Hypothalamic-pituitary-adrenal axis activity and its relationship to the autonomic nervous system in patients with psychogenic erectile dysfunction

Jinzhou Xu; Yinwei Chen; Longjie Gu; Xiaming Liu; Jun Yang; Mingchao Li; Ke Rao; Xiyuan Dong; Shulin Yang; Bo Huang; Lei Jin; Tao Wang; Jihong Liu; Shaogang Wang; Jian Bai

doi:10.3389/fendo.2023.1103621

Hypothalamic-pituitary-adrenal axis activity and its relationship to the autonomic nervous system in patients with psychogenic erectile dysfunction

Front Endocrinol (Lausanne). 2023 Mar 3:14:1103621. doi: 10.3389/fendo.2023.1103621. eCollection 2023.

Authors

Jinzhou Xu¹, Yinwei Chen², Longjie Gu^{1

2}, Xiaming Liu¹, Jun Yang¹, Mingchao Li¹, Ke Rao¹, Xiyuan Dong², Shulin Yang², Bo Huang², Lei Jin², Tao Wang¹, Jihong Liu¹, Shaogang Wang¹, Jian Bai²

Affiliations

¹ Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.
² Reproductive Medicine Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.

Abstract

Background: Psychological stress and its two stress response systems, the hypothalamic-pituitary-adrenal (HPA) axis and the autonomic nervous system (ANS), are closely related to psychogenic erectile dysfunction (pED). However, the analyses of perceived stress and stress systems in pED patients need to be more in-depth, especially the interactions between them.

Methods: Our study included 75 patients with pEDs and 75 healthy men. The International Index of Erectile Function-5 (IIEF-5) and the 10-item Perceived Stress Scale (PSS-10) were used for assessing the severity of ED and perceived stress. All participants collected saliva samples on three consecutive days at eight specific times with strict reference to the time of morning awakening for measuring cortisol parameters and wore electrocardiography for 24 h to derive heart rate variability (HRV).

Results: The PSS-10 scores of pED patients were significantly higher than the control group (p<0.001). Although PSS-10 and IIEF-5 scores were negatively correlated in pED patients, there was no statistical significance between them (r=-0.049, p=0.677). Compared with the control group, the HRV parameters of pED patients were significantly increased in LF/HF ratio (p=0.014) but significantly decreased in LF, HF, and pNN50 (p<0.001). However, the two groups had no statistically significant differences in cortisol variables (all p>0.05). The interaction between sympathovagal modulation (HF, rMSSD) and cortisol awakening response (CAR AUCi) explained significantly greater variance in perceived stress than either stress system alone. Higher parasympathetic activity combined with a higher cortisol awakening response was associated with greater perceived stress.

Conclusion: Our results suggested that the interrelation between ANS and HPA axis activity might enhance our comprehension of how stress affected the physical and mental health of pED patients.

Keywords: HPA axis; autonomic nervous system; cortisol; heart rate variability; perceived stress; psychogenic erectile dysfunction.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Autonomic Nervous System / physiology
Erectile Dysfunction*
Humans
Hydrocortisone / analysis
Hypothalamo-Hypophyseal System*
Male
Pituitary-Adrenal System

Substances

Hydrocortisone

Grants and funding

This work received support from the Hubei Province Health and Family Planning Scientific Research Project (WJ2021F102).