DR ELLIE: You probably don’t need erectile dysfunction pills. The reason you’re struggling to maintain an erection could be much closer to home… or work

I was fascinated to read a study that found erectile dysfunction was strongly linked with workplace stress – and I think it could completely change the way we treat the embarrassing sexual issue.

The research, published earlier this month, tracked the health of about 820 men aged between 22 and 40 over several months. Their stress levels were also recorded, and they were then split into five categories, from most stressed to least.

The first-of-its-kind study concluded that those men with the most stress at work were significantly more likely to experience erectile dysfunction – the medical term for not being able to maintain an erection.

In fact, more than half of these men experienced the problem.

These figures are absolutely staggering. In more than two decades as a GP, I’ve treated countless men with erectile dysfunction. The condition is, understandably, devastating for many.

The majority of these patients have typically been older – as the condition becomes more common later in life. But in recent years I’ve seen a growing number of young men. And it’s a pattern that’s been seen across the country.

Until now the problem has often been managed with the same intervention: medication.

Doctors will always make sure there is no underlying serious health issue. That’s because erectile dysfunction can be an early warning sign of dangerous chronic conditions such as heart disease. However, once these are ruled out, patients are often given tablets.

These drugs, sildenafil and tadalafil (better known as Viagra and Cialis) are incredibly effective at helping patients maintain an erection. In fact, they are so successful a multi-million-pound market has formed online. There are now countless online pharmacies that offer these drugs by post.

The problem is that these medicines, no matter how effective, are not a lasting solution. They only temporarily fix erectile dysfunction. This suits the companies that sell them as it means patients will have to keep coming back.

That is why this study is so significant. It shows that, in many cases, erectile dysfunction could be solved if we tackled the factors that are causing it – namely stress.

Why does stress seem to have such a potent impact on erections?

The study authors have a convincing theory. When we get stressed the body produces a hormone called cortisol. This is essentially a flight-or-fight chemical that puts the body on high alert for threats.

Over time, cortisol suppresses another hormone: testosterone. This is the male sex chemical and, when levels are low, it becomes difficult to maintain erections.

This isn’t just a theory. It’s fact. The new study, published in the International Journal of Clinical Practice, also tracked the cortisol and testosterone levels of the stressed men.

The researchers found that, when cortisol levels went up, testosterone would go down within a month. And, when testosterone went down, erectile dysfunction would occur within six weeks.

Often the best way to prevent erectile dysfunction is to boost testosterone levels.

Tackling stress is the most obvious step. There is good evidence that talking therapy as well as regular exercise can help with stress, and these should prevent excessive cortisol spikes.

Of course, the stress might be caused by issues in the workplace, such as long hours or a difficult boss. In these situations, there is only so much that talking about your feelings and long walks can do.

Stress is also not the only trigger of low testosterone. The problem is linked to obesity and excessive alcohol consumption. Patients struggling with erectile dysfunction should also consider tackling these risks too.

However, I do truly believe stress is not nearly discussed enough as a cause of erectile dysfunction – or other conditions, for that matter.

There is also growing evidence that stress raises blood pressure and can even trigger immune conditions like rheumatoid arthritis.

As a nation we need to get much better at recognising and treating stress. Buying erection tablets from online pharmacies is not a long-term solution.

I’d like to know how you deal with nasty fat jab side-effects

I recently learned that many of my patients who are on weight-loss jabs will only take the medication on certain days of the week.

These drugs can help users lose as much as a fifth of their body weight. However, they can trigger some uncomfortable side-effects – particularly in the first few months.

Often, these side-effects, such as nausea, indigestion or even vomiting, kick in around 24 hours after the jab is taken. As a result, many of my patients say that they will take the jabs just before the weekend, so they can be close to home in case the symptoms kick in.

I’ve also heard people say that they are careful to time their jabs to avoid the side effects getting in the way of big events such as birthdays or weddings.

How do you manage side-effects from your weight-loss jabs? Please email me at DrEllie@mailonsunday.co.uk and let me know.

Your questions answered

I contracted Covid six years ago and lost my sense of smell. My GP told me to buy a smelling kit, but that’s done nothing. What should I do? 

Dr Ellie answers: It’s possible that Covid might not be the cause of a long-term smell loss.

Also known as anosmia, it can be unpleasant as it affects the ability to taste and enjoy food.

It can also have serious health implications, as people who cannot smell may not notice a gas leak, a fire or food that has gone off.

It’s an issue that came to the public’s attention during the pandemic, as countless patients experienced a loss of smell after catching the virus. Other bugs, such as colds and the flu, can have a similar effect.

For most, the sense of smell returns, but others can suffer for months or even years.

For these patients, there are treatments. However, first it is important to rule out other causes.

One common cause for chronic smell loss is nasal polyps – growths inside the nose. Anyone who has smell loss that continues for longer than a few months should be examined by a nose specialist for polyps.

These can be removed through surgery, after which smell should return.

For those without polyps, the best option is smell training – also known as olfactory training. This is a programme that retrains the nose and involves sniffing strong scents such as lemon and eucalyptus several times a day.

It’s not an instant fix – it can take months and many people do not stick with the programme. However, it’s important to keep doing the training, even if it seems like nothing is changing, otherwise the sense of smell will never return.

For more information on smell training, try the charity SmellTaste (smelltaste.org.uk).