There is a close interaction between depression and ED.[38] Several studies have shown that depressed people have a higher risk of ED, and that people with ED are also more likely to have anxiety and even depression.[39,40] Depression was also found to be a risk factor for osteoporosis.[41] In depressed patients, hypothalamic–pituitary–adrenal axis is activated, and excessive secretion of corticotropin-releasing hormone leads to elevated cortisol levels. This evidence concerns the gene CRH and Anxiety.