Effects of weight loss interventions on hormone levels and sexual function_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

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;

Corresponding author：

CHEN Yi, Email: toddy@scu.edu.cn

Keywords：

obesity; bariatric surgery; glucagon-like peptide 1 receptor agonists; sexual function; testosterone; sex hormone-binding globulin

DOI：

10.7507/1007-9424.202506030

Video：

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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) receptor agonists, 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 (with a hazard ratio of approximately 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 bariatric 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.

Citation： FUMPA Mulusa, HOU Dongsheng, SONG Xiaohai, DU Qiang, WAN Qianyi, ZHAO Rui, ZHANG Guixiang, CHEN Yi. Effects of weight loss interventions on hormone levels and sexual function. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2025, 32(9): 1154-1158. doi: 10.7507/1007-9424.202506030 Copy

1.	World Health Organization. Obesity and overweight (fact sheet). WHO, 2021. Accessed May 25, 2025.
2.	Salari N, Hasheminezhad R, Sedighi T, et al. The global prevalence of sexual dysfunction in obese and overweight women: a systematic review and meta-analysis. BMC Womens Health, 2023, 23(1): 375. doi: 10.1186/s12905-023-02544-4.
3.	Molina-Vega M, Asenjo-Plaza M, Banderas-Donaire MJ, et al. Prevalence of and risk factors for erectile dysfunction in young nondiabetic obese men: results from a regional study. Asian J Androl, 2020, 22(4): 372-378.
4.	Bond DS, Wing RR, Vithiananthan S, et al. Significant resolution of female sexual dysfunction after bariatric surgery. Surg Obes Relat Dis, 2011, 7(1): 1-7.
5.	Micic DD, Toplak H, Micic DD, et al. Reproductive outcomes after bariatric surgery in women. Wien Klin Wochenschr, 2022, 134(1-2): 56-62.
6.	Małczak P, Wysocki M, Pisarska-Adamczyk M, et al. Influence of bariatric surgery on erectile dysfunction—a systematic review and meta-analysis. Obes Surg, 2023, 33(6): 1652-1658.
7.	Gregorič N, Šikonja J, Janež A, et al. Semaglutide improved sperm morphology in obese men with type 2 diabetes mellitus and functional hypogonadism. Diabetes Obes Metab, 2025, 27(2): 519-528.
8.	Graybill S, Hatfield J, Kravchenko M, et al. Neutral effect of exenatide on serum testosterone in men with type 2 diabetes mellitus: a prospective cohort. Andrology, 2021, 9(3): 792-800.
9.	Andersen E, Juhl CR, Kjøller ET, et al. Sperm count is increased by diet-induced weight loss and maintained by exercise or GLP-1 analogue treatment: a randomized controlled trial. Hum Reprod, 2022, 37(7): 1414-1422.
10.	Boonchaya-Anant P, Laichuthai N, Suwannasrisuk P, et al. Changes in testosterone levels and sex hormone-binding globulin levels in extremely obese men after bariatric surgery. Int J Endocrinol, 2016, 2016: 1416503. doi: 10.1155/2016/1416503.
11.	Machado MC, da Rosa Soares VR, Mineiro FN, et al. Hormonal and metabolic changes in obese men after bariatric surgery: a prospective study. Obes Surg, 2021, 31(9): 3781-3788.
