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  • Perspective
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GLP-1 receptor agonists and male sexual health: Translating cardiometabolic benefits into erectile outcomes

International Journal of Impotence Research (2026)Cite this article

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Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) have reshaped obesity and diabetes care, offering meaningful and durable weight loss alongside improvements in glycemic control, blood pressure, and inflammatory tone [1]. As use expands into younger and generally healthier populations, urologists may be increasingly asked whether GLP-1 RAs influence male sexual function, particularly erectile function (EF). Two competing narratives have emerged. The first frames GLP-1 RA therapy as potentially erectile-protective through weight loss and vascular risk improvement, a relationship supported by decades of evidence linking cardiometabolic health to erections [2, 3]. The second highlights uncertainty driven by post-marketing case reports and database analyses suggesting possible sexual adverse events in some users, raising the question of whether a true safety signal exists or whether observed associations reflect confounding, detection bias, or rare idiosyncratic effects [4, 5]. This perspective aims to reconcile these narratives and provide a clinical and research framework relevant to sexual medicine and urology.

Erectile function is tightly linked to vascular biology. Obesity and insulin resistance contribute to endothelial dysfunction, reduced nitric oxide bioavailability, and chronic inflammation that impair penile hemodynamics and are mechanistically aligned with erectile dysfunction (ED) as an early marker of cardiometabolic disease [2]. Interventions that reduce weight and improve metabolic risk factors repeatedly improve EF. In a randomized controlled trial, intensive lifestyle changes in obese men with ED improved sexual function, with approximately one-third of participants regaining normal EF over follow-up [2]. A meta-analysis of randomized trials similarly found that weight loss produces a modest but significant improvement in EF as measured by International Index of Erectile Function (IIEF) outcomes, supporting weight reduction as a clinically meaningful adjunct in ED management [3]. These foundational data support a straightforward hypothesis: therapies that produce substantial weight loss and cardiometabolic improvements should, on average, improve erectile outcomes.

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Authors and Affiliations

  1. Florida Atlantic University Charles E. Schmidt College of Medicine, Boca Raton, FL, USA

    Jarrett Noakes, Marshall Daffner, James T. Burns, Alexander K. Bishop, Tate Valerio, Lucas Biondi, Syed Sarwar & Rosstin Afsahi

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  1. Jarrett Noakes
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  2. Marshall Daffner
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Contributions

JN conceived the Perspective; coordinated manuscript development; led the literature review; drafted the initial manuscript; and managed revisions and submission as corresponding author. MD, JTB, AKB, and TV contributed to literature review and drafting and provided critical revisions for intellectual content. LB, SS, and RA contributed to manuscript editing, reference organization, and overall project coordination. All authors reviewed and approved the final manuscript and agree to be accountable for all aspects of the work.

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Correspondence to Jarrett Noakes.

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Noakes, J., Daffner, M., Burns, J.T. et al. GLP-1 receptor agonists and male sexual health: Translating cardiometabolic benefits into erectile outcomes. Int J Impot Res (2026). https://doi.org/10.1038/s41443-026-01254-3

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