Does Mounjaro (tirzepatide) cause sexual dysfunction?

Does Mounjaro (Tirzepatide) Cause Sexual Dysfunction?

Based on current evidence, tirzepatide is not established as a cause of sexual dysfunction, though one case report suggests a possible association in women that requires further investigation.

Evidence Assessment

Limited Direct Evidence

• Only one case report exists documenting sexual dysfunction potentially related to tirzepatide: a 36-year-old woman with obesity class III developed decreased sexual drive, genital dryness, and failure to achieve orgasm (FSFI score dropped from 28.7 to 12.7) after starting tirzepatide 1
• The symptoms resolved when the medication was stopped (FSFI improved to 28.7) and recurred upon restarting (FSFI dropped to 14.7), suggesting a temporal relationship 1
• The proposed mechanism involves potential effects on hormones and neurological pathways, though the specific process remains unknown 1

Absence from Major Safety Data

• Large-scale post-marketing surveillance analyzing 65,974 FAERS reports from 2022-2025 did not identify sexual dysfunction as a significant adverse event signal 2
• The most common adverse events were dosing errors, injection-site reactions, and gastrointestinal issues (nausea, diarrhea, decreased appetite) 2, 3
• Phase III SURPASS trials and comprehensive reviews of tirzepatide safety profiles do not list sexual dysfunction among reported adverse effects 4, 3

Context: Sexual Dysfunction in Diabetes

• Diabetic autonomic neuropathy itself causes sexual dysfunction in both men (erectile dysfunction, retrograde ejaculation) and women (decreased desire, pain during intercourse, decreased arousal, inadequate lubrication) 4
• This creates a confounding factor when evaluating sexual dysfunction in patients taking diabetes medications 4

Clinical Implications

When to Suspect Tirzepatide-Related Sexual Dysfunction

• Temporal relationship: New-onset sexual dysfunction shortly after starting tirzepatide, with improvement upon discontinuation 1
• Rule out other causes first: Ensure metabolic, hormonal, immunologic parameters are normal; assess for diabetic neuropathy progression 4, 1
• Consider psychological factors: Weight loss journey itself can affect sexual function independent of medication 1

Management Approach if Suspected

• Multimodal intervention including lifestyle modification, pelvic floor exercises (for women), pharmacologic support (bupropion 150-400 mg daily for women), topical lubricants, and psychosexual therapy 1
• For men with diabetes and erectile dysfunction: PDE5 inhibitors (sildenafil, tadalafil, vardenafil) remain first-line treatment regardless of diabetes medication, though response may be less robust in diabetic patients 4
• Consider medication adjustment: If temporal relationship is clear and symptoms are severe, discuss risk-benefit of continuing tirzepatide versus switching to alternative GLP-1 receptor agonist 1

Important Caveats

• The evidence is extremely limited: One case report cannot establish causation, and sexual dysfunction was not identified in trials involving thousands of patients 4, 1, 2, 3
• Diabetes itself is a major cause: Diabetic autonomic neuropathy affects sexual function in both genders, making attribution to medication challenging 4
• Reporting bias: Sexual dysfunction is often underreported in clinical trials and post-marketing surveillance 1