Center for Male Sexuality



Site Map




Our Services

Patient Info

Job Opportunities

Contact Info



Center for Male

Center for
Urinary Control

Center for
Prostate Diseases


In-Office Procedures

Your Surgery Details


Health Calculators





Drug Info

John J Bauer, MD, FACS John J. Bauer, M.D.

Urology Services, Inc.
G-1121 West Hill Rd.
Flint, Michigan 48507
Tel: 810.232.8888
Fax: 810.232.9190

More Male Sexuality Services

Testosterone Deficiency | Premature Ejaculation
Peyronie's (Penile Curvatures) | Circumcision

After reading about this topic, please return to:
Center for Male Sexuality (main page)

Testosterone Deficiency

General Information

Normal adult men produce 4-7 mg of testosterone (per day in a circadian pattern, with maximal serum levels reached in early morning and minimal levels in the evening. In young men, about 70% of testosterone is present in serum bound to sex hormone-binding globulin (SHBG), and approximately 30% of the hormone is bioavailable as free testosterone or testosterone loosely bound to albumin.

As men age, changes in testosterone production and secretion patterns often occur. A decline in testosterone concentration is associated with increasing age after the fifth decade. Levels of bioavailable testosterone also appear to decline rapidly with advancing age. In addition, the amplitude of the circadian testosterone secretory pattern is lower in elderly than in young men

Signs and Symptoms

Clinical manifestations of testosterone deficiency depend on the age at onset and duration of deficiency. Prepubertal hypogonadism is generally characterized by infantile genitalia and lack of virilization, while the development of hypogonadism after puberty can result in a variety of complaints, including diminished libido, erectile dysfunction, infertility, gynecomastia, impaired masculinization, muscle weakness, reductions in body and facial hair, and osteoporosis. Lethargy, depression, and other negative mood and energy parameters have also been reported in some testosterone-deficient men.

Erectile dysfunction is a significant health concern that affects millions of men. It may be associated with depression, loss of self-esteem, poor self-image, and increased anxiety and tension; erectile dysfunction is the chief complaint of men seeking treatment in sex therapy clinics. Studies indicate that organic factors contribute to erectile dysfunction in more than 90% of affected men, and that in 6-39% of these men, testosterone deficiency is present. The effect of testosterone on sexual function and behavior appears to be quite complex and is not yet fully understood. Androgen replacement therapy is indicated in these men, with the goal of maintaining serum testosterone levels within the physiologic range.


Testosterone Replacement Therapies

[ Back to top ]

Premature Ejaculation

Premature Ejaculation can be treated with Sexual Therapy, with medication in a select few patients and a novel idea is to use MUSE intraurethral pellets or penile injection therapy to give the patient an erection that will remain even after he may ejaculate prematurely. The two medications that have shown some results are:

[ Back to top ]

Peyronie's Disease (Penile Curvatures)

General Information

Peyronie's Disease refers to idiopathic or unknown scarring of the internal portion of the penis. The patient usually presents with a history of a curvature of the penis with an erection. On feeling the penis, there is either a single or multiple hard lumps or plaques felt in the penis. Pain with an erection is a common complaint but often presents later in the course of the disease. Sometimes the angulation is so severe that sexual intercourse is difficult or impossible. Occasionally, the portion of the penis distal or further away from the body than the plaque does not become erect with sexual arousal. Rarely, the disease presents with a band-like compression around the penis with an erection. Peyronie's is most commonly seen in the 40-60 year old male but may be seen anytime after puberty. An in-depth discussion of the signs and symptoms are at this link as marked.

When the penis is not erect, it appears normal. With an erection, there is usually an upward bend of the penis, which is frequently to the left. It, however, may be in any direction. On feeling the shaft of the penis, there is usually a mass palpable, which is the scarring of the penis and the cause of Peyronie's disease. This scarring is between the two erectile bodies of the penis called the corpora cavernosa.

As the disease progresses, impotence is a common complaint, either due to the pain with the erection or psychological fear. It has been more than two centuries since Francois de la Peyronie, for whom the disease was named, has passed; and the exact etiology of the disease is unknown. The current theory is that there is trauma from intercourse, tearing the septal fibers between the corpora, resulting in the scarring.


The diagnosis is made by the typical history and funding of a plaque in the penis. Approximately 10% of patients who have Peyronie's disease will have Dupuytren's contracture of the hand, the cause of which is also unknown but thought to be due to chronic trauma. Because of this, there is some thought that Peyronie's disease is a manifestation of other connective tissue disorders, but no definite association has been proven.

Treatment Options

Many forms of therapy have been enthusiastically endorsed for this condition and included: observation, Vitamin E, diathermy, ultrasound, histamines, estrogen, iontophoresis, dimethylsulfoxide, radiation, steroids either orally or injected into the plaque, Tamoxifen, potassium para-amino-benzoate (Potaba), and resection of the plaque with or without insertion of a penile prosthesis.

Peyronie's disease is not a fatal disease and does not lead to cancer or other life threatening disorders. With treatment, the condition can usually be controlled and often eradicated. A small number of patients will have spontaneous resolution of the condition without any treatment. Earlier treatment may result in faster and better resolution of this condition. If you have this, you should discuss this with your urologist.

[ Back to top ]


Adult circumcision is completed for multiple reasons; it is best to do it for medical reasons rather than pure cosmetic reasons in the adult. The medical reasons are usually chronic irritation, infection, phimosis, paraphymosis, penile cancer, penile lesions, condyloma (venereal warts), and some other less common conditions. Our office will do an adult circumcision for pure cosmetic reasons, however, the patient must be aware that there is a significant recovery period in which the male is sore. Return to work is not immediate, usually after the pain has resolved in one week. You will be mildly sore for the next two weeks and the sutures will continue to bother you until they dissolve.

The procedure involves a local anesthesia of the penis (Xylocaine and Marcaine) around the base of the shaft and possibly just over the midline pubic bone. One may require a separate injection of the frenulum, which is near the head of the penis. We perform a standard sleeve resection rather than the guillotine procedure. Multiple dissolvable sutures are used to close the incision site; a compressive dressing is placed for 24 hours. Narcotic pain medication is required.

**This procedure requires an escort to drive the patient home!

**This procedure for an adult can be done in the office or in one of the affiliated hospitals/Surgery Centers that we have privileges.

**All pediatric cases are done under general anesthesia and at one of the affiliated hospitals/Surgery Centers.

Adult Circumcision Fees

The fee for a circumcision is $500.00; a $250.00 deposit is required two weeks before the procedure.

[ Back to top ]

After reading about this topic, please return to:
Center for Male Sexuality

John J. Bauer, M.D.
Flint, Michigan [map]

~ ~ ~

FREE Plug-ins you may need for special pages of our site:
[You can download the programs quickly, easily and for no charge at these links.]
For most printer friendly forms: Adobe Acrobat Reader.

[an error occurred while processing this directive]