FUMPA Mulusa 1,2 , HOU DongSheng 1,2 , SONG XiaoHai 1,2 , DU Qiang 1,2 , WAN QianYi 1,2 , ZHAO Rui 1,2 , ZHANG GuiXiang 1 , CHEN Yi 1,2
  • 1. Division of Gastrointestinal Surgery, Department of General Surgery, West China Hospital, Sichuan University, Chengdu 610041, P. R. China;
  • 2. West China School of Clinical Medicine, Sichuan University, Chengdu 610041, P. R. China;
CHEN Yi, Email: toddy@scu.edu.cn
obesity; bariatric surgery; glucagon-like peptide 1 receptor agonists; sexual function; testosterone; sex hormone-binding globulin
10.7507/1007-9424.202506030
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Objective To systematically evaluate the effects of weight-loss interventions on hormone levels and sexual function in patients with obesity. Methods This review was conducted in accordance with PRISMA guidelines. A systematic search of PubMed, EMBASE, and other databases was performed for studies published within the past decade that investigated the effects of bariatric surgery, glucagon-like peptide 1 (GLP-1)-based medications, and lifestyle interventions on sex hormones and sexual function. Results Bariatric surgery (e.g., sleeve gastrectomy, gastric bypass) demonstrated the most pronounced improvements in hormonal balance and sexual function. In males, total testosterone levels doubled postoperatively, with marked increase in erectile function score. In females with polycystic ovary syndrome, androgen levels were reduced by 50%, with significant amelioration in the female sexual function index. GLP-1 receptor agonists (e.g., semaglutide, liraglutide) partially improved sperm quality and testosterone levels, but were also associated with a higher risk of erectile dysfunction (hazard ratio = 4.5). Lifestyle interventions (e.g., low-calorie diet, exercise) could increase sex hormone-binding globulin levels and improve sexual function score, although their efficacy remained inferior to that of surgery. Conclusions Weight-loss interventions can alleviate hormonal imbalances and sexual dysfunction in obesity, with surgery demonstrating the most significant effects. Pharmacological and lifestyle interventions have shown variable efficacy. Future research should further investigate mechanisms underlying effects of different weight-loss modalities on sexual health.

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