The Impact of Obesity on Sexual Health Is Significant
To learn more about the impact of obesity on your sexual health—including libido, performance and reproduction—as well as how to treat it, see what healthcare experts who work in the field of obesity medicine have to say.
Obesity and sexual health
Moderate obesity is responsible for decreasing total testosterone due to reductions in sex hormone-binding globulin (SHBG) that are associated with insulin resistance, according to Kimberly Gomer, M.S., a registered dietitian, licensed dietitian nutritionist and the director of nutrition at Body Beautiful Miami.
SHBG is a protein that carries androgens (testosterone and dihydrotestosterone) and estrogen in the blood, according to Cleveland Clinic.
Severe obesity is associated with reductions in free testosterone levels as well.
"There is evidence that obesity is negatively correlated with testosterone levels," Gomer explained. "One study, for example, found that compared to men with a healthy weight, obese men were more than eight times as likely to have a low testosterone level. Overweight/obesity can cause ED by damaging the blood vessels, decreasing testosterone and causing a state of generalized inflammation in the body. Obesity can cause damage to blood vessels due to the associated hypertension, diabetes mellitus, hypercholesterolemia, hypertriglyceridemia and inflammation."
Researchers hypothesize that the increased state of inflammation may cause free radicals in the body that cause oxidative damage to tissues, which contributes to ED.
"Studies have linked abdominal obesity to erectile dysfunction, especially in older men," Gomer said. "They suggest that having a BMI [body mass index] of 28 increased a man's risks of developing erectile dysfunction by 90 percent. Losing weight, on the other hand, is linked to improvement in symptoms."
Obesity and reproductive health
We typically think of obesity as being a weight issue that affects metabolic and cardiovascular health, but it is a multisystemic issue that can affect reproductive health, too. In fact, obesity is a very common cause of infertility in both men and women, according to Michael L. Glickman, M.D., a double-board-certified family medicine and obesity medicine physician and the founder of Revolution Medicine, Health & Fitness in Washington, D.C.
"For men, obesity can cause lower testosterone levels and reduce the quality of and quantity of your sperm count," Glickman explained. "For women, obesity can cause dysregulation of the hypothalamic-pituitary axis, which regulates our important sex hormones. Imbalances of our sex hormones leads to difficulties with ovulation and lower rates of implantation of an embryo into the uterus."
He added that women with obesity experience higher rates of miscarriage and pregnancy complications that can affect the mother and her baby.
Carrying extra weight can make it difficult to get pregnant, and many obese women also suffer from polycystic ovary syndrome (PCOS), which is caused by elevated insulin levels, Gomer explained.
"Polycystic ovary syndrome, or PCOS, is one of the most common reasons for infertility in women and can also cause obesity," she said. "Overweight and obesity affect fertility by preventing ovulation. Obesity affects infertility by changing the way a woman's body stores sex hormones."
How? Gomer broke it down. Fat cells convert a male hormone known as androstenedione into a female hormone called estrone. Estrone affects the metabolism in the part of the brain that regulates ovarian and testicular function.
With healthy weight loss, however, these complications can be reversed.
"Studies even show that modest weight loss attempts prior to conceiving can increase the success rate of conception," Glickman said.
Obesity, libido and erectile dysfunction
Obesity can significantly affect sexual health for both men and women in the form of reduced libido due to hormonal changes, Glickman explained.
"For men in particular, excess body weight can reduce testosterone levels significantly. Erectile dysfunction is an extremely common symptom," he said. "In fact, erectile dysfunction is often one of the earliest signs of developing heart disease. Plaque deposits in the penile artery are predictive of plaque deposits also developing in other places around your body, including the heart. ED is also caused by dysfunction of the inner lining of the blood vessels."
Libido is both physical and mental for men and women, and the effects of obesity can potentially impact these facets of a person's sex drive.
"Low testosterone, which may occur in both men and women because of insulin resistance, can tank libido," Gomer said. "Additionally, the mental/self-esteem factor of not feeling good in your skin can make libido fall as well."
Obesity treatment is individualized
Obesity treatment is typically comprehensive and may combine lifestyle changes such as diet and exercise with medications and, perhaps, weight-loss surgery.
The first line of treatment for obesity should involve a healthy eating plan and regular physical activity.
"The plan needs to be tailored and individualized based on that person's lifestyle, labs and goals," Gomer said. "There needs to be support, professionally and personally, to offer support and accountability."
Glickman said the latest medication showing promise to treat obesity is Mounjaro, which was approved in May 2022 by the U.S. Food and Drug Administration (FDA).
"Thus far, it has only been approved to treat type 2 diabetes, however, it shows significant promise as an obesity medication. Participants in studies taking Mounjaro lost, on average, over 20 percent of their starting body weight," he said. "There are also many other medications in the research pipeline that show significant promise as future obesity treatments."
Gomer said there's the more extreme option of weight-loss surgery, mainly the gastric sleeve or bypass.