Tirzepatide Affect Sexual Function in Women: Case Report

Abstract

Introduction:

Tirzepatide is a new molecule capable of controlling blood glucose levels by combining the dual agonism of glucose-dependent insulinotropic polypeptide (GIP) and glucose-like peptide-1 (GLP-1) receptors. The Food and Drug Administration approved tirzepatide subcutaneous injections as monotherapy or combination therapy, with diet and physical exercise. Its influence on sexual behavior as an adverse effect is not well known.

Aims:

The purpose of this report was to present a case study of an obese female patient who received tirzepatide treatment for sexual dysfunction.

Methods:

We performed an extensive clinical evaluation, which included the Female Sexual Function Index (FSFI). Metabolic, hormonal, immunologic, and hematologic etiology of sexual dysfunction was ruled out by laboratory examination. The patient was managed by a multimodal approach, with lifestyle modification, pelvic floor strengthening exercises, pharmacologic management with bupropion sustained release 150 to 400 mg per day and topical lubricants, and psychosexual therapy as needed. FSFI scores were longitudinally followed to assess treatment response.

Results:

A 36-year-old woman with obesity class III developed sexual dysfunction after using tirzepatide, a healthy lifestyle with a carb cycle diet, greater physical activity, and exercise for losing weight. All physical, psychological, and hormonal parameters were normal. During treatment, the patient started to complain of decreasing sexual drive, genital dryness, and failure to catch orgasm; female sexual function index (FSFI) = 12.7. Symptoms decreased after stopping the tirzepetide (FSFI = 28.7) and reappeared after retaking the injection (FSFI = 14.7). After 1 month of sexual treatment and support, FSFI = 24.

Conclusion:

The drug’s impact on hormones and neurological pathways may contribute to decreased sexual desire, through the specific process is unknown. Adjuvant sexual education and therapy support has an imperative role in the plan of management in cases on going in the journey of reducing their weight and complaining of sexual performance affection.

Introduction

Tirzepatide is a glucose-dependent insulinotropic polypeptide (GIP) receptor and glucagon-like peptide-1 (GLP-1) receptor agonist that mimics the GLP-1 hormone released after eating. GLP-1 stimulates the body to create more insulin, lowering blood glucose levels. ¹ Tirzepatide has been studied as a treatment for type 2 diabetes. It is also being used to aid in losing weight and control of obesity. ¹ While many adverse effects have been documented, stomach pain and gastrointestinal issues are the most common. ¹ However, there are few reports of tirzepatide-induced sexual dysfunction in women. ²

Women around the world value the delight of sexual engagement. The broad incidence of sexual difficulties poses a risk to the well-being of a large proportion of the population. ³ Sexual dysfunction can be caused by a variety of physiologic and psychological causes. Studies indicate that women’s sexual well-being is significantly influenced by their body image. ³

Concerns about one’s physical appearance might undermine sexual confidence, interest, and enjoyment. ⁴ As a result, body image is a crucial component to consider when determining whether sex is enjoyable or distressing.

Although body image-induced sexual avoidance is not classified as a sexual disease, it can limit women’s involvement and pleasure in sex, reducing both functioning, and satisfaction. ⁴ According to recent studies, several components of body image may have varying effects on women’s sexual experiences. This case is reported to emphasize the clinical relevance of the detection of female sexual dysfunction as a potential symptom of underlying tirzepatide treatment and to demonstrate the excellent therapeutic result achieved by a complete, multidisciplinary approach directed to the sexual sphere in the restoration of sexual health.

Our question is: Is sexual performance affected by tirzepatide?

Case Presentation

Ethical integrity was upheld through approval from the Shaqra University Ethics Committee (CMD/DWD/SU/2024/03/043). Written informed consent for the publication of their details was obtained from the patient.

A 36-year-old female presented to the clinic and complained of sexual performance obstacles such as deceasing sexual drive, dryness of genitalia, and failure to catch orgasm. General examination revealed normal parameters except the obesity. She had a family history of weight problems, hypertension, diabetes, and coronary artery disease. Her height was 157 cm tall and 123 kg; her body mass index (BMI) was 49.9, class III obesity. The female sexual function index (FSFI) was administered and yielded low results (total score = 12.7). She mentioned no other underlying medical, psychological, or surgical concerns. The underlying physical, psychological, and hormonal factors were normal after the evaluation. Hormonal analysis showed that fasting insulin level = 41.52 µIU/mL, fasting plasma glucose = 106 mg/dL, HOMA2-IR 5.29, HOMA2-%B = 222%, HOMA 2-%S = 18.9, 25(OH) vitamin D = 66.77 ng/mL, TSH = 3.454 µIU/mL, free T3 = 2.58 pg/mL, and free T4 = 1.19 ng/dL, serum. The lipid profiles were as follow: cholesterol = 206 mg/dL, high-density lipoprotein cholesterol = 44 mg/dL, low-density lipoprotein cholesterol = 122 mg/dL, non-high-density lipoprotein cholesterol = 162 mg/dL, serum triglyceride = 197 mg/dL, serum very low-density lipoprotein cholesterol = 39 mg/dL, and LDL/HDL cholesterol = 2.77. According to the chemistry unit, the serum uric acid was 5.9 mg/dL, ionized calcium (Ca++) = 5 mg/dL, serum sodium (Na) = 140 mmol/L, serum potassium (K) 4.4 mmol/L, and serum magnesium = 1.8 mg/dL. Glycated hemoglobin (HbA1c) = 5.5%. Antithyroglobulin antibodies were 16.2 IU/mL and antimicrosomal antibodies were 1.4 IU/mL Urine analysis values were normal, and a complete blood picture showed mild microcytic, hypochromic anemia with moderate anisocytosis. During a history of trials and failures to decrease her weight, her endocrinologist, nutritionist, and she decided to start tirzepatide. In the beginning, a healthy lifestyle with a carb cycle diet, greater physical activity, and exercise were recommended. The patient began with tirzepatide 5 mg/week for 1 month, then 7.5 mg/week for the next month, and finally 12.5 mg/week for the remaining 1 year. Weight lowered to 76 kg and BMI 30.8, class I obesity. This is in addition to the multivitamins tab (centrum^®). Tirzepatide was generally accepted, except nausea, gas distention, and constipation. She stopped tirzepatide without sharing her decision with her doctors for 2 months. Then afterward, the patient returned to our clinic. The female sexual function index (FSFI) was administered and yielded enhanced results (total score = 28.7). The sexual drive was enhanced, there was an increase in lubrication, there was a decrease in dryness, and sexual dysfunction symptoms resolved, and FSFI scores improved. However, her weight increased by 7 kg and became 83 kg. The patient returned to tirzepatide with 5 mg/week for 2 months. She lost 5 kg again. But also complain again from difficulties in her sexual performance, same as before. The female sexual function index (FSFI) was administered and yielded enhanced results (total score = 14.7). The underlying physical, psychological, and hormonal factors were normal after the evaluation. For treatment, we started couple counseling and psychosexual counseling. Lifestyle modifications and pelvic floor strengthening exercises. In addition to bupropion sustained release 150 to 400 mg per day and topical lubricants. FSFI after 1 month of sexual treatment and support increased to 24, and she could continue her plan of reducing her weight.

