Can weight loss medications improve erectile dysfunction (ED)?

Erectile dysfunction (ED) is common in men with elevated weight. There are many reasons for this, including (note this is not an exhaustive list):

central hypogonadism – when the pituitary gland in the brain has weakened signaling to the testicles, resulting in lower testosterone production (more on this blogged previously)
(endothelial) dysfunction in the blood vessels of the penis, due to increased systemic inflammation and oxidative stress
elevated blood sugars in people with diabetes
damage to nerves and/or blood vessels serving the penis from longstanding diabetes/metabolic disease/hypertension
sleep apnea causing disruption in circadian rhythm of hormones, and poor sleep leading to fatigue
psychological issues: concomitant depression, anxiety; body image concerns; spousal relationships
side effect of medications used to treat other health issues (eg beta blockers for heart disease or hypertension)

While there is some controversy on this topic, overall, weight loss in men with obesity favors improvement in ED (with these data being with lifestyle change or bariatric surgery – I’ll circle back to this below).

Today’s question is: Can treatment with weight loss medications improve ED?

There are very little clinical trial data to answer this question. A recent presentation at the 2025 ENDO Society meeting described a study of 83 men with obesity and ED, who were allocated, based on their preferences (not randomized) to receive either tirzepatide (Zepbound/Mounjaro), transdermal testosterone (applied through the skin), or no medical treatment for 2 months, in addition to healthy lifestyle changes. They found that men in the tirzepatide group had a significantly greater improvement in ED than the placebo group, and a numerically (though not statitically significant) improvement in ED vs the testosterone treated group. Testosterone levels were significantly higher with tirzepatide than the other two groups, and weight loss was greater with tirzepatide than the other two groups. (note that this trial is way too short to evaluate the full potential benefit of tirzepatide)

As blogged previously, the diabetes GLP1 medication dulaglutide (Trulicity) has shown some benefit to preserve erectile function in men with type 2 diabetes.

There are a whole bunch of ways by which weight management medication could improve ED – including improving testosterone production with weight loss, a possible beneficial effect on the brain (hypothalamic-pituitary) function controlling testosterone production, and possibly by reducing inflammation in blood vessels. Improvement in blood sugars in people with diabetes, and improvement of sleep apnea with weight loss, may also contribute. Benefits to overall metabolic health may further support vascular (blood vessel) health in the penis. For some men losing weight by any treatment modality, psychological aspects of ED (for example, changes in perception of body image, spousal relationships) may improve, not change, or deteriorate, which can impact the ED journey as well.

That there is controversy on whether weight loss in general improves ED likely reflects that the relationship with ED and obesity is complex (as per the list of potential contributors above). For example, for some men, the factors contributing to ED may not be reversible (eg nerve damage), or contributing medications may not be modifiable. The relationship of weight loss with mental health is complex, and psychological factors contributing to ED may change in any direction with weight loss. While I have certainly seen many men in my practice whose ED has improved with weight loss, this has not been the case for others. The degree of weight loss may be important as well – while ED improvement with lifestyle-induced weight loss seems to be more modest, studies of bariatric surgery (where much more weight is lost) seem to show a more clear benefit.

BOTTOM LINE: The causes and contributors to erectile dysfunction (ED) in men with obesity may be complex, and are unique to each individual. There is potential for weight management medication to improve erectile dysfunction (ED) in men with obesity, and there is a pressing need for clinical trial data to give us more definitive answers to this important question.

Disclaimer: I am/have been involved in clinical trials of tirzepatide and dulaglutide. I am a medical education speaker and consultant from the makers of tirzepatide and dulaglutide (Eli Lilly).

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