Tirzepatide is a dual glucose-dependent insulinotropic polypeptide (GIP) and glucagon-like peptide-1 (GLP-1) receptor agonist licensed in the UK for type 2 diabetes mellitus and weight management. Concerns occasionally arise about whether tirzepatide can cause erectile dysfunction. Currently, there is no established causal link between tirzepatide and erectile dysfunction based on clinical trial data, post-marketing surveillance, or the MHRA-approved Summary of Product Characteristics. Erectile dysfunction is multifactorial, with type 2 diabetes itself being a significant risk factor due to vascular and neurological complications. This article examines the evidence, explores alternative contributing factors, and provides guidance on when to seek medical advice regarding sexual health concerns during tirzepatide treatment.
Quick Answer: There is currently no established causal link between tirzepatide and erectile dysfunction based on clinical trial data and post-marketing surveillance.
Tirzepatide is a novel glucose-dependent insulinotropic polypeptide (GIP) and glucagon-like peptide-1 (GLP-1) receptor agonist licensed in the UK for the treatment of type 2 diabetes mellitus and, more recently, for weight management in adults with obesity or overweight with weight-related comorbidities, as per the MHRA-approved Summary of Product Characteristics (SmPC) for Mounjaro.
There is currently no established causal link between tirzepatide and erectile dysfunction based on clinical trial data and post-marketing surveillance. Erectile dysfunction (ED) is not listed as a recognised adverse reaction in the UK SmPC for tirzepatide. The most commonly reported adverse effects of tirzepatide relate to the gastrointestinal system, including nausea, diarrhoea, vomiting, and constipation, which typically diminish over time.
It is important to recognise that erectile dysfunction is a multifactorial condition with numerous potential causes, including cardiovascular disease, diabetes itself, psychological factors, and other medications. Patients with type 2 diabetes—a primary indication for tirzepatide—already have a significantly elevated risk of ED due to vascular and neurological complications of their underlying condition. Therefore, ED during tirzepatide treatment may more commonly relate to underlying comorbidities rather than the medication itself. Nonetheless, all concerns regarding sexual health should be discussed openly with healthcare professionals to ensure appropriate assessment and management.
If you suspect an adverse reaction to tirzepatide or any other medicine, please report it through the MHRA Yellow Card Scheme (yellowcard.mhra.gov.uk or via the Yellow Card app).
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Start HereThe evidence base for tirzepatide's safety profile derives primarily from the SURPASS clinical trial programme, which enrolled thousands of participants with type 2 diabetes across multiple international studies. These randomised controlled trials compared tirzepatide at various doses (5 mg, 10 mg, and 15 mg weekly subcutaneous injections) against placebo and active comparators including semaglutide and insulin. Erectile dysfunction was not identified as a significant adverse event in these trials, as documented in the published SURPASS studies and the European Medicines Agency's European Public Assessment Report (EPAR) for tirzepatide.
ED is not listed in the UK SmPC for tirzepatide, and there are no MHRA Drug Safety Updates identifying ED as a safety signal associated with this medication. This absence of signal provides reassurance, particularly given the large number of patients now receiving the medication globally.
Some limited evidence suggests that GLP-1 receptor agonists—a drug class related to tirzepatide's mechanism of action—may have indirect effects on erectile function through improvements in weight, glycaemic control, and cardiovascular risk factors. These metabolic improvements could potentially benefit erectile function in men with diabetes and obesity, conditions strongly associated with ED. However, direct evidence specifically for tirzepatide's effect on sexual function is currently lacking.
It is worth noting that clinical trials may underreport sexual adverse effects due to patient reluctance to volunteer such information. However, the absence of any signal across large-scale studies and the current pharmacovigilance data provides reasonable confidence that tirzepatide does not directly cause erectile dysfunction through its pharmacological mechanism.
When patients experience erectile dysfunction whilst taking tirzepatide, it is essential to consider the broader clinical context and multiple contributing factors that may be responsible. Type 2 diabetes itself is one of the strongest risk factors for erectile dysfunction, with prevalence rates approximately three times higher than in men without diabetes, according to NICE Clinical Knowledge Summaries. The mechanisms include endothelial dysfunction, autonomic neuropathy, reduced nitric oxide bioavailability, and psychological factors related to chronic disease management.
