GLP1-RA enhances semen quality, testosterone levels in men with metabolic disorder

The use of GLP-1 receptor agonists (RAs) is associated with improved testosterone levels and semen quality in men with metabolic issues, while maintaining gonadotropin function, reports a study.

A team of investigators performed a systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. They searched the databases of PubMed, Embase, Scopus, and Web of Science through April 2025 for randomized controlled trials (RCTs) and cohort studies assessing the effects of GLP1-RAs in adult men.

Finaly, the risk of bias was evaluated using the risk of bias 2 tool for RCT and the Risk Of Bias In Non-Randomized Studies of Interventions tool for observational studies.

Ten studies, including a total of 639 men, met the inclusion criteria. GLP1-RAs showed a consistent association with increased total testosterone, particularly in men with obesity, type 2 diabetes, or functional hypogonadism.

Changes in free testosterone were inconsistent and often offset by concurrent increases in sex hormone-binding globulin. Furthermore, GLP1-RA use led to preserved or increased levels of luteinizing hormone and follicle-stimulating hormone, as opposed to the suppression seen in testosterone therapy comparator groups.

Notably, hypogonadal men or those with obesity were found to show improvements in semen parameters, but no significant changes were noted in healthy individuals.

“[GLP-1RAs] could serve as fertility-sparing alternatives to testosterone therapy in some obesity-related hypogonadism cases,” the investigators said. “More long-term, controlled studies with standardized fertility measures are needed to confirm their role in male reproductive health.”