Can job stress predict erectile dysfunction?

Clinical takeaway: Consider workplace psychological stress as a potential contributor to erectile dysfunction in younger men, particularly in those reporting long hours, high promotion pressure, or poor workplace support. Stress-related hormonal changes may precede erectile symptoms by several weeks, potentially creating an opportunity for early intervention.

ED in younger men is often attributed to psychological factors, but objective markers linking workplace stress to sexual dysfunction have been limited. This study sought to quantify cumulative job-related stress and evaluate its relationship with hormonal changes and erectile function.

In this cross-sectional study, researchers evaluated 826 full-time employed men aged 22 to 40 years using a newly developed Workplace Psychological Stress Accumulation Index incorporating working hours, decision-making autonomy, supervisor support, colleague relationships, and promotion pressure. Erectile function was assessed with the International Index of Erectile Function-5 (IIEF-5) questionnaire, alongside measurements of cortisol, testosterone, and related hormones.

Investigators found a clear dose-response relationship between workplace stress and erectile function. ED prevalence rose from 8% in the lowest-stress group to 54% in the highest-stress group. After adjustment for potential confounders, men in the highest-stress group had more than 10-fold greater odds of ED than those in the lowest-stress group. Moderate-to-severe ED was nearly 19 times more common among highly stressed participants.

Higher stress levels were associated with rising cortisol concentrations and falling testosterone levels. Morning cortisol increased by roughly 74% from the low- to high-stress groups, while testosterone declined by about 41%. Long working hours appeared to impair erectile function largely through cortisol elevation, whereas supervisor support showed a protective effect, helping preserve testosterone levels. The study also identified a potential biologic timeline in which cortisol changes preceded testosterone decline by 2 to 4 weeks, with erectile impairment following another 4 to 6 weeks later.

Because this was a single-center observational study with internal rather than external model validation, causality and the proposed timing require prospective confirmation.

“Integration of psychological stress assessment and hormone testing can effectively identify individuals at high risk for psychogenic erectile dysfunction,” the authors wrote.

Source: Huang W, et al. (2026 Sep 9) Int J Clin Pract. Dose–Response Relationship Between Workplace Psychological Stress Accumulation Index and Erectile Function in Young Men