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Dr. Mariano or anyone else,
I’m having what I consider to be somewhat of a strange issue that I would like someone to provide assistance with. I am a 41 year old male, generally healthy but don’t exercise enough and don’t always eat correctly. I have been unemployed now for 9 months! Not by choice however, I was laid off from my job. I am under what I would consider to be extreme emotional stress. My question is along those lines. I have also been on TRT for about 2 years due to low pituitary hormones that the doctor thinks has a genetic component. Anyway I experience very sporadic ED and along with the ED complete loss of interest in anything at all that is sexual. I used to think it might be because of somewhat high estradiol levels after my testosterone injections (and I still think that plays a physical role) but all tests prove that my sensitive estradiol hovers between 18-26 pg/ml. I think I got those units correct. Sometimes I get positively rock hard erections either through partner or self stimulation and I almost always have morning erections. However there are periods of time that I feel like I might want sex but emotionally really am too distracted to think about it. These are the times I experience ED. The ED isn’t necessarily profound and usually with the right stimulation I can achieve and maintain an erection for sex but sometimes don’t care whether or not I orgasm. Now, don’t get me wrong, I know I’m not 22 anymore and stuff like that but I have a lot of friends my age and older who tell me they aren’t experiencing any kind of problems such as this and their wives and girlfriends, etc have corroborated this to me. So I’m wondering how profound the effect of stress can be on libido in general, despite good testosterone levels and it’s effect on ED. Thanks in advance for your time.
Stress can greatly impair libido, despite optimal testosterone and estrogen levels.
When the mind senses stress, it increases norepinephrine production. Norepinephrine is the signal for stress.
In general, the brain is built to withstand short durations of stress, but not prolonged stress as can be found in modern life.
Prolonged stress can lead to numerous signaling changes and metabolic changes. These changes include pro-inflammatory changes in immune system signaling, suppression of adrenal function, changes in kidney function, changes in fat cell function, loss of zinc and magnesium and other nutrients, changes in gut bacterial populations – which changes function, impaired thyroid hormone activity, changes in brain glial function, reduction of mass in certain brain structures (such as the hippocampus, possibly the libido circuitry), etc. etc.
These changes in function can be viewed as defensive actions in order for the body to survive.
However, these changes due to stress can also lead to changes in brain function leading to loss of libido. Some of these, such as loss of brain functional unit mass – can lead to prolonged loss of function.
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