GLP-1 medicines, weight loss and ED: what the labels and studies show

Status: FDA-approved for another condition, not for ED. Source: Wegovy, Ozempic, Zepbound and Mounjaro prescribing information, DailyMed, checked 2026-10-17.

In short: GLP-1 medicines such as semaglutide (Wegovy, Ozempic) and tirzepatide (Zepbound, Mounjaro) are now widely used for weight and type 2 diabetes, and many men taking them want to know whether they affect erections. The honest answer is that nobody knows yet. The drug labels do not list ED, the published studies point in different directions, and none of them was designed to prove cause. This page sets out what each source actually found, what weight loss itself has been shown to do, and when to raise it with a clinician.

Does semaglutide cause erectile dysfunction?

There is no proof that it does, and no proof that it does not. One study of men without diabetes found more recorded ED after semaglutide was prescribed (Able et al., Int J Impot Res 2024), while a study of tirzepatide in men with type 2 diabetes found less recorded ED with tirzepatide than with semaglutide and other diabetes medicines (Cowart et al., J Diabetes Complications 2025). Both were built from health records, which show how often things occur together, not why. A randomized trial with erection data, which tested a different GLP-1 medicine, found slightly fewer new cases of moderate or severe ED than placebo (Bajaj et al., Lancet Diabetes Endocrinol 2021).

Do GLP-1 labels mention ED?

No. We searched the current US prescribing information on DailyMed for Wegovy, Ozempic, Zepbound and Mounjaro for the words “erectile”, “sexual” and “libido”, and none of the four labels uses them. The most common side effects the labels list are mostly digestive. Ozempic’s label names nausea, vomiting, diarrhea, abdominal pain and constipation (Ozempic prescribing information), Wegovy’s list adds items such as headache, fatigue, dizziness and hair loss, and Zepbound’s adds fatigue and hair loss among others (Wegovy prescribing information; Zepbound prescribing information). A label’s silence is not a guarantee. The authors of the 2024 semaglutide study wrote that package inserts include sexual dysfunction as a side effect (Able et al., 2024); we did not find that in the current US labels checked for this page.

None of the four is approved for ED. Tirzepatide acts on two hormone receptors, GIP and GLP-1, which is why its labels describe it as a GIP and GLP-1 receptor agonist (Mounjaro prescribing information). Zepbound’s sleep apnea use is worth knowing, because sleep apnea itself is linked to ED, as our guide to sleep apnea and ED explains.

What have cohort studies reported?

They disagree, and the difference partly tracks who was studied. In men without diabetes, a 2024 study used the TriNetX health-record network to compare 3,094 men aged 18 to 50 with obesity who were prescribed semaglutide against an equal number of matched men who never were. The semaglutide group was more likely to get a new ED diagnosis or a prescription for an ED pill (1.47% vs 0.32%, a risk ratio of 4.5, 95% CI 2.3 to 9.0) and more likely to get a new low-testosterone diagnosis (1.53% vs 0.80%) (Able et al., 2024). The absolute numbers in both groups were small.

In men with type 2 diabetes, the results split. A 2026 University of Pennsylvania study compared 4,910 men starting a GLP-1 medicine with 5,524 starting a DPP-4 inhibitor, another diabetes medicine. New ED diagnoses were somewhat more common with GLP-1 medicines (35.2 vs 28.0 per 1,000 person-years, hazard ratio 1.26), but the link weakened and was no longer statistically significant after a calibration step meant to catch hidden bias. The authors wrote that the findings “may reflect residual or selection bias and do not establish causation” (Tang et al., eClinicalMedicine 2026). A 2025 TriNetX study of men aged 18 to 70 with type 2 diabetes found the opposite direction for tirzepatide: a lower risk of an ED diagnosis or ED prescription than with sitagliptin (risk ratio 0.70), injectable semaglutide (0.67) or dulaglutide (0.55). Its authors also said randomized trials are needed to confirm this (Cowart et al., 2025).

What did a randomized trial find?

Randomized evidence comes from REWIND, a placebo-controlled randomized trial of dulaglutide (Trulicity), a GLP-1 medicine for type 2 diabetes. Men in the trial could fill in a standard erectile function questionnaire at several points, and 3,725 men with a mean age of 65.5 were analyzed. New moderate or severe ED occurred at 21.3 per 100 person-years with dulaglutide and 22.0 with placebo (hazard ratio 0.92), and erectile function scores fell slightly less with dulaglutide. The authors concluded that long-term dulaglutide “might reduce” the incidence of moderate or severe ED in men with type 2 diabetes (Bajaj et al., 2021).