12.	Jedamzik J, Schierling K, Eickhoff D, et al. Effects of one-anastomosis gastric bypass vs. Roux-en-Y gastric bypass on testosterone and sexual function in male patients: a prospective cohort study. Obes Surg, 2023, 33(2): 476-483.
13.	Fahmy NM, El-Malik EM, Hegazy AM. Erectile function after sleeve gastrectomy compared to laparoscopic Roux-en-Y gastric bypass: a randomized controlled study. Obes Surg, 2021, 31(2): 602-609.
14.	Ruiz-Tovar J, Gonzalez G, Bolaños MD, et al. Changes in sexual functioning in women with severe obesity after bariatric surgery: impact of postoperative adherence to mediterranean diet. Nutrients, 2025, 17(4): 605. doi: 10.3390/nu17040605.
15.	Singh D, Sharma SK, Thakkar RD, et al. Fertility outcomes in women with PCOS after bariatric surgery. Clin Endocrinol (Oxf), 2020, 93(3): 425-432.
16.	Ezzat RS, Abdallah W, Elsayed M, et al. Impact of bariatric surgery on androgen profile and ovarian volume in obese polycystic ovary syndrome patients with infertility. Saudi J Biol Sci, 2021, 28(9): 5048-5052.
17.	Li G, Wang D, Liu Y, et al. Hormonal changes after sleeve gastrectomy in women with PCOS: a retrospective study. Hum Reprod, 2024, 39(2): 328-337.
18.	Uzelli Şimşek A, Türkçüoğlu A, Gökdeniz D, et al. Long-term changes in female sexual function and sex hormones after bariatric surgery. Obes Surg, 2025, 35(3): 1020-1028.
19.	Sarwer DB, Diewald LK, Spitzer JC, et al. Long-term sexual function and psychosocial status in women after bariatric surgery. Fertil Steril, 2018, 110(2): 345-351.
20.	Menezes F, Dantas CM, Machado PM, et al. Sexual function improvements in women after Roux-en-Y gastric bypass: an observational study. Obes Surg, 2021, 31(6): 2552-2558.
21.	Esler WP, Singh B, Sumithran P, et al. Testosterone levels in obese men treated with exenatide or placebo: a double-blind RCT. Clin Endocrinol (Oxf), 2022, 96(6): 831-839.
22.	Gao X, Dai X, Wang X, et al. Impact of bariatric surgery on semen parameters in men with obesity: a prospective study. Hum Reprod, 2024, 39(4): 711-722.
23.	Gao Q, Yuan C, Zhao S, et al. Bariatric surgery and sperm quality: a retrospective cohort study. Surg Obes Relat Dis, 2024, 20(5): 1112-1119.
24.	Samarasinghe SNS, Leca B, Alabdulkader S, et al. Bariatric surgery for spontaneous ovulation in women living with polycystic ovary syndrome: the BAMBINI multicentre, open-label, randomised controlled trial. Lancet, 2024, 403: 2489-2503.
25.	Makhsosi BR, Ghobadi P, Otaghi M, et al. Impact of bariatric surgery on infertility in obese women: a systematic review and meta-analysis. Ann Med Surg (Lond), 2024, 86: 7042-7048.
26.	Al Qurashi AA, Qadri SH, Lund S, et al. The effects of bariatric surgery on male and female fertility: a systematic review and meta-analysis. Ann Med Surg (Lond), 2022, 80: 103881. doi: 10.1016/j.amsu.2022.103881.
27.	Gregorič N, Janež A, Jensterle M. Semaglutide and male reproductive function: a randomized trial in patients with obesity and hypogonadism. Diabetes Obes Metab, 2024, 26(11): 2956-2964.
