 2006.
During an 8-year period, a total of 307 men seen at our outpatient clinic were diagnosed with Peyronie's disease. Clinical characteristics, penile deformities and the erectile status of patients with PD and DM together (n=102) were retrospectively analyzed and compared to patients with Peyronie's disease alone with no risk factors for systemic vascular diseases (n=97). Results: The prevalence of Peyronie's disease among men with DM and sexual dysfunction was 10%. The mean age of diabetic patients with Peyronie's disease was (55+/-8.9) years; in the no risk factor group it was (48+/-9.0) years. The median duration of DM was 5 years. The majority of diabetic patients with Peyronie's disease (56.0%) presented in the chronic phase, and they were more likely to have a severe penile deformity (>60 degree) than the no risk factor group. In the diabetic group, the most common presenting symptom was penile curvature (81.4%), followed by a palpable nodule on the shaft of the penis (22%) and penile pain with erection (14%). A total of 19% of patients were not aware of their penile deformities in the diabetic group. Erectile function, provided by history and in response to intracavernosal injection and a stimulation test, was significantly diminished in patients with Peyronie's disease and DM). Conclusion: DM probably exaggerates the fibrotic process in Peyronie's disease. Diabetic patients have a higher risk of severe deformity and erectile dysfunction (ED). Peyronie's disease seems to be a silent consequence of diabetes mellitus and should be actively sought in diabetic men.

Side effects of glucosamine? Reports from users
In 2001 I started taking glucosamine and MSM in an attempt to provide for long term joint health and reduce popping of joints. Approximately 4 to 5 months later I suddenly developed severe Peyronies Disease. The urologist suggested that I had jammed and damaged the penis; however there was no notable such occasion. There were no other lifestyle changes in the year prior to onset of Peyronies except that I had started taking the glucosamine and MSM. These were immediately discontinued but the Peyronies did not correct. After over a year of the urologist attempting to relieve the Peyronies, I had corrective surgery.
    Thanks for letting us know. It is difficult to say in one case report of the association between glucosamine, MSM, and Peyronies disease, but if we receive other reports this will add more confidence to a possible association.

I recently read on one of your webpages an email sent in by someone who noticed that his penis had developed a curvature after taking a glucosamine and chondroitin supplement for osteoarthritis. Thanks for letting me know that I'm not the only one that this has happened to, and that the condition may well reverse itself if I decide to stop the supplement. I went to see a urologist after this happened, and he said it was indeed Peyronie's, as he could find the scarring within my penis (which he called "plaque"). But since nobody really knows what causes Peyronie's disease, and since it occurred at about the same time I began the supplement, I've always been suspicious that there was a connection there. The email on your site has convinced me to stop the supplement, as soon as I can find some other way to bring my shoulder arthritis under control. I'll probably try turmeric next. In the past, when I stopped the glucosamine / chondroitin, my shoulder pain increased dramatically. But perhaps it was merely a placebo effect? In any case, especially now that I've got a good relationship beginning (where I'll need my penis), I'm definitely motivated to change to some other supplements. Thanks!

I am from Argentina. I used glucosamine for approximately 4 month and started with sympthoms of Peyronie disease that reversed months later after discontinue the glucosamina intake. Many years form then, last month I used glucosamine for only 20 days and the Peyronie pain came again. So I’m sure becouse of my double experience. I saw your reference to this in your article and wanted to give you my testimonie.

Questions
Q. I was reading your site on the use of acetylcarnitine and potaba and was wondering how effective they are in reducing the plaque and straightening the penis? I was also on the site -- www.peyroniesmd dot com/ site by Dr Theodore R Herazy and his enzymes therapy caplet Neprinol, and wonder if you have any comments on that product. I am trying to get some info about some products so I can discuss they with my urologist.
   A. We are not familiar wit Neprinol.  I have personally not treated patients with Peyronie's disease so I don't have good first hand knowledge about this condition.

I have been suffering with Peyronie's condition for quit some years now. I have taken Vitamin E 1000mg for about 1 year and have had not results. I went to a Urology Clinic and the Doctor said there was no cure for this. My girlfriend and I cannot have sex now since it hurts her and pushes against her bladder. She is having problems and I need a solution to this problem. This is really causing a major problem in my life and would like to find a solution to this before I lose my love of my life. Can you offer a remedy for my disease?