From Marjolaine Bernstein, Marriage and Family Therapist Trainee, guided by Linda M Rio, LMFT and Pituitary World News and Adrenal World News contributor – Imagine this: you love your partner, but suddenly their energy drops, their mood feels flat, and sex starts to feel tense or effortful. Touch decreases. Initiation slows. And before either person says the real words, “I don’t feel like myself.” The relationship fills in the blanks: They’re not attracted to me. I’m failing. Something is wrong with us.
Sometimes the relationship is the problem, but sometimes it starts as a body problem. A pituitary/endocrine disruption can cause real distress, but the real damage can come from what happens next:
Hormone shifts → distress and misinterpretation → shame/avoidance → disconnection → stress physiology →worsened symptoms → deeper shame.
The pituitary: the hormonal “switchboard”
The pituitary helps regulate the systems that shape everyday life and relationships: stress response, energy, mood stability, and sexual functioning. One clinical review defines hypopituitarism as “an endocrine disorder characterized by a deficiency of one or more pituitary hormones” (Iglesias et al.). When those signals are disrupted (or shifting during treatment), people feel it in their emotional bandwidth, body confidence, and sexual connection (Iglesias et al.).
What couples notice first: mood, energy, and availability
In a nationwide cohort study, people with hypopituitarism had a higher risk of developing depression and anxiety disorders (Wei et al.). That matters because depression and anxiety don’t just affect someone internally, they change how they show up in the relationship: less initiation, more irritability or shutdown, lower resilience during conflict, less interest in touch or playfulness (Wei et al.; Iglesias et al.). If couples don’t name what’s happening early, the partner often interprets it as rejection.
Sex changes make it personal
A systematic review on prolactinomas found worse quality of life than healthy controls, especially in “mental and psychosocial wellbeing” (Castle-Kirszbaum et al.). And in one prolactinoma sample (n=176), 59.10% screened positive for anxiety and 28.98% for depression; 54.55% reported low self-efficacy, even as prolactin levels decreased over treatment follow-up (Miao et al.). In plain terms: a lot of people were struggling emotionally and didn’t feel confident in themselves. And when you don’t feel like yourself, it’s easy for sex and connection to feel less appealing.
If you’re the partner on the receiving end of changed desire, it can feel personal. If you’re the one with the symptoms, it can feel embarrassing. That’s where shame usually enters.
The shame spiral
Shame turns a solvable problem into a silent one. A sexual health review by Graziani and Chivers puts it plainly: “Sexual shame negatively affects women’s sexual functioning, impacting arousal, desire, orgasm, and pain.” It also notes that the relationship between sexual shame and sexual functioning is often reciprocal, meaning shame can worsen sexual functioning, and sexual struggles can increase shame.
That’s why the cycle accelerates: shame → avoidance → fewer positive experiences → more shame.
And even when hormone levels normalize, the lived experience can lag. A study of biochemically controlled prolactinoma by van Trigt et al. found that patients still reported more psychological complaints, and a prospective “real-life” Cushing syndrome study by Theodorou et al. found that quality of life improvement after biochemical control was common but not universal (“minimal important difference” achieved in 64.6%).
Translation: biochemical control isn’t always the same thing as feeling fully recovered.
Why people don’t get help (and why that’s understandable)
In a nationally representative survey of adults ages 50–75, 31% reported sexual difficulties in the past year, and among those with persistent issues, only 7.6% sought professional help (Gore-Gorszewska et al.). That’s not because people don’t care. It’s because sex, shame, and health are hard to talk about.
What to do next
Starting with a medical check-in can be helpful if you’re noticing persistent libido collapse plus fatigue/mood shifts, menstrual changes/galactorrhea, erectile/sexual function changes, headaches/vision changes (especially new), or rapid body/mood changes (cortisol-related concerns). You don’t have to guess alone, there are clear evaluation pathways (Petersenn et al.; Theodorou et al.).
