Semaglutide improved sperm morphology in obese men with type 2 diabetes mellitus and functional hypogonadism.

Semaglutide significantly increased the percentage of morphologically normal sperm from baseline to end of study.

• Morphologically normal sperm increased from 2% [2; 3.5] at baseline to 4% [2; 5.5] after 24 weeks in the SEMA group (p = 0.012).
• No comparable improvement in sperm morphology was observed in the TRT group.
• The SEMA group had a significantly higher number of morphologically normal sperm compared to TRT at end of study.
• Baseline sperm quality for the overall cohort was poor, below the 5th percentile of reference values.

Testosterone replacement therapy significantly decreased sperm concentration and total sperm number.

• Sperm concentration and total number decreased significantly in the TRT group from baseline to week 24.
• Compared to TRT, the SEMA group had a significantly higher sperm concentration and total sperm number at end of study.
• TRT was administered as intramuscular testosterone undecanoate 1000 mg every 10–12 weeks for 24 weeks.
• These findings are consistent with known suppression of spermatogenesis by exogenous testosterone.

Both semaglutide and TRT led to increases in total testosterone levels and improvement in Aging Symptoms in Men (AMS) scores.

• Both treatment groups experienced an increase in total testosterone from baseline to week 24.
• Both groups showed improvement in the AMS score over the 24-week treatment period.
• The study enrolled 25 men with type 2 diabetes and functional hypogonadism (aged 50 [46–60] years, BMI 35.9 [32.8–38.7] kg/m²).
• The AMS questionnaire was used to assess symptoms of hypogonadism in aging men.

IIEF-15 score (erectile function) significantly improved only in the TRT group, not in the semaglutide group.

• The International Index of Erectile Function-15 (IIEF-15) score showed significant improvement in the TRT group but not in the SEMA group.
• Both groups completed the IIEF-15 questionnaire at baseline and after 24 weeks of treatment.
• This suggests TRT may have specific advantages over semaglutide for erectile function in this population.

The study was a randomised open-label trial comparing semaglutide to testosterone replacement therapy over 24 weeks in obese men with type 2 diabetes and functional hypogonadism.

• 25 men were randomised to either semaglutide 1 mg/week subcutaneously or intramuscular testosterone undecanoate 1000 mg every 10–12 weeks.
• Participants had a median age of 50 [46–60] years and median BMI of 35.9 [32.8–38.7] kg/m².
• Semen analysis and parameters of functional hypogonadism were measured at baseline and after 24 weeks.
• The trial was registered under NCT06489457.
• Participants also completed IIEF-15 and AMS questionnaires at both time points.