Does Semaglutide Increase Testosterone? What the Evidence Shows

Does semaglutide increase testosterone? Studies mostly show modest increases in men with obesity or type 2 diabetes, especially those starting with low testosterone, and those increases track weight loss. In healthy men with normal testosterone, a placebo-controlled trial of a GLP-1 drug found no significant change. Most of the evidence is small or observational, and one database study points the other way. Which group you belong to matters more than any headline.

Key takeaways

• In men with obesity, type 2 diabetes or functional hypogonadism, GLP-1 drugs such as semaglutide are consistently linked to higher total testosterone, but free testosterone changes are inconsistent (Journal of Sexual Medicine, 2026).
• In healthy men with normal testosterone, a placebo-controlled trial of a GLP-1 drug found no significant hormonal or reproductive effect (Cells, 2026).
• The closest head-to-head evidence is a 25-man open-label randomized trial that compared semaglutide with testosterone therapy, not with placebo (Diabetes, Obesity and Metabolism, 2024).
• A database study in non-diabetic men aged 18 to 50 found more low-testosterone diagnoses after semaglutide, an association that cannot show cause (International Journal of Impotence Research, 2024).
• If you are on TRT and start a GLP-1, your levels may shift, and monitoring and any changes are your clinician's decision.

Does semaglutide increase testosterone? It depends on which men

GLP-1 drugs, including semaglutide, are linked to modest testosterone increases in men whose low testosterone is driven by excess weight or diabetes, while a placebo-controlled GLP-1 trial in healthy men with normal levels found no clear change. The "boosts T" and "lowers T" headlines come from different men and different study designs, so each can be accurate within its limits.

Semaglutide is a GLP-1 (glucagon-like peptide-1) receptor agonist, a drug that mimics a gut hormone involved in appetite and blood sugar. It is the active ingredient in Ozempic and Wegovy. Here is how the main studies on semaglutide and related GLP-1 drugs compare, with randomized trials first and observational studies after.

Sources for each row: the trial (Diabetes, Obesity and Metabolism, 2024), the placebo-controlled GLP-1 trial as described in a systematic review (Cells, 2026), the cohort (Endocrine Society, 2025) and the database study (International Journal of Impotence Research, 2024).

Is it the drug or the weight loss?

The best current reading is that weight loss and metabolic improvement do most of the work. A 2025 meta-analysis found testosterone rises tracked weight loss and concluded that current data cannot settle whether GLP-1 drugs act directly on the testes (Andrology, 2025).

Start with why excess weight lowers testosterone. Fat tissue contains aromatase, an enzyme that converts testosterone into estradiol, a form of estrogen. More estradiol suppresses gonadotropins, the pituitary hormones LH (luteinizing hormone) and FSH (follicle-stimulating hormone) that signal the testes to make testosterone and sperm. The result is functional hypogonadism: low testosterone caused by a suppressed signal, not by damaged testes (Andrology, 2025). A systematic review notes this pattern is highly prevalent in men with obesity and type 2 diabetes (Cells, 2026). For how low testosterone is diagnosed in the first place, see our guide to low testosterone symptoms and testing.

The meta-analysis found a strong association between weight loss and higher total and free testosterone. It also noted that continuous intravenous GLP-1 in healthy young men did not change total testosterone, which fits the idea that weight, not the drug alone, drives the change (Andrology, 2025).

Total and free testosterone can also move differently. SHBG (sex hormone-binding globulin) is a blood protein that binds testosterone. Total testosterone counts both bound and unbound hormone. Free testosterone is the small unbound fraction that tissues can use. SHBG tends to run low in obesity and can rise as weight falls, so total testosterone may climb while free testosterone stays flat. A systematic review of 10 studies covering 639 men found consistent rises in total testosterone but inconsistent free testosterone changes, often offset by rising SHBG (Journal of Sexual Medicine, 2026). A total testosterone result on its own can overstate how much has changed.

Semaglutide vs TRT: what the randomized trial found

In a small open-label randomized trial, semaglutide and testosterone replacement therapy (TRT) both raised total testosterone in men with type 2 diabetes, obesity and functional hypogonadism. Erectile function scores improved only with TRT (Diabetes, Obesity and Metabolism, 2024).

The design: 25 men, median age 50, with a body mass index around 36, randomly assigned to semaglutide or injectable testosterone undecanoate. Open-label means participants and researchers knew who received which treatment.

The findings:

• Total testosterone rose in both groups.
• Scores on the AMS (Aging Males' Symptoms scale, a questionnaire on physical, psychological and sexual symptoms) improved in both groups.
• Scores on the IIEF-15 (International Index of Erectile Function, a 15-item questionnaire) improved significantly only in the TRT group.

