Is Ozempic (semaglutide) associated with a condition known as 'Ozempic penis'?

"Ozempic Penis" - Understanding the Phenomenon

"Ozempic penis" is a colloquial term referring to the apparent increase in penile size that some men report after significant weight loss on semaglutide (Ozempic), though this is not an actual enlargement but rather improved visibility due to reduction of suprapubic fat pad—however, one recent study suggests semaglutide may paradoxically increase the risk of erectile dysfunction in non-diabetic obese men. 1

The Mechanism Behind the Phenomenon

The term "Ozempic penis" has emerged in popular culture as men lose substantial weight on semaglutide therapy. The explanation is anatomical rather than pharmacological:

• Semaglutide produces significant weight loss, with mean reductions of 14.9% total body weight at 68 weeks in non-diabetic patients with obesity, compared to 2.4% with placebo 2
• Weight loss of 2-4% occurs with standard GLP-1 receptor agonists, but semaglutide can achieve up to 10% weight loss at higher doses used for obesity management 3
• As suprapubic and lower abdominal fat decreases, the penile shaft becomes more visible, creating the appearance of increased size without actual tissue growth

Important Contradictory Evidence on Sexual Function

A critical 2024 study found that non-diabetic obese men prescribed semaglutide had a 4.5-fold increased risk of developing erectile dysfunction (1.47% vs 0.32%; RR: 4.5; 95% CI [2.3,9.0]) compared to matched controls who did not receive semaglutide 1. This same study also found:

• 1.9-fold increased risk of testosterone deficiency (1.53% vs 0.80%; RR: 1.9; 95% CI [1.2,3.1]) 1
• The study controlled for diabetes, prior ED, testosterone deficiency, and other confounding factors 1
• This represents a significant safety signal that warrants discussion with patients 1

Clinical Context of Semaglutide Use

FDA-Approved Indications

• Ozempic (semaglutide injection) is FDA-approved for type 2 diabetes only, not for weight loss 3
• Wegovy (semaglutide 2.4 mg) is the FDA-approved formulation for chronic weight management in adults with BMI ≥30 or BMI ≥27 with weight-related comorbidities 2

Cardiovascular Benefits

• Semaglutide reduces major adverse cardiovascular events by 20% in patients with preexisting cardiovascular disease and obesity without diabetes (6.5% vs 8.0%; HR 0.80; 95% CI 0.72-0.90) 4
• Cardiovascular death, nonfatal MI, or nonfatal stroke are significantly reduced over a mean follow-up of 39.8 months 4

Common Pitfalls and Patient Counseling

Setting Realistic Expectations

• Patients should understand that any perceived increase in penile size is due to fat loss, not actual tissue growth 2
• The erectile dysfunction risk must be disclosed, particularly in younger non-diabetic men seeking weight loss 1
• Weight loss effects are substantial but require sustained treatment—discontinuation leads to weight regain 2

Monitoring Requirements

• Monitor for new onset erectile dysfunction or decreased libido during semaglutide therapy, especially in non-diabetic patients 1
• Consider baseline and follow-up testosterone levels given the increased risk of testosterone deficiency 1
• Gastrointestinal side effects (nausea, vomiting, diarrhea) occur commonly but are typically transient with gradual dose titration 3

Contraindications to Emphasize

• Absolute contraindication: personal or family history of medullary thyroid cancer or multiple endocrine neoplasia syndrome type 2 3
• Use caution in patients with severe renal impairment or end-stage renal disease 3
• Increased hypoglycemia risk when combined with insulin or sulfonylureas—dose reduction of these agents is required 3

The Bottom Line for Clinical Practice

While the "Ozempic penis" phenomenon reflects real and substantial weight loss benefits of semaglutide therapy, clinicians must balance this against the newly identified 4.5-fold increased risk of erectile dysfunction in non-diabetic obese men 1. This risk-benefit discussion is essential before initiating therapy, particularly in younger men without diabetes who are seeking weight loss for cosmetic or general health reasons rather than cardiovascular risk reduction.