(040) Can Glucagon-Like Peptide-1 Receptor Agonists Be Used in Men with Type 2 Diabetes Mellitus or Obesity Who Complain of Erectile Dysfunction? A Systematic Review and Meta-Analysis

Introduction Erectile dysfunction (ED) is common in men with type 2 diabetes mellitus (T2DM) and obesity, largely due to insulin resistance, inflammation, and endothelial impairment. Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) improve glycemic control, promote weight loss, and enhance cardiometabolic health, and may also influence hormonal and vascular pathways involved in erectile function. However, their impact on sexual health outcomes in this population remains uncertain. Objective To evaluate the effects of GLP-1 RAs on erectile function and androgen profile in men with T2DM or obesity presenting with ED, assessing outcomes related to International Index of Erectile Function (IIEF) scores, total testosterone (TT), free testosterone (FT), and sex hormone-binding globulin (SHBG). Methods A systematic search was conducted in PubMed, Embase, Cochrane Library, and Web of Science from inception to July 2025. We included randomized controlled trials (RCTs) and observational studies involving adult men with T2DM or obesity treated with GLP-1 RAs, reporting at least one of the prespecified outcomes. A random-effects meta-analysis was conducted to calculate pooled standardized mean differences (SMD) and 95% confidence intervals (CI). Heterogeneity was assessed using the I2 statistic. Results Six studies (n=470 participants) met inclusion criteria. Treatment with GLP-1 RAs was associated with a statistically significant improvement in erectile function, by an increase in IIEF score (SMD 1.28; 95% CI 0.39, 2.18; p<0.01). TT levels increased modestly but significantly (SMD 0.81; 95% CI 0.17, 1.45; p=0.01), while FT demonstrated a trend toward GLP-1 RAs, but it was not significant (SMD 0.37; 95% CI -0.19, 0.93; p=0.2). Similarly, SHBG levels showed no statistically significant change (SMD 1.78; 95% CI -0.10, 3.65; p=0.06). Heterogeneity was substantial across analyses, largely attributable to variations in controls, follow-up duration and baseline metabolic severity. The methodological quality assessment of the included studies was mostly considered fair by the Newcastle-Ottawa Scale. Conclusions GLP-1 RAs may improve erectile function and modestly enhance androgen levels in men with T2DM or obesity experiencing ED. These findings suggest that the metabolic and vascular benefits of GLP-1 RAs may extend to sexual health, offering a therapeutic option that addresses both systemic disease and quality-of-life concerns. Further RCTs are needed to determine optimal treatment regimens and to clarify mechanisms of improvement. Disclosure No