GLP-1s: Should You Be Prescribing Them? The Great Debate from the 27th Annual SMSNA Fall Scientific Meeting

Amy Pearlman, MD

On Thursday, October 8, at the 27th Annual SMSNA Fall Scientific Meeting, Drs. Amy Pearlman and Kevin Chu engaged in a lively debate about whether sexual health professionals should prescribe GLP-1 medications.

Dr. Pearlman argued that sexual health professionals should prescribe GLP-1s. She cited a systematic review of 10 studies showing that GLP-1s may improve erectile dysfunction (ED), likely indirectly through weight loss. Dr. Pearlman also presented a case in which fertility improved with GLP-1 use. Other data showed that men with diabetes who were taking semaglutide experienced improvements in ED, while the same was not observed in men without diabetes. Maintaining a healthy weight and muscle mass can contribute to overall sexual health and vitality. Dr. Pearlman pointed out that many of the necessary procedures are already in place and may simply need to be adapted. She asked Dr. Chu: If sexual health professionals already prescribe treatments for conditions associated with metabolic disease, why shouldn't they treat metabolic disease itself?

Dr. Chu argued that sexual health professionals should not prescribe GLP-1s. He explained that ED is often the "canary in the coal mine" for other health concerns. However, most sexual medicine professionals do not directly manage conditions such as hypertension or cardiovascular disease. Dr. Chu noted that the same studies Dr. Pearlman cited could also support his argument, as the evidence remains inconclusive about whether GLP-1s improve ED or fertility. He also raised concerns about adverse events that may be beyond a sexual health professional's scope of practice, potentially creating additional burdens for both providers and patients. Instead, he recommended a multidisciplinary approach in which specialists work together to manage ED, ejaculatory disorders, and underlying metabolic conditions.

Should GLP-1 prescribing become part of sexual medicine practice, or is it best left to other specialists?

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