World J Mens Health. 2026 Aug 6. doi: 10.5534/wjmh.260045. Online ahead of print.
ABSTRACT
The use of glucagon-like peptide-1 receptor agonists (GLP1-RAs) and sodium-glucose cotransporter 2 inhibitors (SGLT2is) resulted in weight loss and long-term cardiovascular (CV) and renal safety preservation. Their role in male sexual hormones and behavior is still not sufficiently investigated. This paper aims at summarizing the effects of GLP1-RA and SGLT2i on obesity-associated hypogonadism and sexual dysfunctions. Both GLP1-RA and SGLT2i resulted in an improvement of body composition and metabolic profile, supporting erectile function amelioration. Only GLP1-RA showed a weight loss dependent increase in total and calculated free testosterone with lower effects on gonadotropin levels, while for SGLT2i, the data are contradictory. Finally, the use of testosterone replacement therapy showed better results as compared to GLP1-RA when orgasm and sexual satisfaction domains were investigated. In conclusion considering the beneficial effects of GLP1-RA on long-term CV mortality and morbidity, compared to the substantially neutral effects derived from the use of testosterone replacement therapy, we support the use of this class of medications for improving sexual dysfunction and its underlying CV problems in overweight and obese patients with erectile dysfunction.
PMID:42608153 | DOI:10.5534/wjmh.260045