The effect of stress on testosterone and sexual function.

Stress influences male reproductive and sexual health through physiological and psychological pathways, each with distinct mechanisms, durations, and downstream effects. This narrative review investigates how acute physiological stress and chronic psychological stress affect testosterone levels and sexual function. Acute physiological stress induces predictable, transient reductions in testosterone and temporary impairments in sexual function, primarily driven by sympathetic nervous system activation, hypothalamic-pituitary-adrenal axis engagement, and energy imbalance. In contrast, chronic psychological stress, conceptualized through accumulations in allostatic load, leads to sustained endocrine dysregulation, often linked indirectly to testosterone suppression via its association with metabolic dysregulation. Chronic stress is further correlated to long-term declines in sexual health, including diminished sperm quality, erectile dysfunction, and reduced sexual desire. Together, these findings highlight the importance of distinguishing between stress types to better understand their individual and cumulative effects on male endocrine and sexual health.