Semaglutide for weight loss may increase risk for ED in non-diabetic men

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Although low, men experienced a higher risk for erectile dysfunction and hypogonadism after being prescribed semaglutide for weight loss; however, further questions remain.

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“Our findings [were] in the opposite direction of the expectation, where we expected that weight loss would improve symptoms of erectile dysfunction,” said study author Brian Liao.

Non-diabetic men treated with semaglutide (Ozempic/Wegovy) appeared to be at an increased risk for developing erectile dysfunction (ED) and hypogonadism; however, the rate was low at 1.5%, according to a retrospective analysis presented at the 24th Annual Fall Scientific Meeting of Sexual Medicine Society of North America in San Diego, California.1

“Our findings [were] in the opposite direction of the expectation, where we expected that weight loss would improve symptoms of erectile dysfunction,” Brian Liao, John Sealy School of Medicine, University of Texas Medical Branch, said during the presentation.

Package inserts for semaglutide—approved in 2017 for the treatment of diabetes and in 2021 for weight loss in non-diabetic individuals—include sexual dysfunction as a side effect. However, no studies have assessed the risk or frequency of these effects.

Therefore, the investigators assessed the risk for ED and hypogonadism in non-diabetic men following the prescription of semaglutide for weight loss, using the TriNetX Research database starting June 1, 2021. To be included, men had to be 18 to 50 years of age. Men with a history of ED, had received phosphodiesterase-5 inhibitors, had pelvic radiation, had a prostatectomy, or with pulmonary hypertension were excluded from the review.

The study cohort was comprised of 3532 non-diabetic men prescribed semaglutide compared with non-diabetic men never prescribed the agent.

Propensity-score matching was performed based on age, race, ethnicity, body mass index, hypertension, sleep apnea, and hyperlipidemia.

Risk of new ED diagnosis with or without the prescription of semaglutide served as the primary outcomes, while the secondary outcome was risk of new hypogonadism diagnosis.

Non-diabetic men prescribed semaglutide were more likely to develop ED, compared with the control group (0.4%; risk ratio [RR], 4.1; 95% CI, 2.2-7.5), and hypogonadism (3.1% vs 1.5%, respectively; RR, 2.0; 95% CI, 1.5-2.8).

“Despite its increasing popularity for weight loss, both clinicians and patients should be aware of potential hormonal effects when discussing and considering the medication,” the study authors concluded.

Liao noted that further research is need. “Future questions are what are the pathophysiological mechanisms that result in a higher risk for these disorders?” Liao added. “Also, is this a dose-dependent relationship?”

Reference

1. Liao B, Able C, Sonstein J, Kohn T. Prescribing Ozempic and Wegovy for weight loss is associated with an increased risk of erectile dysfunction and hypogonadism in non-diabetic males. Presented at: 24th Annual Fall Scientific Meeting SMSNA; November 16-18, 2023; San Diego, CA. Abstract 157.

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