Considering therapy (individual or couples) if this is affecting your connection can also be supportive. Therapy isn’t “for broken relationships.” It’s support for a hard season, especially when health changes start messing with mood, confidence, sex, and closeness. It helps you stop mind-reading, notice the pattern, reduce shame, and rebuild intimacy without turning sex into a performance test.
The point isn’t that hormones cause relationship problems. It’s that the shame, misinterpretation, and avoidance caused by physiology can turn it into a relationship problem. The cycle is predictable, which means it’s interruptible. If you’re in it, you’re not broken. You’re responding to a real shift, and you can get your power back.
You can reach Marjolaine at: bernsteinmarjolaine@gmail.com
Marjolaine Bernstein is a recent graduate from Pepperdine University, School of Education and Psychology. She is working toward her certification in sex therapy and plans to specialize in working with those with chronic illnesses, as well as helping her clients reconnect with themselves and their partners. Currently, she practices at the Free Clinic of Simi Valley in California under the supervision of Mary Ann Lovegren, LMFT #39405, and Linda Rio, LMFT #23156.
Linda M. Rio, M.A., LMFT (805) 619-0950
The book The Hormone Factor in Mental Health is available through Amazon.com and other major booksellers.Order your copy here.
Sources:
- Iglesias P. et al. An Update on Advances in Hypopituitarism: Etiology, Diagnosis, and Current Management. (PMC full text): https://pmc.ncbi.nlm.nih.gov/articles/PMC11508259/ | (PubMed):https://pubmed.ncbi.nlm.nih.gov/39458112/
- Wei IH. et al. Risk of Mental Illnesses in Patients With Hypopituitarism: A Nationwide Population-Based Cohort Study. (PMC full text): https://pmc.ncbi.nlm.nih.gov/articles/PMC9233955/
- Castle-Kirszbaum M. et al. Quality of life in Prolactinoma: A systematic review. (PMC full text):https://pmc.ncbi.nlm.nih.gov/articles/PMC11150290/ | (PubMed):https://pubmed.ncbi.nlm.nih.gov/38656635/
- Miao X. et al. A study on the correlations of PRL levels with anxiety, depression, sleep disturbances, and self-efficacy in prolactinoma patients. (PMC full text):https://pmc.ncbi.nlm.nih.gov/articles/PMC10989272/ | (PubMed):https://pubmed.ncbi.nlm.nih.gov/38572480/
- van Trigt VR. et al. Subtle Cognitive Impairments and Psychological Complaints in Patients With Prolactinoma Despite Biochemical Control. (JCEM / OUP):https://academic.oup.com/jcem/article/111/1/e9/8161762 | (PubMed):https://pubmed.ncbi.nlm.nih.gov/40512752/
- Theodorou A. et al. Prospective Assessment of Mood and Quality of Life in Cushing Syndrome Before and After Biochemical Control. (JCEM / OUP): https://academic.oup.com/jcem/advance-article/doi/10.1210/clinem/dgaf598/8307075 | (PubMed): https://pubmed.ncbi.nlm.nih.gov/41168092/
- Graziani C. & Chivers ML. Sexual Shame and Women’s Sexual Functioning. (Sexes, MDPI):https://www.mdpi.com/2411-5118/5/4/47 | (DOI): https://doi.org/10.3390/sexes5040047
- Gore-Gorszewska G. et al. Silent struggles: help-seeking barriers for sexual difficulties among adults 50+ in Czechia. (PMC full text): https://pmc.ncbi.nlm.nih.gov/articles/PMC12361151/ | (Frontiers full text): https://www.frontiersin.org/journals/psychology/articles/10.3389/fpsyg.2025.1622872/full | (PubMed): https://pubmed.ncbi.nlm.nih.gov/40837270/
- Petersenn S. et al. Diagnosis and management of prolactin-secreting pituitary adenomas: a Pituitary Society international Consensus Statement. (Nature Reviews Endocrinology):https://www.nature.com/articles/s41574-023-00886-5 | (PubMed):https://pubmed.ncbi.nlm.nih.gov/37670148/
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