From the Guidelines
Metformin is not commonly associated with reduced libido, and its impact on sexual function is generally considered minimal. Metformin, typically prescribed at doses ranging from 500mg to 2000mg daily for type 2 diabetes and other conditions like polycystic ovary syndrome (PCOS), primarily affects blood glucose metabolism rather than sexual function directly. However, some patients report decreased sexual desire while taking this medication, which might be related to metformin's potential to lower testosterone levels slightly in some individuals or could be associated with other side effects like fatigue or gastrointestinal distress that indirectly impact sexual interest 1. Interestingly, in patients with PCOS, metformin may actually improve libido by addressing hormonal imbalances that were previously causing sexual dysfunction. According to the 2020 standards of medical care in diabetes, screening for low testosterone levels is recommended in men with diabetes who have symptoms or signs of hypogonadism, such as decreased sexual desire (libido) or activity, or erectile dysfunction 1. If you experience reduced libido while taking metformin, discuss this with your healthcare provider, as dosage adjustments or alternative medications might be considered. Key points to consider include:
- Metformin's primary effect is on blood glucose metabolism, not sexual function
- Some patients may experience decreased libido due to metformin's side effects or hormonal changes
- Metformin may improve libido in patients with PCOS by addressing hormonal imbalances
- Screening for low testosterone levels is recommended in men with diabetes who have symptoms of hypogonadism It's essential to weigh the benefits of metformin in managing diabetes against potential side effects and to discuss any concerns with a healthcare provider, as proper diabetes management remains crucial for overall health.
From the Research
Metformin and Libido
- The relationship between metformin and libido is complex, with some studies suggesting that metformin may reduce libido in men with type 2 diabetes mellitus (T2DM) 2, 3, 4.
- A study published in the Journal of Clinical and Diagnostic Research found that metformin treated patients had lower total testosterone serum levels, free testosterone, and bioavailable testosterone compared to sulfonylurea treated patients and healthy control men, which may contribute to reduced libido 2.
- Another study published in Diabetes Care found that 1-month oral metformin may decrease serum testosterone levels independent of blood glucose control in men with T2DM 3.
- A study published in Frontiers in Endocrinology found that 3-month metformin therapy can reduce testosterone levels and counteract the testosterone elevation that accompanied with the improvement of blood glucose in men with T2DM 4.
Testosterone Levels and Libido
- Testosterone levels play a crucial role in regulating libido, with lower testosterone levels often associated with reduced libido 2, 3, 4.
- The studies suggest that metformin may reduce testosterone levels, which could contribute to reduced libido in men with T2DM 2, 3, 4.
- However, it is essential to note that the relationship between metformin, testosterone, and libido is not fully understood and requires further research.
Other Factors Influencing Libido
- Other factors, such as blood glucose control, insulin sensitivity, and overall health, may also influence libido in men with T2DM 5, 6.
- A review published in Current Opinion in Endocrinology, Diabetes, and Obesity discussed the potential therapeutic implications of testosterone treatment on glycemic control and T2D prevention, highlighting the complexity of the relationship between testosterone, libido, and T2DM 5.
- Another review published in Current Diabetes Reports provided an update on metformin, including its potential benefits and limitations, and highlighted the need for further research on its effects on various health outcomes, including libido 6.