Stress at work appears to be linked to erectile dysfunction (ED) in young men, according to a study in the International Journal of Clinical Practice.

Researchers identified working hours as the factor most strongly associated with poorer erectile function, while supervisor support appeared protective. Researchers from the Department of Urology at The Second Affiliated Hospital in Hangzhou, China, examined how work-related psychological strain may affect men’s sexual function.

“The size of the reported association is quite glaring,” said Denise Asafu-Adjei, MD, MPH, medical director of men’s health and male reproductive medicine at The University of Chicago in Chicago, who was not involved in the study.

After adjustment for age, BMI, smoking, and alcohol use, men in the highest-stress group had more than 10-fold the odds of ED than those in the lowest-stress group, the study showed.

Previous research has linked psychological stress with ED, but the authors of the current study said much of that research relied on measurements of the condition at specific moments in time, stress broadly, and single hormones. They developed a workplace-specific index to examine various occupational stressors and whether hormonal changes might help explain any relationship with ED.

Working hours, pressure for promotions, decision-making autonomy, supervisor support, and colleague relationships were measured in the new index. They assessed erectile function using the International Index of Erectile Function 5, and measured morning and evening cortisol, testosterone, and other hormones.

More than 800 men (age range, 22-40 years) who had been in stable relationships for at least 6 months were recruited through the Zhejiang University School of Medicine in China. Researchers excluded men with several potential causes of ED, including diabetes, hypertension, cardiovascular and neurologic disease, endocrine disorders, and psychiatric disorders.

The prevalence of ED rose progressively as stress increased, from 8.21% in the lowest-stress group to 54.37% in the highest. Working hours showed the strongest association with erectile function. Each additional 10 hours worked per week was associated with a 1.82-point decrease in erectile function scores, and promotion pressure showed the second strongest association in dysfunction.

Men in the highest-stress quartile worked an average of about 65 h/wk compared with about 42 hours in the lowest-stress group. Strong supervisor support showed the strongest protective association.

Tobias Kohler, MD, MPH, a professor of urology and head of men’s health at the Mayo Clinic in Rochester, Minnesota, said the association did not surprise him.

“The higher the stress, the more cortisol, and the less testosterone,” Kohler said.

In otherwise healthy younger men, ED is often by anxiety, sleep loss, distraction, and increased fight-or-flight reactions, and less by hormonal imbalances, he said.

The study found cortisol levels rose and testosterone declined as workplace stress scores increased. Researchers estimated hormone-mediated pathways accounted for about 40% of the association between stress and erectile function.

Elevations of cortisol preceded testosterone decline by 2-4 weeks on average. ED usually occurred roughly a month after the decline in testosterone, suggesting a possible 6- to 10-week window for intervention.

Asafu-Adjei said clinicians should routinely assess workplace stress while completing a medical, psychological, and sexual health evaluation.

“Workplace stress deserves to be treated as a clinically important but modifiable contributor to ED,” she said. “It is a health indicator.”

The study population limits how broadly the findings can be applied. The exclusion of men with many common contributors to ED made the sample less representative of patients commonly seen in practice, Asafu-Adjei said. The index was also developed for this study, rather than being a validated screening tool already used in clinical settings.

Workplace stress should be considered during evaluation of younger men with ED but not treated as a diagnosis by itself, Kohler said.

ED is “the check engine light for men,” Kohler said. “There are areas of improvement either physically, mentally, or behaviorally that we should look into.”

The experts cited in this article had no relevant disclosures.

Kelley Butler is a freelance writer based in the Washington, DC, metro area, covering a broad range of healthcare topics and trends.