28.	Able C, Liao B, Saffati G, et al. Prescribing semaglutide for weight loss in non-diabetic, obese patients is associated with an increased risk of erectile dysfunction: a TriNetX database study. Int J Impot Res, 2025, 37(4): 315-319.
29.	Moran LJ, Brinkworth GD, Clifton PM, et al. Effects of weight loss on male reproduction: a randomized controlled trial. Int J Obes (Lond), 2016, 40(5): 978-982.
30.	Giagulli VA, Di Girolamo FG, Altieri B, et al. Degree of weight loss versus glycemic control in restoring testosterone levels in men with obesity and type 2 diabetes. Endocrine, 2020, 68(1): 149-155.
31.	Abdelsamea MM, Ahmed NY, Soliman NL. Effect of weight loss on sexual function of obese women: a randomized controlled trial. BMC Womens Health, 2022, 22: 5. doi: 10.1186/s12905-021-01571-0.
32.	Duggan SN, Perdomo JS, Doherty DA, et al. Exercise and dieting lower free testosterone and improve menstrual regularity in obese women. Clin Endocrinol (Oxf), 2019, 90(2): 157-165.
33.	Hordern MD, Ng D, Dunn S, et al. Exercise intervention improves sexual function in overweight postmenopausal women. J Sex Med, 2016, 13(4): 607-615.
34.	Clark AM, Thornley S, Tomlinson L, et al. Randomized trial of a lifestyle intervention in obese women with polycystic ovary syndrome. Fertil Steril, 2013, 100(2): 462-462.
35.	Syed AH, Chandnani A, Khan A, et al. Association of weight loss with improved sexual function in females. Cureus, 2021, 13(8): e16849. doi: 10.7759/cureus.16849.
36.	Azimi N, Yassaee F, Mehdizadeh G, et al. Ketogenic diet in women with PCOS: effects on anthropometric and reproductive parameters. Horm Metab Res, 2023, 55(3): 212-218.
37.	Chai JX, Zhang QH, Li X, et al. Effects of physical exercise on improving erectile function: a systematic review and meta-analysis of randomized controlled trials. J Mens Health, 2025, 21(2): 11-25.
38.	Brzozowska MM, Bliuc D, Mazur A, et al. Sex-differential testosterone response to long-term weight loss. Int J Obes (Lond), 2024, 48(10): 1481-1488.
39.	Dionisi T, De Vita V, Di Sario G, et al. The implications of metabolic and bariatric surgery on psychosocial and relational health: a narrative review. Obes Surg, 2025 Sep 6. doi: 10.1007/s11695-025-08193-w.
40.	Abdelsamea GA, Amr M, Tolba AMN, et al. Impact of weight loss on sexual and psychological functions and quality of life in females with sexual dysfunction: a forgotten avenue. Front Psychol, 2023, 14: 1090256. doi: 10.3389/fpsyg.2023.1090256.
41.	Li H, Xu W, Wang T, et al. Effect of weight loss on erectile function in men with overweight or obesity: a meta-analysis of randomised controlled trials. Andrologia, 2022, 54(1): e14250. doi: 10.1111/and.14250.
42.	Armamento-Villareal R, Aguirre LE, Qualls C, et al. Effect of lifestyle intervention on the hormonal profile of frail, obese older men. J Nutr Health Aging, 2016, 20(3): 334-340.
43.	Dombrowski SU, Knittle K, Avenell A, et al. Long term maintenance of weight loss with non-surgical interventions in obese adults: systematic review and meta-analyses of randomised controlled trials. BMJ, 2014, 348: g2646. doi: 10.1136/bmj.g2646.

