Question: How is libido affected during active Cushing’s and why? Does this return to normal post Cushing’s?

Answer: The effect of Cushing’s on libido has not been well studied and is a complex issue. Many women with Cushing’s report a decrease in libido. The effects of high amounts of cortisol have many effects that may well interfere with libido. Mood disorders including depression are common and can have a deleterious effect.

Sleep disorders are also common. The profound loss of well-being including weakness, fatigue, weight gain and many other physical changes can contribute. The effects of hypertension, if present, as well as hyperglycemia and its treatment can contribute as well. Depending on the patient, a number of hormone abnormalities can also accompany Cushing’s. Men with Cushing’s may have a lowering of the hormone testosterone which can cause a marked decrease in libido.

In sum, the many effects that Cushing’s has can all contribute to loss of libido. Once hypercortisolemia is over and Cushing’s is in remission, patients will often see a return of libido but this can take time and is also affected by any persistent or new hormone abnormalities that may occur after surgery or other therapies that require correction.

By Dr. Anne Klibanski, Director, Neuroendocrine and Pituitary Tumor Clinical Center Massachusetts General Hospital, Boston, MA, Spring, 2017