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As cortisol levels rise, the ability of our body to produce the hormones we need to support optimal fertility decrease and, in turn, impact the quality of our eggs and sperm

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NICE-aligned management typically involves: Addressing modifiable risk factors (smoking cessation, weight loss, increased physical activity, alcohol reduction) Optimising management of underlying conditions (diabetes, hypertension, depression) Trial of PDE5 inhibitor therapy Referral to specialist services (urology/andrology) if first-line treatments fail or where structural/neurological/endocrine causes are suspected Consideration of psychosexual therapy where appropriate Men should be reassured that ED is a medical condition with effective treatments, and seeking help through proper channels ensures safety, appropriate investigation of underlying causes, and access to evidence-based therapies

Avoidance also may derive from the number of people with obesity being so largefar larger than the number with diabetesand therefore more costly to treat, the authors note