Intimacy and GLP-1 Medication
The New York Times recently published an article about how a GLP-1 (e.g. Ozempic) impacted a couple’s marriage. The piece told the story of Jeanne and Javier, whose names have been changed, and how Zepbound upended their life. Jeanne started taking Zepbound, resulting in her losing 60lbs, stemming from a change in her appetite. However, that wasn’t the only change. Her outlook on the world shifted as she navigated the world in a skinny body and noticed how differently the world responded to her. Furthermore, their marriage shifted greatly, as their sex-life changed. Notably, they also stopped having sex as soon as Jeanne started taking Zepbound...
There have been some studies addressing the impacts of GLP-1s on sexuality. The article noted findings showing a decrease in libido and others noted the opposite effect. In this blog, I offer my opinion on why we’re seeing such mixed results. Let’s start why GLP-1s may inhibit sex drive. The desire to eat and to have sex are both regulated, in part, in the part of our brain that is responsible for rewards and motivation. Simply put, if we do something that feels good, like eating or being intimate, our brain releases feel-good chemicals and we want more. While I am not a neuroscientist, I am guessing that the reduction in appetite while using GLP-1’s may be due to dampening the rewards and motivation system. This could help folks to have less of an appetite. But, theoretically, if that were true, the result would be a dampening of sexual desire. For many relationships, the sex that folks are having is “good enough” and frankly, that is really an appropriate goal for many couples. However, when sex drive is suddenly impacted, for instance, when starting a GLP-1, the sex that couples are having may no longer be good enough, causing a disconnect in the rewards system and a drop off in sex. In theory, if GLP-1 medications are impacting the rewards and motivation system, it would have implications for substance use treatment as well.
However, we still have to account for the improvement in some people’s sex life. There seem to be various straight-forward explanations, in my opinion. Let’s start with biology. First of all, GLP-1s help folks lose weight and improve their health. One substantial contributor to sexual dysfunction is poor cardiac health. For men, cardiac problems and erectile dysfunction are (ahem) hand in hand because cardiac problems create blood flow issues and erections are the direct result of blood flow. While this is an arousal problem, poor cardiac health can also impact women’s sexuality creating not only decreased arousal, but also decreased desire for sex. When cardiac health improves, so can desire. Furthermore, it makes sense to me that if people are losing weight and generally feeling better, they may have more energy, resulting in a new willingness and interest in sex. I’ve heard arguments that losing weight can improve one’s hormones. While I can’t rule out that argument, my understanding of how hormones regulate sexuality is that the picture is far more complicated, and I personally do not endorse that theory at this time.
Another way that I could foresee GLP-1s improving sex life is through a better body image in folks who lose weight. Our partners can tell us we’re good-looking and desirable, but at the end of the day, our body image is modulated only by the person in the body. And feeling better naked, impacts sex and sexuality.
I anticipate that in years to come, we will learn much more about how GLP-1s impact sex and sexuality. In the meantime, please know that sex is complicated and taking GLP-1s may or may not change your sex life. Furthermore, how your sexlife may change when you start taking GLP-1s isn’t truly knowable. The best we can do is to weigh the pros and cons in each situation and accept the tradeoffs we make.