Cardiovascular disease, hypertension, and dyslipidaemia—conditions frequently comorbid with type 2 diabetes—independently contribute to erectile dysfunction through impaired penile blood flow. Many patients initiating tirzepatide will have established vascular disease that predates their treatment. Obesity is another significant risk factor, with studies demonstrating a clear correlation between increasing body mass index and ED prevalence. Whilst tirzepatide promotes weight loss that may ultimately improve erectile function, the underlying metabolic dysfunction may persist during early treatment phases.
Polypharmacy represents another important consideration. Patients with type 2 diabetes often take multiple medications, some of which have recognised associations with erectile dysfunction. These include:
Antihypertensive agents: particularly beta-blockers and thiazide diuretics
Antidepressants: especially selective serotonin reuptake inhibitors (SSRIs)
5-alpha-reductase inhibitors: such as finasteride and dutasteride
Statins and fibrates: though evidence is mixed; discuss with a clinician before changing therapy
Spironolactone and some antipsychotics: may also affect sexual function
Psychological factors including depression, anxiety, and diabetes-related distress can significantly impact sexual function. The stress of managing a chronic condition, concerns about body image, and relationship dynamics all play important roles. Lifestyle factors such as smoking, excessive alcohol consumption, and physical inactivity further compound erectile dysfunction risk, as highlighted in NHS guidance. A comprehensive assessment should therefore evaluate all these potential contributors rather than attributing symptoms solely to any single medication.
Patients experiencing erectile dysfunction whilst taking tirzepatide should feel empowered to discuss these concerns with their healthcare team. Sexual health is an important component of overall wellbeing and quality of life, and healthcare professionals are accustomed to addressing such matters sensitively and confidentially. Early consultation allows for proper assessment, identification of underlying causes, and appropriate management strategies.
Patients should contact their GP or diabetes specialist nurse if they experience:
New onset or worsening erectile dysfunction after starting tirzepatide
Sexual dysfunction accompanied by other concerning symptoms such as chest pain, breathlessness, or leg pain (which may indicate cardiovascular disease)
Psychological distress related to sexual function affecting quality of life or relationships
Concerns about whether tirzepatide or other medications may be contributing to symptoms
During consultation, healthcare professionals will typically conduct a comprehensive assessment including medical history, medication review, cardiovascular risk evaluation, and consideration of psychological factors. NICE Clinical Knowledge Summary guidance on erectile dysfunction recommends assessing for underlying conditions, particularly cardiovascular disease and diabetes complications. Investigations may include blood tests (HbA1c, lipid profile, morning total testosterone on two occasions if low, possibly SHBG and prolactin if indicated, thyroid function) and blood pressure measurement. Referral to urology or specialist sexual health services may be appropriate if there is failure of first-line therapy, suspected endocrine or anatomical causes, or complex comorbidities.
It is important that patients do not discontinue tirzepatide without medical advice if they suspect it may be affecting sexual function. The benefits of improved glycaemic control and weight loss typically outweigh unsubstantiated concerns about erectile dysfunction, particularly given the lack of evidence linking the two. Alternative explanations are far more likely, and many causes of ED are treatable without stopping diabetes medication. Management options may include lifestyle modifications, treatment of underlying cardiovascular disease, psychological support, or specific ED therapies such as phosphodiesterase-5 inhibitors (e.g., sildenafil), which can be safely used alongside tirzepatide in most patients following cardiovascular assessment. It is important to note that PDE5 inhibitors are contraindicated with nitrates and riociguat, and should be used with caution in patients taking alpha-blockers or those with unstable cardiovascular disease, as per BNF guidance.
No, erectile dysfunction is not listed as a recognised adverse reaction in the UK Summary of Product Characteristics for tirzepatide. The most commonly reported adverse effects are gastrointestinal, including nausea, diarrhoea, vomiting, and constipation.
Type 2 diabetes itself is a major risk factor for erectile dysfunction due to vascular complications, autonomic neuropathy, and reduced nitric oxide bioavailability. Other contributing factors include cardiovascular disease, obesity, polypharmacy, and psychological factors, all of which are common in patients prescribed tirzepatide.
No, do not discontinue tirzepatide without medical advice. Erectile dysfunction during treatment is more likely related to underlying conditions such as diabetes or cardiovascular disease rather than the medication itself. Consult your GP or diabetes specialist for comprehensive assessment and appropriate management options.
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