Response to comment on: GLP-1 receptor agonists and male sexual health: translating cardiometabolic benefits into erectile outcomes

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We thank Grimolizzi for his thoughtful Comment on our Perspective, “GLP-1 receptor agonists and male sexual health: Translating cardiometabolic benefits into erectile outcomes [1, 2].” We agree with the central premise that glucagon-like peptide-1 receptor agonists (GLP-1 RAs) should not be studied through erectile outcomes alone. Our original article focused deliberately on male erectile function because that is where the most developed urologic literature currently sits, but the Comment appropriately emphasizes that sexual health is broader than erection, that desire is a distinct construct, and that future research should capture central motivational effects alongside vascular, endocrine, and metabolic pathways [2].

The distinction between erectile function and sexual desire is especially important because GLP-1 signaling intersects with reward biology. Preclinical and translational work has linked endogenous GLP-1 activity to mesolimbic dopamine pathways involved in appetite and motivated behavior [3]. Newer clinical observational data have also associated GLP-1 RA use with lower risk across multiple substance use disorder outcomes, supporting the hypothesis that these agents may influence reward-related behavior beyond food intake [4]. These findings do not prove that GLP-1 RAs reduce libido, and they should not be interpreted as evidence of a uniform adverse sexual effect. They do, however, strengthen the argument that validated desire measures should be incorporated into prospective studies rather than relying only on erectile function scales or adverse-event reporting.