The limits matter. This was an exploratory analysis, not the trial’s main question, it covered older men with diabetes rather than men using these medicines for weight alone, it tested dulaglutide rather than semaglutide or tirzepatide, and the trial was funded by Eli Lilly and Company (Bajaj et al., 2021). A separate 2024 genetic study, which used gene variants as a stand-in for the drug’s target, also pointed toward lower ED risk, and its authors said the result still needs confirming in randomized trials (An et al., Front Endocrinol 2024).

What do adverse event reports show?

The FDA Adverse Event Reporting System (FAERS) is a large database of adverse event reports collected after medicines reach the market. A 2026 analysis found 49 ED reports associated with semaglutide, which was somewhat more often than expected compared with other drugs in the database (reporting odds ratio 1.53). It found similar signals for two diabetes medicines from other classes, sitagliptin and dapagliflozin, and none for dulaglutide or metformin. The authors called the findings “preliminary and hypothesis-generating” and said they do not establish causality (Lin et al., Andrology 2026). The authors also noted that the database is subject to reporting bias: underreporting is common for sensitive outcomes such as ED, and public attention can drive extra reporting (Lin et al., 2026). Report counts can flag a question but cannot measure how often something happens.

Does losing weight change erectile function?

In trials of diet and exercise, it can help some men, modestly. A randomized trial of 110 men aged 35 to 55 with obesity and ED, but no diabetes, high blood pressure or high cholesterol, gave half detailed advice on losing weight through eating less and moving more. After two years, average erectile function scores rose from 13.9 to 17 in that group and stayed level in the comparison group, and the authors linked lifestyle change to improvement in about one third of the men (Esposito et al., JAMA 2004). In the Look AHEAD trial, older men with type 2 diabetes and excess weight in an intensive lifestyle program lost 9.9% of their body weight in a year, against 0.6% in the comparison group. Erectile function held up slightly better in the lifestyle group, and the authors described weight loss as “mildly helpful in maintaining” it (Wing et al., J Sex Med 2010).

These trials tested diet and activity, not GLP-1 medicines, so they cannot tell you what a medicine-driven weight loss will do. The NIH lists maintaining a healthy body weight among the lifestyle changes a clinician may suggest for ED, and says a healthy weight can improve testosterone levels and self-esteem and help prevent diabetes and high blood pressure, which can cause ED (NIDDK, Treatment for ED). Our guide to lifestyle and ED covers activity, alcohol and the other habits on that list.

Why is an association not proof?

Because the men who start these medicines differ from the men they are compared with, in ways a database cannot fully measure. The Penn authors named “residual or selection bias” as a possible explanation for their own result (Tang et al., 2026), and every cohort above counted ED from diagnosis codes or prescriptions, which capture men who brought it up with a clinician rather than every man who had it. Excess weight and diabetes are themselves tied to ED, as our page on chronic conditions and ED covers, so the condition being treated and the medicine treating it are hard to separate. Our explainer on how to read ED evidence walks through why a randomized trial sits above a cohort study, and why a risk ratio describes a group, not you.

Are compounded GLP-1 products FDA-approved?

Status: Compounded: not FDA-approved. Source: FDA, FDA’s Concerns with Unapproved GLP-1 Drugs Used for Weight Loss, checked 2026-10-17.

No. The FDA says compounded drugs are not FDA approved, which means the agency does not review them for safety, effectiveness or quality before they are sold. It has warned about fraudulent compounded semaglutide and tirzepatide, salt forms such as semaglutide sodium that differ from the approved active ingredient, products sold falsely as “for research purposes”, and telehealth red flags such as claims that a compounded drug is the same as an approved one (FDA). None of the studies on this page tested compounded products, so their findings on ED cannot be carried over to them.

When should you talk to a clinician?

If you notice a change in your erections after starting a GLP-1 medicine, or before you start one, it is worth raising with the clinician who prescribes it. The NIH says clinicians treat the underlying cause of ED when possible, that sometimes the exact cause is not known, and that a clinician may review the medicines you take and suggest a different dose or a switch. It is also clear on one point: “Do not stop taking any medicines on your own” (NIDDK, Treatment for ED). Our pages on ED and diabetes and medicines that can affect erections go further into those causes.