The limits matter as much as the results. The trial was very small. It was open-label, which can influence questionnaire scores. It had no placebo arm, so it cannot separate a direct drug effect from the effect of weight loss. It enrolled only men with type 2 diabetes. It does not show that semaglutide treats hypogonadism or can replace TRT, and no FDA-approved semaglutide product is indicated for low testosterone. It also does not address compounded semaglutide specifically.

Does semaglutide affect sperm quality?

In the same trial, the share of normally shaped sperm rose with semaglutide, while sperm concentration and total count fell with TRT. That is an early signal from one small study, not evidence that semaglutide treats infertility.

Baseline sperm quality was poor, below the 5th percentile of reference values. In the semaglutide group, morphologically normal sperm rose from 2% to 4% (p = 0.012). In the TRT group, sperm concentration and total number dropped significantly. Compared with TRT, the semaglutide group ended with significantly higher normal morphology, concentration and total count (Diabetes, Obesity and Metabolism, 2024).

A broader review found LH and FSH were preserved or increased with GLP-1 drugs, compared with suppression in testosterone therapy comparator groups (Journal of Sexual Medicine, 2026). That difference is a plausible explanation for the sperm pattern, though the studies did not prove it: outside testosterone tells the brain to cut LH and FSH, which the testes need to make sperm. Our explainer on how TRT affects fertility covers this in detail. Reviewers say larger prospective studies are needed before drawing firm conclusions (Cells, 2026).

Can semaglutide lower testosterone? What the observational studies show

One database study linked semaglutide to more low-testosterone diagnoses in younger non-diabetic men, while a conference cohort of men with obesity or diabetes found more men reaching normal levels. Both are observational, so neither proves the drug caused the change.

The ENDO 2025 cohort, presented at the Endocrine Society's annual meeting, reviewed health records of 110 men with obesity or type 2 diabetes taking semaglutide, dulaglutide or tirzepatide. None were on testosterone or hormonal therapy. Total and free testosterone were measured before and during treatment over 18 months. Alongside about 10% weight loss, the share of men with normal total and free testosterone rose from 53% to 77%. The investigator noted that weight loss from lifestyle change or bariatric surgery is already known to raise testosterone (Endocrine Society, 2025). The weaknesses: no comparison group, three different drugs pooled, and a conference presentation, which gets less scrutiny than a peer-reviewed journal paper.

The TriNetX study pulled health-record and claims data on 3,094 non-diabetic men aged 18 to 50 with a BMI over 30 who were prescribed semaglutide, matched to an equal number who were not. It excluded men with prior erectile dysfunction, prior testosterone deficiency or a testosterone prescription, and diabetes (International Journal of Impotence Research, 2024).

• New testosterone deficiency diagnoses: 1.53% vs 0.80%, a relative risk of 1.9. Relative risk compares the rate in one group with the other.
• New erectile dysfunction diagnosis or a PDE5 inhibitor prescription (the erectile dysfunction pill class): 1.47% vs 0.32%, a relative risk of 4.5.

Read those numbers carefully. They are absolute rates in each group, and they are low in both. The 1.47% figure is how many men in the semaglutide group had the outcome, not a "1.47% higher risk." Outcomes were diagnosis codes, not measured hormone levels. Men starting a new prescription may also be seen and tested more often, which can inflate diagnoses. And this was a younger, non-diabetic group, unlike the men with metabolically driven low testosterone in the trials.

Already on TRT and starting a GLP-1?

Your testosterone results may shift as weight comes off, so lab monitoring and any change to your TRT are decisions for the clinician managing it. Do not adjust or stop testosterone on your own.

Most of the studies above either excluded men on testosterone therapy or compared the two treatments, so direct evidence on using both is thin. What is known is that weight loss can change SHBG and how testosterone is carried in the blood. Questions worth raising with your prescriber:

1. Should my labs be rechecked after I start a GLP-1, and which values will you look at?
2. If different clinicians prescribe each medication, how will they share results?
3. If fertility matters to me, does my current plan account for that?
4. What changes in how I feel should prompt me to contact you?

Our guide to TRT blood work and monitoring explains what these labs usually include.

Who shouldn't use semaglutide

People with a personal or family history of medullary thyroid carcinoma (MTC) or multiple endocrine neoplasia type 2 (MEN 2), or a history of pancreatitis, should not use these medications, and a licensed clinician screens for this.

The FDA-approved Wegovy label carries a boxed warning because semaglutide caused thyroid C-cell tumors in rodents at clinically relevant exposures. Whether it causes them in humans, including MTC, is unknown. The label lists a personal or family history of MTC, MEN 2 (an inherited condition that raises the risk of certain endocrine tumors) and known hypersensitivity to semaglutide as contraindications. Acute pancreatitis is a labeled warning and has been observed in people treated with GLP-1 receptor agonists (FDA Wegovy label, 2026). Our GLP-1 eligibility checklist covers the rest of what screening involves.

