Increasingly, younger men are developing erectile dysfunction (ED), although from reasons different from older men, who tend to develop ED when they have underlying conditions such as cardiovascular disease (CVD).

Impotence in young men is usually triggered by stress, and affects approximately 26% and 40% of men in their 30s and 40s. The term ‘executive ED’ is used to describe ED in young men whose high-pressure jobs and long working hours increase cortisol – a type of stress hormone – affecting blood flow in the pelvic region, resulting in weak erections.

The difference between the two types of ED

Dr Sriram Narayanan, a senior vascular and endovascular surgeon from the Harley Street Heart and Vascular Centre says, “‘Executive ED’ patients are often in their 30s to 40s. The condition is typically seen in those with successful but high-pressure careers, such as lawyers, stock traders, bankers, or those whose jobs require working with people in different continents and time zones.”

He adds, “While age-related ED is caused by a narrowing of the arteries, diabetes and decreased testosterone levels – all of which decrease blood flow to the pelvic organs – these are not usually issues in younger men. In young men, the blood flow in veins that take blood away from the pelvic region and back to the heart flows too rapidly to sustain an erection. In other words, they can initiate an erection but then go flaccid too quickly.”

How do long working hours, working from home, and stress cause ED?

A recent spike in Covid-19 cases linked to the emergence of a new variant, B1617, has led to the stricter enforcement of social-distancing and self-isolation measures across Southeast Asia. Many companies are abandoning staggered hours in the office and instructing their employees to work from home by default.

Dr Sriram explains, “Many executives are working longer hours from home than they did in their offices; partly because their clients and colleagues in different times zones are also working from home and more likely to ask for video meetings round the clock. All of this adds up to longer working hours, more stress and less sleep.”

He adds, “Working odd hours affects the body’s circadian rhythm – the natural cycle of sleeping and waking which is synchronized to the hours of daylight and darkness. The body’s production of cortisol, a stress hormone, follows a similar circadian rhythm where it reaches highest levels in the morning after we wake, and lowest levels at night when we should sleep.”

“Staying up late and staring at brightly lit screens tricks the body into believing it is still daytime, thereby keeping the body’s cortisol levels high. When this happens, elevated levels of stress hormones cause the veins to go floppy, with a rapid outflow of blood from the veins in the pelvis.”

The function of cortisol

Cortisol is essential for a healthy functioning body. Back when our ancestors were hunter gatherers, the fight or flight response was important because it helped them perform better under pressure, such as when fighting off predators. Once the threat passes however, cortisol and adrenaline levels would return to normal, as did the heart rate and blood pressure.

“However, today, perceived threats persist. Whether it is Covid-19, rushing a deadline, or having meetings at all hours, stress is almost constant, resulting in cortisol levels that remain elevated for days, weeks or even months,” says Dr Sriram.

So naturally, managing cortisol levels with regular hours that follow the circadian rhtyhm can reduce ‘executive ED’. According to Dr Sriram, most people can manage their cortisol levels with healthy lifestyle changes alone. These include:

  1. Getting enough sleep – “Even if you work from home, set a cut off-time for work. If your sleep patterns have been disturbed, it might take a while to get back into a regular pattern, but it is worth the effort. I recommend setting a routine, dimming the lights over the course of the evening, steering clear of bright screens an hour before bedtime, and avoiding caffeine after sundown.”
  2. Practising healthy habits – “A healthy diet, regular exercise and relaxation techniques such as yoga and mindfulness can help regulate cortisol levels. Try a few until you find one that suits you.”
  3. Avoiding certain medications – “If you are on a long-term corticosteroid, you might want to consult your doctor to see if you can use or switch to a non-corticosteroid treatment.”

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