1. World Health Organization. Obesity and overweight (fact sheet). WHO, 2021. Accessed May 25, 2025.
2. Salari N, Hasheminezhad R, Sedighi T, et al. The global prevalence of sexual dysfunction in obese and overweight women: a systematic review and meta-analysis. BMC Womens Health, 2023, 23(1): 375. doi: 10.1186/s12905-023-02544-4.
3. Molina-Vega M, Asenjo-Plaza M, Banderas-Donaire MJ, et al. Prevalence of and risk factors for erectile dysfunction in young nondiabetic obese men: results from a regional study. Asian J Androl, 2020, 22(4): 372-378.
4. Bond DS, Wing RR, Vithiananthan S, et al. Significant resolution of female sexual dysfunction after bariatric surgery. Surg Obes Relat Dis, 2011, 7(1): 1-7.
5. Micic DD, Toplak H, Micic DD, et al. Reproductive outcomes after bariatric surgery in women. Wien Klin Wochenschr, 2022, 134(1-2): 56-62.
6. Małczak P, Wysocki M, Pisarska-Adamczyk M, et al. Influence of bariatric surgery on erectile dysfunction—a systematic review and meta-analysis. Obes Surg, 2023, 33(6): 1652-1658.
7. Gregorič N, Šikonja J, Janež A, et al. Semaglutide improved sperm morphology in obese men with type 2 diabetes mellitus and functional hypogonadism. Diabetes Obes Metab, 2025, 27(2): 519-528.
8. Graybill S, Hatfield J, Kravchenko M, et al. Neutral effect of exenatide on serum testosterone in men with type 2 diabetes mellitus: a prospective cohort. Andrology, 2021, 9(3): 792-800.
9. Andersen E, Juhl CR, Kjøller ET, et al. Sperm count is increased by diet-induced weight loss and maintained by exercise or GLP-1 analogue treatment: a randomized controlled trial. Hum Reprod, 2022, 37(7): 1414-1422.
10. Boonchaya-Anant P, Laichuthai N, Suwannasrisuk P, et al. Changes in testosterone levels and sex hormone-binding globulin levels in extremely obese men after bariatric surgery. Int J Endocrinol, 2016, 2016: 1416503. doi: 10.1155/2016/1416503.
11. Machado MC, da Rosa Soares VR, Mineiro FN, et al. Hormonal and metabolic changes in obese men after bariatric surgery: a prospective study. Obes Surg, 2021, 31(9): 3781-3788.
12. Jedamzik J, Schierling K, Eickhoff D, et al. Effects of one-anastomosis gastric bypass vs. Roux-en-Y gastric bypass on testosterone and sexual function in male patients: a prospective cohort study. Obes Surg, 2023, 33(2): 476-483.
13. Fahmy NM, El-Malik EM, Hegazy AM. Erectile function after sleeve gastrectomy compared to laparoscopic Roux-en-Y gastric bypass: a randomized controlled study. Obes Surg, 2021, 31(2): 602-609.
14. Ruiz-Tovar J, Gonzalez G, Bolaños MD, et al. Changes in sexual functioning in women with severe obesity after bariatric surgery: impact of postoperative adherence to mediterranean diet. Nutrients, 2025, 17(4): 605. doi: 10.3390/nu17040605.
15. Singh D, Sharma SK, Thakkar RD, et al. Fertility outcomes in women with PCOS after bariatric surgery. Clin Endocrinol (Oxf), 2020, 93(3): 425-432.
16. Ezzat RS, Abdallah W, Elsayed M, et al. Impact of bariatric surgery on androgen profile and ovarian volume in obese polycystic ovary syndrome patients with infertility. Saudi J Biol Sci, 2021, 28(9): 5048-5052.
17. Li G, Wang D, Liu Y, et al. Hormonal changes after sleeve gastrectomy in women with PCOS: a retrospective study. Hum Reprod, 2024, 39(2): 328-337.
18. Uzelli Şimşek A, Türkçüoğlu A, Gökdeniz D, et al. Long-term changes in female sexual function and sex hormones after bariatric surgery. Obes Surg, 2025, 35(3): 1020-1028.
19. Sarwer DB, Diewald LK, Spitzer JC, et al. Long-term sexual function and psychosocial status in women after bariatric surgery. Fertil Steril, 2018, 110(2): 345-351.
20. Menezes F, Dantas CM, Machado PM, et al. Sexual function improvements in women after Roux-en-Y gastric bypass: an observational study. Obes Surg, 2021, 31(6): 2552-2558.
21. Esler WP, Singh B, Sumithran P, et al. Testosterone levels in obese men treated with exenatide or placebo: a double-blind RCT. Clin Endocrinol (Oxf), 2022, 96(6): 831-839.
22. Gao X, Dai X, Wang X, et al. Impact of bariatric surgery on semen parameters in men with obesity: a prospective study. Hum Reprod, 2024, 39(4): 711-722.
