Nothing on the semaglutide label speaks to this. A full-text search of the Ozempic and Wegovy prescribing information finds no occurrence of libido, sexual function or erectile dysfunction. [1][2]
That absence is not a reassurance. It means the trials behind the label did not collect the outcome, so the evidence has had to come from elsewhere.
What the label does record is set out in semaglutide side effects. This page covers the outcome it leaves out, and the evidence points two ways at once.
In men, the measured effects run favorable
The strongest evidence concerns testosterone, and it is consistent. A 2025 systematic review pooled seven studies covering 680 men on this drug class [3].
Total testosterone rose, with a standardized mean difference of 1.39 ng/mL (95% CI 0.70 to 2.09, p<0.0001). Free testosterone, sex hormone-binding globulin, LH and FSH rose too, while weight, BMI and HbA1c fell.
The authors are careful about what that means. Meta-regression tied the testosterone gain to the amount of weight lost, and they state the literature cannot demonstrate a direct action on testicular function.
A second 2026 meta-analysis, of seven studies in 237 men, measured erectile function directly [4]. Scores improved by a mean difference of 2.73 (95% CI 1.64 to 3.83), with total testosterone up as well.
| Study type | Size | Result | Direction |
|---|---|---|---|
| Testosterone meta-analysis, 2025 | 7 studies, 680 men | Total testosterone SMD 1.39 ng/mL | Favorable |
| Erectile function meta-analysis, 2026 | 7 studies, 237 men | ED score MD 2.73 (95% CI 1.64–3.83) | Favorable |
| Records study, 2026 | 4,910 vs 5,524 men | HR 1.26 (95% CI 1.08–1.46), lost after calibration | Unfavorable, then null |
| Adverse event reports, 2025 | 182 cases | ROR 0.41 (95% CI 0.36–0.48) | Reported less than expected |
The study that points the other way
A 2026 analysis emulated a trial inside a health system's records, comparing 4,910 men who started a GLP-1 drug with 5,524 who started a different diabetes drug [5].
Erectile dysfunction was diagnosed at 35.2 per 1,000 person-years in the GLP-1 group against 28.0, giving a hazard ratio of 1.26 (95% CI 1.08 to 1.46).
Then the authors did something that deserves attention. They calibrated the result against negative control outcomes, and the association was attenuated and no longer statistically significant.
Their own interpretation is that the findings may reflect residual or selection bias and do not establish causation. A man who starts a weight-loss drug is also a man seeing a doctor more often.
In women, there is almost nothing
A 2026 review in a sexual medicine journal set out to synthesize this literature and found the same imbalance[7].
GLP-1 drugs show promising results in men on erectile function, testosterone and sperm parameters, it reports, while direct evidence in women remains limited.
It also names the structural reason. Across every weight-loss drug class, sexual endpoints were typically secondary outcomes rather than something a trial was designed to measure.
What exists in women is individual reports. One 2025 case describes a 36-year-old woman whose sexual function index fell to 12.7 on tirzepatide, recovered to 28.7 after stopping, and fell again to 14.7 on restarting[8].
A single case with that pattern is suggestive and cannot be generalized. Another report describes anorgasmia beginning after a GLP-1 drug was started [9].
How to read the two directions together
The favorable findings and the unfavorable ones are measuring different things, which is why they can both be true.
The meta-analyses measure hormones and erectile function in men losing weight, where the benefit of the weight loss itself is doing much of the work.
The records study and the case reports measure diagnoses and complaints, which capture things a questionnaire about erections does not: desire, arousal and orgasm.
A 2026 review makes that gap explicit. Testosterone replacement performed better than this drug class on the orgasm and sexual satisfaction domains, even where erectile function improved [10].
What to raise with a prescriber
Timing is the useful detail to bring. Whether a change began with the first dose, with a step up, or after substantial weight loss points in different directions.
Testosterone is worth checking in men, since the measured effect there is real and the drug can change it.
Other explanations deserve ruling out too, including sleep, mood, alcohol and other medications. What happens on stopping is covered in what happens when you stop taking semaglutide.
For the peptides studied against low desire itself, see PT 141 for men and the sexual health hub. To compare prescribers by monthly cost, see the compounded semaglutide rankings.