Effects of glucagon-like peptide-1 receptor agonists on male reproductive hormones, semen parameters, and metabolic outcomes: a systematic review.
Level 2 - randomized trial
Systematic review including both randomized controlled trials and observational cohort studies.
PubMed 41498523 · doi:10.1093/jsxmed/qdaf381
What was done
A systematic review following PRISMA guidelines was conducted across PubMed, Embase, Scopus, and Web of Science up to April 2025. Eligible studies were randomized controlled trials (RCTs) and cohort studies evaluating the effects of GLP-1 receptor agonists (liraglutide, semaglutide, dulaglutide, exenatide) on male reproductive hormones, semen parameters, and metabolic outcomes in adult men. Risk of bias was evaluated using RoB 2 for RCTs and ROBINS-I for observational studies.
What was found
Ten studies totaling 639 men were included. GLP-1RA therapy was consistently associated with increases in total testosterone, especially in men with obesity, type 2 diabetes, or functional hypogonadism. Free testosterone changes were inconsistent due to concurrent increases in sex hormone-binding globulin. Luteinizing hormone and follicle-stimulating hormone levels were preserved or elevated, avoiding the gonadotropin suppression seen with testosterone therapy. Improvements in semen parameters occurred in obese or hypogonadal men, with no significant changes in healthy individuals. The abstract reported no specific numerical values, effect sizes, or confidence intervals.
Why it matters
GLP-1RAs may support testosterone recovery in obesity-related functional hypogonadism while preserving gonadotropin secretion and spermatogenesis, potentially serving as a fertility-sparing alternative to exogenous testosterone therapy.
Limits
The abstract provides no quantitative effect sizes, variance measures, or p-values. The evidence base is small (10 studies, 639 total men) and combines RCTs with observational cohorts. Long-term fertility outcomes, live birth rates, and standardized reproductive endpoints were not reported.
Cited by
- supports Men taking GLP-1 receptor agonists experience improvements in testosterone levels.