Nobody Tells You What GLP-1s Do to Your Sex Drive | GLS #213

GLP-1 receptor agonists, while transformative for metabolic health, exert divergent effects on sexual function that depend heavily on the patient's sex and metabolic baseline. For men with obesity, these medications often enhance sexual health by reducing inflammation and increasing free testosterone. Conversely, women—especially those who are lean or postmenopausal—may experience diminished libido and difficulty reaching orgasm due to the drugs' dampening effect on brain reward circuitry and potential reductions in free testosterone. A significant clinical oversight persists, as no major trials have utilized validated sexual function questionnaires for female participants, leaving a critical gap in safety data. Patients should treat sexual health as a vital sign, establishing baselines before treatment and considering dose adjustments or molecule switching if dysfunction occurs, rather than assuming a uniform class effect across all populations.