Cortisol and libido: what is known about stress hormones and sex drive

Lower interest in sex is listed for two cortisol conditions: Cushing’s syndrome (too much cortisol over a long time) and adrenal insufficiency (too little). Outside those, we found no source we can use that shows a cortisol level explains low desire. Most low libido has other causes.

Cushing’s syndrome and sex drive

NIDDK says men with Cushing’s syndrome may have decreased fertility with lowered interest in sex, and may have erectile dysfunction. MedlinePlus says the same about men, and adds that women may have irregular or absent periods and extra hair on the face, neck, chest, belly or thighs.

A 2019 questionnaire of 320 people with Cushing’s syndrome, mostly women, gives a sense of how often it comes up. 32.5 percent said decreased libido was among the symptoms they first noticed. After treatment, 25.3 percent still reported it, and it was reported more often by those who had waited longer for a diagnosis. About half said their sexual life had been affected (Endocrine Connections, 2022). The survey was online, and remission was self-reported, so treat the figures as rough. They also describe people who already have the condition. They don’t tell you how likely it is that your own low desire comes from it.

Adrenal insufficiency and sex drive

NIDDK lists “loss of interest in sex” among the symptoms of adrenal insufficiency, together with irregular or absent periods. It sits among the other symptoms on the list, after the most common ones: long-lasting fatigue, muscle weakness, loss of appetite, weight loss and abdominal pain. See low cortisol symptoms.

Stress, cortisol and desire

We found no source we can use that measures how everyday stress or a cortisol level changes sexual desire, so we don’t state an answer. The same goes for the question of whether sex itself raises or lowers cortisol.

What we can quote is narrower. NIDDK says anxiety, depression or stress can cause erectile dysfunction or make it worse. It says the common underlying causes include diabetes, chronic kidney disease, obesity, heart and blood vessel disease, high blood pressure, hormone issues such as low testosterone and thyroid imbalance, and nerve damage. It also lists medicines, among them antidepressants and blood pressure medicines. NIDDK says erectile dysfunction may be a symptom of another health problem. Cortisol is not on that list. If you take any of these medicines, don’t stop them on your own. Ask your prescriber.

What about DHEA-S?

DHEA-S is a hormone made mostly by the adrenal glands. MedlinePlus says levels peak around puberty and fall with age, and that when low levels are related to aging, symptoms can include decreased sex drive, erectile dysfunction in men and thinning of vaginal tissues in women. It also says DHEA supplements are promoted as anti-aging treatments with no reliable evidence behind the claims, and that they may cause serious side effects. If you’re thinking about them, talk to a provider first. See the DHEA-S test and testosterone and cortisol.

When to see a clinician

• The change is new, lasting, or upsetting. A clinician can check medicines, mood, sleep, other health conditions and hormone levels together, and choose the tests that fit. Your own cortisol result alone can’t do that.
• It comes with other signs of Cushing’s syndrome. NIDDK lists weight gain, thin arms and legs, a round face, easy bruising, wide purple stretch marks and weak muscles.
• It comes with other signs of adrenal insufficiency. Those include long-lasting fatigue, weight loss, dizziness when you stand and, in Addison’s disease, darkening skin.
• Periods are irregular or have stopped. NIDDK lists this among the symptoms of both conditions. It’s a reason to see a clinician.
• You take a steroid medicine. Tell the prescriber. Don’t change the dose yourself.

Vomiting you can’t stop, fainting or severe weakness need urgent care. See adrenal crisis.

Keep reading

• DHEA-S test

  A hormone made mostly by the adrenal glands and what a test can show.

• Testosterone and cortisol

  How the two relate and what a test can and can't show.

• Low cortisol in women and men

  How low cortisol can differ and what to ask.

• High cortisol in men

  What high cortisol can mean for men.