Few new drugs have sparked as much interest and as many questions as GLP-1 agonists. Originally developed to manage blood sugar and support weight loss, these medications are currently being studied for their potential effects on sexual function.
Some patients reported an increase in libido, while others experienced an unexpected decline. The same molecule that regulates glucose may also influence the brain’s “pleasure signals.”
Research has shown that these effects on sexual desire vary widely and are shaped by physiologic, psychological, and neurobiological factors. GLP-1 agonists are believed to act on multiple pathways, including the brain’s reward system, appetite signals, and sex hormone regulation through metabolic changes.
Available data show that GLP-1 receptor agonists (RAs) mimic endogenous GLP-1 and trigger metabolic effects that may influence sexual health.
A 2025 systematic review and meta-analysis in men with overweight or obesity found that GLP-1 RAs increased total testosterone, luteinizing hormone, and follicle-stimulating hormone levels, while reducing body weight, BMI, waist circumference, and A1c.
Compared with other antidiabetic or weight-reducing treatments, GLP-1 RAs produced increased gonadotropins and sex hormone-binding globulin and improved erectile function, with serum androgen levels comparable to or exceeding those of other agents. The analysis suggested a potential direct testicular effect, but the primary benefit may be hormonal optimization in men with functional hypogonadism related to excess weight. This hormonal rebalance may translate into improved sexual desire, erectile function, and spermatogenesis.
A 2025 review noted that in men with type 2 diabetes (T2D) and obesity who had erectile dysfunction, GLP-1 RAs improved erectile function, likely via restoration of metabolic and vascular balance essential for the male sexual response.
One year-long study of men with T2D and erectile dysfunction showed that combining metformin with liraglutide or dulaglutide significantly improved International Index of Erectile Function scores, especially in those who lost more weight or had baseline vascular impairment.
However, not all individuals respond similarly. Potential adverse effects may occur in patients with neuroendocrine disorders, preexisting testosterone deficiency, or drug interactions. Rarely do some patients experience reduced sexual desire or erectile function, warranting individualized clinical decisions.
In contrast, in healthy men without metabolic disease, dulaglutide did not significantly affect sexual desire or gonadal hormone levels after 4 weeks.
Evidence in women is limited but includes case reports of sexual dysfunction. One publication described a 71-year-old postmenopausal woman who abruptly developed anorgasmia after starting liraglutide with no hormonal or psychological abnormalities. She reported a loss of clitoral sensitivity and sexual pleasure.
The authors proposed peripheral mechanisms such as reduced genital blood flow and central modulation of dopamine and noradrenaline in brain regions regulating reward and arousal. Nonpharmacologic strategies and sex therapy were ineffective while on liraglutide and switching to semaglutide did not improve the symptoms. However, after transitioning to tirzepatide, the patient regained orgasmic ability, suggesting drug-specific effects.
Another case involved a 36-year-old woman with obesity who developed reduced sexual desire, genital dryness, and anorgasmia after starting tirzepatide. Symptoms resolved after discontinuing treatment and recurred on rechallenge, suggesting medication-related effects. Management included sex therapy, lifestyle modifications, and adjunctive pharmacologic support.
The sexual response in women depends on a complex interplay between estrogen, progesterone, testosterone, and psychosocial factors, complicating the direct attribution to medication.
The leading hypothesis is that GLP-1 RAs modulate dopaminergic reward pathways that regulate hunger, motivation, and satisfaction. Suppression of appetite may also reduce erotic motivation in some patients.
Clinical responses vary widely, with some women reporting increased desire and confidence following weight loss and metabolic improvement.
GLP-1 RAs may influence self-image and social behavior.
A US survey of 2000 single adults found that 59% felt that these medications changed their dating life, and 52% reported changes in their sex life. Within this group, 18% experienced increased sexual desire and 16% reported decreased desire. Men reported improved confidence and attractiveness more frequently than women.
Experts caution that these reports rely on self-reporting, do not distinguish between clinical and cosmetic use, and reflect perceptions rather than confirmed physiologic effects.
Clinicians should proactively address the sexual health of patients treated with GLP-1 RAs. Asking about libido, arousal, and satisfaction can help differentiate medication effects from other causes and guide shared decisions regarding treatment continuation or modification.
This story was translated from El Medico Interactivo, part of the Medscape Professional Network.