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

**Dr. Gabrielle Lyon** (0:00)
The GLP-1 receptor might be hurting your sex life. Women are experiencing a sexual side effect signal that is being systematically missed because nobody is measuring it. The evidence for safety in women is not weak. It's non-existent. The FDA's reporting system only captures one and 10% of side effects that happen. And sexual side effects are among the most under-reported in all of medicine. Now, let me explain why the same drug can help men and potentially hurt women. And this is where it becomes so interesting.
It's not the specific drug that matters most, it's the receptor, the lock that all these drugs fit into. And this argument is simple. Does this class of medication harm sexual health? Or is it a positive? I'm going to start with the scariest version of this story. The strongest case that GLP-1 drugs are causing sexual problems. And I'm going to give it to you at full strength. Let's look at what we know.
If a medication could kill your cravings for pancakes and your craving for sex, would you still take it? That's the question millions of people on Ozempic, Moderna, and the rest of the GLP-1 class are asking.
Okay, so it's either pancakes or you put in the other P word. Here's what should bother you about it. The receptors these drugs hit to switch off appetite is the same receptor sitting in your reward circuitry.
Your hormones and the smooth muscle of your body. Think about this, appetite and arousal running on one wire. If we turn down appetite, what happens to arousal? For most people, the drug, well, they didn't really think about this. No one ever checked what happened to the other. I'm going to give you a breakdown so that you have a clear decision landscape. Let's use a case similar to what I see in my own medical practice. Okay, imagine this, a 35-year-old woman sitting across from you in clinic. She's a marketing director, two kids under five, her life is absolutely insane. She's been on an SSRI for postpartum anxiety for two years.
Frankly, it's working. She feels level-headed, she doesn't have anxiety, she doesn't want to touch it. Six months ago, her primary care doctor started her on a GLP-1, for weight. Her BMI was 33, she did not have diabetes, she does not have PMOS, formerly known as PCOS. She's down 28 pounds. Blood pressure is better. On paper, a total success story.
That's not why she's here.
It took her three visits to say these words out loud. Are you ready? Has nothing to do with the in-laws. It is. The interest in sex is almost gone. When it happens, it takes me a million years to feel aroused. And orgasm, which had never been a problem before, is now absolutely unreliable and sometimes it doesn't even happen.
She assumed it was the SSRI medication, so she dropped the dose. Nothing changed. Now she's wondering, is there something wrong with her marriage? And then she gets the courage to ask you the question, could it be the weight loss drug?
The honest answer is we don't know. Can you imagine that? We don't know. And it wouldn't matter which GLP she was on because the question itself has never been answered for many of them. Same drug class. Think about that. Pancakes or penis? You turn down the desire for pancakes because on that same reward circuitry, what happens to the desire for sex? Well, I'm going to argue both sides with myself. Again, it's just another Tuesday to come up with a conclusion for you. What does her doctor do? Her doctor switches her to semaglutide, also known as ozempic or wagovi. No change. Then they try a different medication, which is terzepotide, the drug also known as monjourno or zeppound. Her sex drive and ability to orgasm comes back. Meanwhile, in a completely different study, get this, men with obesity and low testosterone are put on the same class of the drug. Their testosterone goes up, their erections improve, and their sex lives get better. Same family of drugs, opposite outcomes.
Just think about that for a second. A woman, a 35-year-old woman is put on these medications.
A male, roughly the same age, is also put on these medications. His testosterone goes up, his erections get better, and his sex drive improves, while hers is totally turned off. I'm going to share both sides, and this argument is simple. Does this class of medication harm sexual health?
Or is it a positive? The case that these drugs might be hurting your sex life. I'm going to start with the scariest version of this story. The strongest case that GLP-1 drugs are causing sexual problems. And I'm going to give it to you at full strength, because if I can't be honest about the concern, you shouldn't trust me when I get to the reassurance.