Effects of glucagon-like peptide-1 receptor agonists on male reproductive hormones, semen parameters, and metabolic outcomes: a systematic review.

Plain-language summary

This systematic review set out to assess how GLP-1 receptor agonists (a class of diabetes and weight-loss drugs) affect male reproductive hormones, semen quality, and metabolic health. It pooled data from 10 studies involving 639 men, comparing those on GLP-1 drugs to controls or testosterone therapy groups. The review found these drugs consistently raised total testosterone in men with obesity, diabetes, or low testosterone, while preserving or boosting key fertility hormones that testosterone therapy often suppresses. Semen quality improved in metabolically unhealthy men but not in healthy ones.

Key findings

• GLP-1RAs increased total testosterone, especially in men with obesity, type 2 diabetes, or hypogonadism.
• Free testosterone changes were inconsistent due to rises in SHBG (sex hormone-binding globulin, which binds testosterone).
• Luteinizing hormone (LH, which signals the testicles to make testosterone) and follicle-stimulating hormone (FSH, which supports sperm production) levels were preserved or increased with GLP-1RAs, unlike the suppression seen with testosterone therapy.
• Semen parameters improved in obese or hypogonadal men but not in healthy individuals.