(157) Prescribing Ozempic and Wegovy for Weight Loss is Associated with an Increased Risk of Erectile Dysfunction and Hypogonadism in Non-Diabetic Males
Authors: Liao B , Able C , Sonstein J , Kohn T 
Published: February 2024

Abstract

Introduction
The use of antidiabetic medications, such as metformin or sulfonylureas, can have diverse effects on sex hormones, potentially influencing erectile function. While both Ozempic and Wegovy (semaglutide) include sexual dysfunction as a side effect of the medication, no study has assessed how frequently men will experience sexual dysfunction with these medications. Recently, semaglutide was approved in June of 2021 for weight loss in non-diabetic patients and has exploded in popularity.

Objective
Our objective is to assess the risk of developing ED in non-diabetic males after starting semaglutide using a large claims-based database.

Methods
We queried the TriNetX Research database, a comprehensive insurance claims database. Our study cohort included males aged 18 to 50 who have been prescribed semaglutide after June 1st, 2021. We excluded individuals with a history of pelvic radiation, prostatectomy, pulmonary hypertension, diabetes mellitus, or any hemoglobin A1c measurement ≥7%. Propensity-matching was performed between the cohorts for age, ethnicity, race, BMI, hypertension, sleep apnea, and hyperlipidemia. Our primary outcome was comparing the proportion of men that received an ED diagnosis and/or prescription for phosphodiesterase-5 inhibitors (PDE5i) from one day to any time after the index prescription of semaglutide. The secondary outcome of interest included the risk of developing testosterone deficiency. Risk was reported using relative risk (RR) with 95% confidence intervals (CI). Statistical significance was set using a two-sided alpha at 0.05.

Results
We found 2,117 non-diabetic males with a prescription of semaglutide, which were compared to an equivalent number of propensity matched controls (Table 1). Compared to matched controls, males with a semaglutide prescription were significantly more likely to be diagnosed with ED and/or prescribed PDE5i (1.4%) when compared to control males who were never prescribed semaglutide (0.14%) (RR: 10.0, 95% CI [3.05 – 32.82]). Similarly, males with a prescription for semaglutide were more likely to receive a subsequent diagnose of testosterone deficiency (3.83%) compared to controls (1.7%), (RR: 2.25, 95% CI [1.53 – 3.32]) from one day to any time after the index prescription.

Conclusions
In this claims-based analysis, we found that non-diabetic males with a prescription of semaglutide have a significantly higher risk of developing ED and testosterone deficiency. Rates of erectile dysfunction in men prescribed semaglutide are overall low at 1.4% but, we were surprised that these rates were so much higher than those not receiving semaglutide as we expected that weight loss drugs would improve erectile function. Further studies are needed to assess the impact of semaglutide in non-diabetic men to assess how this drug impacts the male hypothalamic-pituitary-gonadal axis. Despite its increasing popularity for weight loss, both clinicians and patients should be aware of potential hormonal effects when discussing and considering the medication.

Disclosure
No.