GLP-1 receptor agonists consistently increased total testosterone in men with obesity or diabetes while preserving gonadotropin function, suggesting they could be fertility-sparing alternatives to testosterone therapy.
Fertility preservedUnlike testosterone therapy, GLP-1 drugs maintained or increased LH and FSH — the hormones essential for sperm production
What the researchers found
GLP-1RAs consistently increased total testosterone in men with metabolic dysfunction while preserving or increasing LH and FSH levels, in contrast to testosterone therapy which suppresses gonadotropins and fertility.
Why it matters
Many men with obesity have low testosterone and want treatment, but testosterone replacement suppresses fertility. GLP-1 drugs could offer both metabolic and reproductive benefits without compromising sperm production.
How the study worked
Systematic review following PRISMA guidelines, searching 4 databases through April 2025, including RCTs and cohort studies with risk of bias assessment using RoB 2 and ROBINS-I tools.
What this study cannot tell us
Relatively few studies with small sample sizes. Free testosterone changes were inconsistent. No long-term fertility outcomes measured. Most evidence from men with metabolic conditions.
How to read the evidence
Systematic review of RCTs and cohort studies with formal bias assessment. Evidence is consistent but limited by small study sizes.
When this study was published
Published in 2025, providing the first systematic synthesis of GLP-1 effects on male reproduction.
The bigger picture
This positions GLP-1 drugs as potential fertility-sparing alternatives to testosterone therapy in obese men with low testosterone, addressing two major health concerns simultaneously.
Questions still open
- Could GLP-1 drugs replace testosterone therapy in obese men with hypogonadism who want to preserve fertility?
- What is the optimal GLP-1 drug and dose for maximizing testosterone improvement?
- Do the reproductive benefits persist long-term or only during active treatment?
Common questions
Can GLP-1 drugs help with low testosterone?
Will GLP-1 drugs affect my ability to have children?
Read the original research
Effects of glucagon-like peptide-1 receptor agonists on male reproductive hormones, semen parameters, and metabolic outcomes: a systematic review.
The journal of sexual medicine, 23(2)
Citation
Deameh, Mohammad Ghassab; Ramez, Mohamed; Rowaiee, Rashed; Bani Irshid, Baha' Aldeen; Mohamed, Hamza; Abdelshafi, Abdelrahman; Al-Osoufi, Mohammad Ali; Mohamed, Tarek; Hegazin, Safa Botros; Raheem, Omer. (2026). Effects of glucagon-like peptide-1 receptor agonists on male reproductive hormones, semen parameters, and metabolic outcomes: a systematic review.. The journal of sexual medicine, 23(2). https://doi.org/10.1093/jsxmed/qdaf381