(051) DEGREE OF WEIGHT LOSS IS ASSOCIATED WITH NEW ERECTILE DYSFUNCTION AFTER GLUCAGON-LIKE PEPTIDE-1 (GLP-1) RECEPTOR AGONIST MEDICATION PRESCRIPTION
Authors: Roth B , Ljubetic B , Bajic P , Bole R 
Published: December 2024

Abstract

Introduction
Glucagon-like peptide receptor agonists (GLP-1ra) such as semaglutide are utilized as an adjunctive to metformin in the treatment of type 2 diabetes when concomitant atherosclerotic disease is present. GLP-1ra’s are also commonly used off-label as a weight loss medication for those with obesity. These drugs have seen an exponential increase in use in recent years. Data on the sexual impact of these medications is limited; however, a recent database study demonstrated an increased relative risk of new-onset erectile dysfunction (ED) in nondiabetic obese patients compared to a matched cohort who had not been treated with GLP-1ra’s. It remains unknown what factors may predict the development of ED after starting these medications.

Objective
To determine which factors may be associated with a new diagnosis of erectile dysfunction in nondiabetic patients after starting a GLP-1ra.

Methods
We retrospectively reviewed nondiabetic male patients seen at a large, tertiary care center who had been started on GLP-1ra medications for the indication of being overweight or obese from 2019-2024. We compared those who were on the medication for at least one year with subsequent new diagnosis of erectile dysfunction to a cohort matched for prescription length without diagnosis of ED. Patients were excluded if they had any prior diagnosis of erectile dysfunction or had not been on the medication for at least 1 year. Age, BMI at GLP-1ra start, change in BMI%, and history of hypertension (HTN), hyperlipidemia (HLD), coronary artery disease (CAD), and testosterone deficiency were compared between groups. Multivariable logistic regression for independent prediction of new onset ED was also performed with age, change in BMI%, and history of HTN or HLD as covariates.

Results
4037 patients met inclusion criteria. A total of 50 patients (1.24%) developed new-onset ED during the study period while 3987 (98.76%) had no new diagnosis of ED. Those who developed ED were older (58.78 (±11.52) vs 53.95 (±13.71), p = 0.005) when compared to the non-ED cohort on unadjusted analysis. Patients were relatively matched on baseline comorbidities, although HTN occurred more frequently in the ED group (74% vs 52.1%, p = 0.002) (Table 1). On multivariable analysis, change in BMI % was independently associated with new onset ED (aOR 1.027, 95%CI 1.0268– 1.0272, p &lt; 0.0001), signifying that less drop in BMI had higher odds of new onset ED (Table 2). When controlling for age and history of HTN or HLD, initial BMI was not associated with new onset ED (Table 3).

Conclusions
Older patients and those with a history of HTN may be at higher risk of new-onset ED when starting on GLP-1ra’s for weight loss. Those who experience less weight loss when starting these medications may be at risk for new onset ED irrespective of age, underlying comorbidities, or initial BMI. Further studies are needed to validate these results in a prospective multicentric setting.

Disclosure
Any of the authors act as a consultant, employee or shareholder of an industry for: Coloplast Corporation; Boston Scientific.