The bottom line

The current US labels for Wegovy, Ozempic, Zepbound and Mounjaro do not list ED. Health-record studies disagree, with one finding more recorded ED after semaglutide in younger men without diabetes and others finding small increases or decreases in men with diabetes, and none can prove cause. The randomized evidence covered here, for dulaglutide in older men with diabetes, leaned slightly toward fewer new cases. Weight loss through diet and activity has helped erectile function modestly in some trials. If something changes, talk it through with your prescriber rather than guessing.

Sources

Every clinical statement on this page traces to a primary or guideline source:

• Wegovy (semaglutide) prescribing information, Novo Nordisk, DailyMed (effective June 2026): approved uses; most common adverse reactions; no mention of erectile, sexual or libido terms.
• Ozempic (semaglutide) prescribing information, Novo Nordisk, DailyMed (effective June 2026): approved uses; most common adverse reactions; no mention of erectile, sexual or libido terms.
• Zepbound (tirzepatide) prescribing information, Eli Lilly, DailyMed (effective August 2026): approved uses including obstructive sleep apnea in adults with obesity; most common adverse reactions; no mention of erectile, sexual or libido terms.
• Mounjaro (tirzepatide) prescribing information, Eli Lilly, DailyMed (effective August 2026): approved uses; GIP and GLP-1 receptor agonist; no mention of erectile, sexual or libido terms.
• Able C, et al. Prescribing semaglutide for weight loss in non-diabetic, obese patients is associated with an increased risk of erectile dysfunction: a TriNetX database study (Int J Impot Res, 2024): 3,094 matched pairs of men aged 18 to 50; ED diagnosis or PDE5 prescription 1.47% vs 0.32% (RR 4.5); testosterone deficiency 1.53% vs 0.80%.
• Tang H, et al. GLP-1 receptor agonist and risk of erectile dysfunction in men with type 2 diabetes: a target trial emulation (eClinicalMedicine, 2026): 4,910 GLP-1 and 5,524 DPP-4 inhibitor initiators; 35.2 vs 28.0 per 1,000 person-years (HR 1.26); attenuated after negative control calibration; possible residual or selection bias.
• Cowart K, et al. Association of tirzepatide with erectile dysfunction in people with type 2 diabetes (J Diabetes Complications, 2025): lower risk of ED diagnosis or PDE5 prescription with tirzepatide than sitagliptin (RR 0.70), injectable semaglutide (0.67) and dulaglutide (0.55); trials needed.
• Bajaj HS, et al. Erectile function in men with type 2 diabetes treated with dulaglutide: an exploratory analysis of the REWIND placebo-controlled randomised trial (Lancet Diabetes Endocrinol, 2021): 3,725 men; new moderate or severe ED 21.3 vs 22.0 per 100 person-years (HR 0.92); smaller fall in erectile function scores; funded by Eli Lilly.
• Lin S, et al. Sexual Safety Signals of Common Antidiabetic Drugs: Insights From FAERS Disproportionality Analysis (Andrology, 2026): 49 semaglutide ED reports (ROR 1.53); signals also for sitagliptin and dapagliflozin, none for dulaglutide, linagliptin or metformin; not causal, hypothesis-generating; full text (PMC) notes reporting bias and underreporting of ED.
• An H, et al. Glucagon-like peptide-1 receptor agonists and the risk of erectile dysfunction: a drug target Mendelian randomization study (Front Endocrinol, 2024): genetically proxied GLP-1 receptor agonism associated with lower ED risk; validation in randomized trials needed.
• Esposito K, et al. Effect of lifestyle changes on erectile dysfunction in obese men: a randomized controlled trial (JAMA, 2004): 110 men; erectile function score 13.9 to 17 with weight-loss advice vs 13.5 to 13.6 in controls over two years; improvement in about one third.
• Wing RR, et al. Effects of weight loss intervention on erectile function in older men with type 2 diabetes in the Look AHEAD trial (J Sex Med, 2010): 9.9% vs 0.6% weight loss at one year; erectile function maintained slightly better with intensive lifestyle intervention.
• NIH NIDDK, Treatment for Erectile Dysfunction (last reviewed October 2024): healthy body weight among suggested lifestyle changes; how a healthy weight may help prevent ED; medicine review; “Do not stop taking any medicines on your own”; seek care right away for priapism or vision or hearing loss.
• FDA, FDA’s Concerns with Unapproved GLP-1 Drugs Used for Weight Loss (updated October 2026): compounded drugs are not FDA approved; fraudulent compounded products; salt forms; research-use products; telehealth red flags.