23. Gao Q, Yuan C, Zhao S, et al. Bariatric surgery and sperm quality: a retrospective cohort study. Surg Obes Relat Dis, 2024, 20(5): 1112-1119.
24. Samarasinghe SNS, Leca B, Alabdulkader S, et al. Bariatric surgery for spontaneous ovulation in women living with polycystic ovary syndrome: the BAMBINI multicentre, open-label, randomised controlled trial. Lancet, 2024, 403: 2489-2503.
25. Makhsosi BR, Ghobadi P, Otaghi M, et al. Impact of bariatric surgery on infertility in obese women: a systematic review and meta-analysis. Ann Med Surg (Lond), 2024, 86: 7042-7048.
26. Al Qurashi AA, Qadri SH, Lund S, et al. The effects of bariatric surgery on male and female fertility: a systematic review and meta-analysis. Ann Med Surg (Lond), 2022, 80: 103881. doi: 10.1016/j.amsu.2022.103881.
27. Gregorič N, Janež A, Jensterle M. Semaglutide and male reproductive function: a randomized trial in patients with obesity and hypogonadism. Diabetes Obes Metab, 2024, 26(11): 2956-2964.
28. Able C, Liao B, Saffati G, et al. Prescribing semaglutide for weight loss in non-diabetic, obese patients is associated with an increased risk of erectile dysfunction: a TriNetX database study. Int J Impot Res, 2025, 37(4): 315-319.
29. Moran LJ, Brinkworth GD, Clifton PM, et al. Effects of weight loss on male reproduction: a randomized controlled trial. Int J Obes (Lond), 2016, 40(5): 978-982.
30. Giagulli VA, Di Girolamo FG, Altieri B, et al. Degree of weight loss versus glycemic control in restoring testosterone levels in men with obesity and type 2 diabetes. Endocrine, 2020, 68(1): 149-155.
31. Abdelsamea MM, Ahmed NY, Soliman NL. Effect of weight loss on sexual function of obese women: a randomized controlled trial. BMC Womens Health, 2022, 22: 5. doi: 10.1186/s12905-021-01571-0.
32. Duggan SN, Perdomo JS, Doherty DA, et al. Exercise and dieting lower free testosterone and improve menstrual regularity in obese women. Clin Endocrinol (Oxf), 2019, 90(2): 157-165.
33. Hordern MD, Ng D, Dunn S, et al. Exercise intervention improves sexual function in overweight postmenopausal women. J Sex Med, 2016, 13(4): 607-615.
34. Clark AM, Thornley S, Tomlinson L, et al. Randomized trial of a lifestyle intervention in obese women with polycystic ovary syndrome. Fertil Steril, 2013, 100(2): 462-462.
35. Syed AH, Chandnani A, Khan A, et al. Association of weight loss with improved sexual function in females. Cureus, 2021, 13(8): e16849. doi: 10.7759/cureus.16849.
36. Azimi N, Yassaee F, Mehdizadeh G, et al. Ketogenic diet in women with PCOS: effects on anthropometric and reproductive parameters. Horm Metab Res, 2023, 55(3): 212-218.
37. Chai JX, Zhang QH, Li X, et al. Effects of physical exercise on improving erectile function: a systematic review and meta-analysis of randomized controlled trials. J Mens Health, 2025, 21(2): 11-25.
38. Brzozowska MM, Bliuc D, Mazur A, et al. Sex-differential testosterone response to long-term weight loss. Int J Obes (Lond), 2024, 48(10): 1481-1488.
39. Dionisi T, De Vita V, Di Sario G, et al. The implications of metabolic and bariatric surgery on psychosocial and relational health: a narrative review. Obes Surg, 2025 Sep 6. doi: 10.1007/s11695-025-08193-w.
40. Abdelsamea GA, Amr M, Tolba AMN, et al. Impact of weight loss on sexual and psychological functions and quality of life in females with sexual dysfunction: a forgotten avenue. Front Psychol, 2023, 14: 1090256. doi: 10.3389/fpsyg.2023.1090256.
41. Li H, Xu W, Wang T, et al. Effect of weight loss on erectile function in men with overweight or obesity: a meta-analysis of randomised controlled trials. Andrologia, 2022, 54(1): e14250. doi: 10.1111/and.14250.
42. Armamento-Villareal R, Aguirre LE, Qualls C, et al. Effect of lifestyle intervention on the hormonal profile of frail, obese older men. J Nutr Health Aging, 2016, 20(3): 334-340.
43. Dombrowski SU, Knittle K, Avenell A, et al. Long term maintenance of weight loss with non-surgical interventions in obese adults: systematic review and meta-analyses of randomised controlled trials. BMJ, 2014, 348: g2646. doi: 10.1136/bmj.g2646.

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