Effect of Wegovy (Semaglutide) on Testosterone Levels in Women
Based on the available evidence, Wegovy (semaglutide) does not increase testosterone levels in women. In fact, studies suggest that GLP-1 receptor agonists like liraglutide may actually decrease free testosterone levels and increase sex hormone binding globulin (SHBG) in women with polycystic ovary syndrome (PCOS) 1.
Evidence on Semaglutide and Hormonal Effects
Impact on Testosterone and Other Hormones
In studies of women with PCOS, liraglutide (another GLP-1 receptor agonist similar to semaglutide) was found to be superior to placebo for:
- Decreasing free testosterone levels
- Increasing SHBG levels
- Decreasing the Free Androgen Index (FAI) 1
These hormonal improvements were observed in conjunction with weight loss, which is the primary mechanism through which semaglutide affects hormone levels.
One trial comparing liraglutide 1.8 mg daily versus placebo showed median changes in free testosterone of -0.005 nmol/L with liraglutide versus +0.004 nmol/L with placebo (p = 0.05) 1.
Mechanism of Action
The hormonal effects of semaglutide appear to be mediated primarily through:
- Weight loss: Reduction in adipose tissue leads to decreased peripheral aromatization of androgens
- Improved insulin sensitivity: Reduces hyperinsulinemia which can drive ovarian androgen production
- Increased SHBG: Higher SHBG levels bind free testosterone, reducing bioavailable testosterone
Semaglutide's Effects in Different Populations
Women with PCOS
- Women with PCOS often have elevated testosterone levels at baseline
- GLP-1 receptor agonists like liraglutide have been shown to improve hormonal parameters in these women 1
- Limited data exists specifically on semaglutide in PCOS, but the mechanism would be expected to be similar to liraglutide
Women Without PCOS
- No evidence suggests that semaglutide increases testosterone in women without hormonal disorders
- The primary effect of semaglutide is weight reduction (14.9-16.0% at 68 weeks) 2, 3
- Weight loss itself can normalize hormone levels in women with obesity
Postmenopausal Women
- A study of postmenopausal women using semaglutide showed improvements in cardiometabolic risk markers but did not report increases in testosterone levels 4
- Women on hormone therapy (HT) using semaglutide actually showed greater weight loss than those not on HT (16% vs 12% at 12 months) 4
Clinical Implications
Weight Loss Effects
- Semaglutide produces substantial weight loss (14.9% at 68 weeks) 3
- This weight loss is maintained with continued treatment but largely reversed when treatment is discontinued 5
- The weight loss effect is likely the primary driver of any hormonal changes observed
Side Effect Profile
- The most common adverse effects are gastrointestinal (nausea, vomiting, diarrhea)
- Approximately 4.5% of patients discontinue treatment due to GI events 3
- No adverse effects related to testosterone or other sex hormone changes have been reported
Conclusion
Wegovy (semaglutide) does not increase testosterone levels in women. If anything, through its weight loss effects, it may help normalize hormone levels in women who have elevated testosterone due to conditions like PCOS. The available evidence indicates that GLP-1 receptor agonists like liraglutide can actually decrease free testosterone and increase SHBG in women with hormonal imbalances.