First approved in 2021, the new weight loss drugs, “GLP-1 receptor agonists,” include several medications, notably semaglutide (Wegovy, Ozempic). The GLP-1s suppress appetite so well that they are the most effective weight-loss drugs ever developed. They also reduce blood sugar, which helps treat diabetes.
In 2026, just five years after the first GLP-1 was approved, an estimated 12 percent of American adults—one in eight—now take them. Many report losing 20 to 40 pounds, sometimes more, and hail the GLP-1s as miracles.
Many users also report improved sex. This makes biological sense, especially for diabetics. Diabetes damages the arteries, including those that carry blood through the genitals. Diabetes is notorious for causing sexual impairment, notably erectile dysfunction (ED). GLP-1s normalize blood flow. As blood flows more freely through the genitals, erections firm.
In addition, lugging extra weight around takes a great deal of energy. When the drugs reduce weight, most users report less fatigue and more energy for enjoyable activities, including sex.
But an undercurrent of reports also associates the GLP-1s with a variety of sexual complaints. The package inserts that come with the drugs mention possible sexual side effects, presumably because some turned up during the approval process. But research into all this is still in its infancy.
So far, it appears that only a small fraction of GLP-1 users develop sex problems. But everyone involved—users and the sexuality and mental health professionals who deal with them—should understand that GLP-1s may cause sexual side effects.
Recent Research on Sexual Side Effects of GLP-1 Drugs
Here’s a round-up of recent research:
- Libido loss. We would expect GLP-1-induced weight loss to boost sexual desire. People who shed pounds feel more energetic. They feel better, and get told they look better. Add them up, and many GLP-1 users report more interest in sex.
But there have also been scattered reports of libido loss in some GLP-1 users. Researchers at George Washington University speculate it has to do with drug-induced changes to serotonin, a neurotransmitter involved in mood regulation, including erotic feelings. The popular SSRI antidepressants (Prozac et al.) also impact serotonin and cause sexual side effects. In some people, the GLP-1s apparently have similar action.
- Weaker orgasms. GLP-1 weight reduction mostly involves losing fat. In addition, there’s also some loss of muscle tissue, including from the pelvic floor muscles. In all genders, these are the muscles that contract during orgasm, providing pleasure. If GLP-1s reduce pelvic floor muscle mass, they may not contract as powerfully. Orgasms may feel weaker and less pleasurable. In one case report, a woman taking GLP-1s lost the ability to have orgasms. Now, this is just one case report, among millions of users. Still, users and professionals should understand the possibility.
- Hormonal changes. The sex hormones, estrogen and testosterone, are synthesized from cholesterol. Loss of body fat may reduce cholesterol levels (usually a good thing), and change blood levels of these hormones (possibly bad). If you take a GLP-1 and notice sexual changes, ask your doctor to check your sex hormone levels. Estrogen ointment or testosterone supplementation may be indicated.
- Vulvar skin changes. The vagina’s fleshy outer lips (labia majora) protect the inner lips (labia minora) and the entrance to the vagina. When women use GLP-1s, the labia majora lose some of their fat, and may shrink, stretch, sag, or become less prominent. As the outer lips shrink, the inner lips may appear more prominent. Some physicians now call this “Ozempic vulva.” Some women have also reported labial discomfort, itching, and even ulcers.
- Mixed impact on erections. Among diabetic men, the GLP-1s improve erections. Italian researchers gave 108 diabetic men, average age 60, either a standard diabetes medication or that drug plus a GLP-1. After a year, those taking the GLP-1 reported considerable relief from erectile dysfunction (p < 0.0001).
As body fat decreases, blood levels of testosterone decline. Testosterone levels fluctuate throughout the day, but when men take GLP-1s, testosterone may fall to the point of impairing libido and testicular function. A different group of Italian investigators analyzed studies of GLP-1 use by 680 obese, diabetic men suffering these problems. The drugs helped. In addition to substantial weight loss, participants’ testosterone levels increased, and their testicular function improved (p < 0.0001).
However, among obese non-diabetic men, it’s a different story. Researchers at Johns Hopkins and the University of Texas gave a GLP-1 to 3,094 obese middle-aged men who did not have diabetes. Compared with similar non-diabetic men who did not take the GLP-1, those who did were “significantly more likely” to report erectile dysfunction. It’s not clear why, but the large sample lends credence to this finding.
- Gastrointestinal (GI) distress. GLP-1s slow stomach emptying. The gut is involved in emotions, as the phrase “gut feelings” implies. Drug users may experience slowed stomach emptying as GI distress, and it may compromise libido and reduce the pleasure of lovemaking.
- Constipation. GLP-1s also slow the passage of food through the lower digestive tract. This may cause or aggravate chronic constipation, one of the nation’s most prevalent medical problems, affecting an estimated 20 percent of American adults. Chronic constipation may reduce sexual desire and pleasure. If you take a GLP-1, make sure your smaller meals include foods that prevent constipation: fruits, vegetables, and whole grains. Regular exercise also helps. Physicians who prescribe GLP-1s often remind users to exercise more. But as GLP-1s reduce muscle mass, users may find this harder to do. Work to stay active. Aim for 30 to 60 minutes of exercise daily, for example by taking walks.
GLP-1s can be lifesavers. They help control diabetes and obesity, both of which substantially raise risk for heart disease and stroke. But this good news must be tempered somewhat by emerging findings that the GLP-1s are not sexually benign. GLP-1 users and the professionals who advise them should understand that the drugs may cause or aggravate sex problems.
As new findings become available, I will report them.
