Effect of GLP-1 agonists on testosterone levels: a systematic review and meta-analysis.
Level 3 - non-randomized controlled study
Systematic review and meta-analysis combining RCTs, cohort studies, and retrospective pre-post analyses rather than exclusively randomized trials.
PubMed 41291666 · doi:10.1186/s12894-025-02005-0
What was done
A systematic review and meta-analysis searched Embase, PubMed, Scopus, Cochrane, and Google Scholar through December 2024. Eligible studies included randomized controlled trials, cohort studies, and retrospective analyses comparing hormone and glycemic levels before and after GLP-1 receptor agonist (GLP-1 RA) administration. Evaluated outcomes included total, free, and bioavailable testosterone, sex hormone-binding globulin (SHBG), and HbA1c.
What was found
Four studies comprising 219 patients pre-treatment and 216 post-treatment were included. GLP-1 RA use was significantly associated with: - Increased bioavailable testosterone: MD -57.18 (95% CI -87.60 to -26.76; p < 0.001; I² = 86%). - Decreased HbA1c: MD 0.79 (95% CI 0.58 to 1.00; p < 0.001; I² = 0%). - Free testosterone showed no significant change: MD -1.62 (p = 0.051). - SHBG showed no significant change: MD -6.62 (p = 0.120). Total testosterone numerical values were not reported in the abstract.
Why it matters
This review synthesizes early data suggesting GLP-1 agonists may improve bioavailable testosterone alongside glycemic control, identifying a potential endocrine effect that warrants targeted trials.
Limits
The total sample size is very small (4 studies, ~216-219 patients). The meta-analysis pooled observational and retrospective designs with RCTs using pre-to-post comparisons rather than placebo-controlled contrasts. Heterogeneity was high for bioavailable testosterone (I² = 86%), and patient sex, specific GLP-1 agents, and total testosterone metrics were not detailed in the abstract.
Cited by
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