How access works through New Blue

New Blue is a technology and administrative services platform. Medical services are provided by independent licensed clinicians; medications are dispensed only if prescribed. The semaglutide pathway is not a testosterone or fertility product.

1. You complete an asynchronous intake covering your health history, medications and screening questions.
2. A licensed clinician reviews it. Some treatments or states may require a live visit.
3. If prescribed, a licensed partner pharmacy ships the medication directly to you.

Not everyone qualifies. Eligibility depends on your intake and clinical review, and that's how it should work. Compounded semaglutide has the same active ingredient as Ozempic and Wegovy, which are FDA-approved brand products. Compounded medications are not FDA-approved. They are prepared by state-licensed 503A compounding pharmacies or FDA-registered 503B outsourcing facilities. This research does not address compounded semaglutide specifically.

Availability varies by state. The Semaglutide GLP-1 pathway ships to every state New Blue Health serves except North Dakota; check state availability. For current pricing, see the Semaglutide GLP-1 pathway. New Blue's testosterone pathways are separate and synchronous, requiring a live clinician visit plus lab work. Adults 21 and older only. Not for emergencies.

Frequently Asked Questions

Does Ozempic raise testosterone?

Ozempic is an FDA-approved brand product whose active ingredient is semaglutide. In men with obesity or type 2 diabetes, especially those with low testosterone, studies mostly link GLP-1 drugs like it to modest rises in total testosterone. In healthy men with normal levels, a placebo-controlled trial of a GLP-1 drug found no significant change.

Will semaglutide raise my testosterone?

No one can promise that. The studies looked at specific groups, mostly men with metabolically driven low testosterone, and results varied. Free testosterone did not reliably rise even when total testosterone did.

Can I take semaglutide and TRT together?

That is a decision for your clinician, made with your full history and lab results. Direct research on using both is limited, and testosterone results may shift as weight changes. Monitoring and any adjustments belong to the clinician managing your TRT.

Does semaglutide cause erectile dysfunction?

It has not been shown to cause it, though the database study's authors noted that package inserts list sexual dysfunction. A database study of non-diabetic men aged 18 to 50 found more erectile dysfunction diagnoses or prescriptions after semaglutide (1.47% vs 0.32%), but it was observational and cannot prove cause. In a small randomized trial comparing semaglutide with TRT, erectile function scores improved significantly only in the TRT group.

Should I get my testosterone checked before starting semaglutide?

Ask your clinician. Testing decisions depend on your symptoms, history and goals. If you want to know whether levels change later, a baseline result gives a comparison point, ideally including free testosterone.

Is semaglutide a fertility treatment?

No. One small trial found the share of normally shaped sperm rose with semaglutide in men whose sperm quality started very poor. That early finding needs larger studies, and no FDA-approved semaglutide product is indicated for infertility.

Sources

1. Semaglutide improved sperm morphology in obese men with type 2 diabetes mellitus and functional hypogonadism. Diabetes, Obesity and Metabolism, 2024. https://doi.org/10.1111/dom.16042
2. Anti-obesity medications can normalize testosterone levels in men (ENDO 2025 press release). Endocrine Society, 2025. https://www.endocrine.org/news-and-advocacy/news-room/endo-annual-meeting/endo-2025-press-releases/portillo-canales-press-release
3. Prescribing semaglutide for weight loss in non-diabetic, obese patients is associated with an increased risk of erectile dysfunction: a TriNetX database study. International Journal of Impotence Research, 2024. https://www.nature.com/articles/s41443-024-00895-6
4. Effects of glucagon-like peptide 1 receptor agonists on testicular dysfunction: A systematic review and meta-analysis. Andrology, 2025. https://doi.org/10.1111/andr.70022
5. Effects of glucagon-like peptide-1 receptor agonists on male reproductive hormones, semen parameters, and metabolic outcomes: a systematic review. The Journal of Sexual Medicine, 2026. https://pubmed.ncbi.nlm.nih.gov/41498523/
6. Metabolic Reversal of Functional Hypogonadism? GLP-1 Receptor Agonists and Male Reproductive Endocrinology: A Systematic Review. Cells, 2026. https://pubmed.ncbi.nlm.nih.gov/42587729/
7. WEGOVY (semaglutide) prescribing information. U.S. Food and Drug Administration (Drugs@FDA), 2026. https://www.accessdata.fda.gov/drugsatfda_docs/label/2026/215256s025lbl.pdf

Medical disclaimer: This article is for educational purposes only and is not medical advice. Treatment decisions are made by a licensed clinician based on your individual history and clinical review. New Blue Health is a technology and administrative services platform, not a medical provider.