Discussion

Tirzepatide is made up of two polypeptides, one of which is a GIP/GLP-1 receptor Agonist mimic. ¹ These analogs bind to and activate their respective receptors, effectively replicating the effects of naturally existing incretin. Tirzepatide activates GLP-1 receptors, which enhance glucose-mediated insulin production while decreasing glucagon secretion. ¹ Tirzepatide activation of GIP receptors improves insulin sensitivity and secretion, hence thus strengthening the mechanisms that regulate blood glucose levels. The drug’s other effects, such as delayed stomach emptying and greater satiety following nutrient absorption, are linked to lower food intake and weight loss. ¹

Tirzepatide adverse reactions are most typically associated with gastrointestinal symptoms such as abdominal discomfort, constipation, diminished appetite, diarrhea, nausea, and vomiting. ¹ The sensation of heartburn, increased heart rate, fever, facial puffiness, and itchy or red skin are some less usual adverse effects. Tirzepatide can only be used in select people due to contraindications. Those who are already taking GLP-1 agonists (eg, liraglutide or semaglutide) as well as those who are at risk for certain thyroid-related cancers (eg, medullary thyroid carcinoma) or have a history of multiple endocrine neoplasia syndrome type 2 may be more likely to cultivate such tumors if they take tirzepatide. ¹

Tirzepatide has not been associated with female sexual dysfunction, unlike other GLP-1 receptor agonists such as semaglutide. ¹ Semaglutide, a GLP-1 receptor agonist used largely for weight control and diabetes, has been linked to a variety of adverse reactions, notably gastrointestinal problems and suspected effects on sexual function. ⁵ Whilst certain research findings indicate that semaglutide could potentially enhance sexual function by promoting weight loss and glycemic control, other patients have reported sexual dysfunction. This might show as diminished libido or erectile dysfunction, which may be connected to hormonal shifts or psychological factors affecting body image and health. ⁶

The mechanism by which GLP-1 receptor agonists may inhibit sexual activity is not fully understood, but several factors could contribute:

GLP-1 receptor agonists may negatively affect sex hormones in several ways: [1] Hormonal changes and fluctuations: certain individuals may suffer variations in their hormone levels because of metabolic changes, which can lead to sex hormone imbalances. Furthermore, semaglutide influences hormone release, including insulin and perhaps sex hormones, which can have an impact on libido and sexual performance. ⁷ [2] Weight Loss and Body Image: While weight loss generally improves hormone profiles, rapid changes in body composition can sometimes lead to temporary disruptions in hormone levels, affecting libido, and sexual function. In addition, weight loss can have a dual effect; while it may boost confidence in some, others might struggle with body image issues, leading to decreased sexual desire. ⁸ [3] Impact on Insulin: As semaglutide improves insulin sensitivity, reduced insulin levels might lead to decreased levels of sex hormones in some individuals, especially in those with conditions like PCOS. ⁹ [4] Glycemic Control: While improved blood sugar levels can enhance sexual function in some, others might experience fluctuations that can negatively impact libido. ⁵ [5] Gastrointestinal Side Effects: Nausea and other GI issues associated with semaglutide can lead to decreased overall well-being, which might indirectly affect sexual activity. ⁵ [6] Psychological Effects: The stress or anxiety associated with managing a chronic condition or experiencing side effects can influence sexual desire and function, which may indirectly affect hormone levels. ¹⁰

Overall, the effects of tirzepatide on sex hormones can vary among individuals, and more research is needed to clarify these interactions. Further research is needed to comprehensively clarify the relationship between tirzepatide and sexual health. Patients need experiencing these side effects to discuss them with their healthcare provider, as management strategies may vary based on individual circumstances. Adjuvant sexual education and therapy support has an imperative role in the plan of management in cases on going in the journey of reducing their weight and complaining of sexual performance affection.