With all the anxiety from fear of job loss and the stress of keeping it, sex was probably the furthest thing from our minds last year.

For some men, lovemaking may have been underwhelming for many reasons — too many people at home, a “circuit breaker” body or just the inability to get it up or stay up.

Erectile dysfunction (ED) is a common phenomenon for men over 50 according to a study conducted by the Singapore Medical Journal, which reported that age is the single most important physiologic factor affecting erectile function.

According to The Massachusetts Male Aging Study, it has been projected that by the year 2025, 322 million men between 40 and 70 will have some degree of erectile dysfunction.

Lately, doctors have become aware of a new health pandemic occurring amongst younger men called Executive ED — a form of erectile dysfunction caused by disturbed cortisol rhythms that, in pre-pandemic times, was seen in comparatively young, high-flying executives with stressful jobs.

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Typically affecting men in their 30s and 40s, medical professionals speculate that it may be a combination of factors such as the breakdown of barriers between work and personal time. There is also more worry about job security and the economy in general, all of which can lead to increased stress, disturbed sleep patterns and disturbed cortisol rhythms.

Elevated cortisol levels can constrict the blood vessels in the penis. When blood cannot flow properly to the penis, it is difficult to achieve an erection and can lead to erectile dysfunction (ED).

Worrying about performing in the bedroom also adds another layer of stress. Over time, chronic stress and chronically high cortisol levels can decrease the amount of testosterone the body is making which further adds to the ED problem.

If your sex life last year was underwhelming, you can blame it on the pandemic. Thankfully, ED in younger men is reversible. To tell us how, Options speaks to Dr Sriram Narayanan, senior consultant vascular and endovascular surgeon at Gleneagles Hospital’s Harley Street Heart and Vascular Centre.


Dr Sriram Narayanan: There is a strong correlation with elevated cortisol levels and erectile dysfunction caused by the change in working patterns

What is ‘Executive ED’?
Executive erectile dysfunction is unusual in that it is a form of ED that affects younger, often professionally successful men, unlike other forms of ED which tend to affect men in later middle age and older. Executive ED patients are often only in their mid-30s or early 40s. I typically see it in people with successful careers as lawyers, stock market traders, and bankers, and particularly those who work round-the-clock with overseas clients and colleagues.

How is it different from ED in older men?
In older men, age related narrowing of the arteries from deposition of cholesterol, diabetes, decreased testosterone levels and medication that they may be on for heart disease all can lead to a decreased blood flow into the pelvic organs leading to progressive ED. These are not usually issues in younger men. In them, the veins that take blood away from the pelvic and back to the heart can flow too rapidly; meaning that even if they have healthy arteries with good blood flow in, it flows out too quickly to sustain an erection. So, what flows in doesn’t stay in long enough for them to finish. Typically, they can initiate an erection but then go soft too soon. Repeated episodes of this rapidly affect their confidence and soon they cannot even initiate an erection, resulting in significant psychological distress.

Why is it more prevalent since the onset of the Covid-19 pandemic?
I think there is a strong correlation with the change in working patterns since the onset of the pandemic which has seen more people working longer hours from home, conducting meetings via Zoom, Microsoft Teams and Skype for example, with people from different time zones. All that adds up to longer and more irregular working hours, more stress and less sleep.

How do irregular working hours, Zoom calls and stress cause ED?
They do so by disturbing the sleep patterns. Working at odd hours, especially late into the evening or night which can upset the body’s normal circadian rhythm. The production of cortisol, a key hormone in our bodies, follows a similar circadian rhythm, at its highest in the morning shortly after we wake and at its lowest at night, when we should be asleep. Staying up late, using bright artificial lighting and staring at brightly lit screens interferes with that natural daylight rhythm of cortisol. High cortisol levels cause the veins to go floppy, with a high and rapid outflow of blood from the veins in the pelvis.

Is cortisol good or bad for us? Views seem to be mixed about this. 
Cortisol is essential for normal healthy functioning of the body. The problem is that our bodies evolved to cope with different stresses and dangers. The flight or fight response was okay when the stresses and threats we faced were over pretty quickly. As adrenaline and cortisol levels dropped, the heart rate and blood pressure returned to normal, and other systems could resume their regular activities. The problem is that today’s perceived stresses and threats persist. Whether it is Covid-19, paying the bills, your manager chasing you for a report, or overseas colleagues dragging you into Zoom meetings at all hours, stress is almost constant. So instead of coming and going occasionally and in short bursts, cortisol levels remain elevated for days, weeks and even months.

Apart from ED what are the other symptoms of chronically high cortisol levels?
The symptoms are trouble concentrating, impaired memory, and mood swings, often with anxiety, depression or irritability. Slowed recovery from injuries so that bruises, cuts and scrapes take a long time to heal, weight gain especially around the belly and torso, high blood pressure, reduced testosterone production and insomnia. It becomes a vicious circle — disturbed sleep patterns and stress push up the cortisol level, high cortisol levels make it harder to sleep and concentrate and affect your mood making you more susceptible to stress, resulting in anxiety and irritability which drive up your cortisol levels. The same with the ED, worrying about not being able to perform increases stress and cortisol, and can make the ED more likely.

Can chronically high cortisol levels lead to other long-term health issues?
Yes, definitely. Left untreated, raised cortisol levels become a vicious, self-perpetuating circle or downward spiral of health issues. On the physical side, chronic weight gain, insomnia, stress, and high blood pressure are a recipe for cardiovascular disease. They are also bad for mental health and linked to depression.

What can we do to correct disturbed cortisol rhythms and ensure that they are in the healthy range?
The good news is that most people can manage their cortisol levels with some lifestyle changes. The first step is to get enough sleep. If you have enough sleep it is easier to cope with stress. Even if you are working from home, set a cut off time for work and stop answering your phone and opening emails; they will still be there in the morning. If your sleep patterns have been disturbed it might take a while to get them back to normal but it is worth the effort. Set a routine, dim the lights over the course of the evening, don’t look at bright screens, including phones and TVs for an hour or more before bedtime, reduce your caffeine intake and take none after sundown at the latest. Other things that can help to correct your cortisol levels are a healthy diet, regular exercise and relaxation techniques; there are lots from simple breathing exercises to yoga and mindfulness; try a few until you find one that suits you. Managing cortisol levels will definitely help with Executive ED and the other related health issues like high blood pressure and insomnia.

Are there natural methods, diet or lifestyle changes that can help to maintain or boost testosterone levels?
There are and many of them are the same ones that will help with reducing the high cortisol levels that could be partially responsible for reducing your testosterone levels. Get plenty of sleep, manage your stress levels and exercise like specifically resistance training with weights, eat a healthy diet with plenty of protein, make sure you have plenty of zinc and magnesium in your diet by eating pumpkin seeds, nuts and lots of green leafy vegetables like broccoli, bok choy and spinach. Finally, take a 15 or 20 minute walk in the sunshine everyday to make sure you maintain healthy vitamin D levels.

PHOTO: Unsplash/Damir Spanic