Can I Take Semaglutide and Testosterone Together?

If you’re a man with low testosterone, losing weight can feel like an uphill battle. Your energy is low, your metabolism has slowed, and hitting the gym doesn’t deliver the results it used to. That’s where testosterone replacement therapy (TRT) comes in: Restoring testosterone levels helps build muscle, burn fat, and improve motivation.

Then there’s semaglutide, the GLP-1 drug behind Ozempic and Wegovy, which works in an entirely different way to support weight loss: it dials down appetite, stabilizes blood sugar, and shifts the body into fat-burning mode.

Together, testosterone and semaglutide tackle weight loss from both sides for the right candidates. Understanding how they interact, when the combination makes sense, and when it doesn’t, is key. Here’s what experts say about using semaglutide and TRT together for fat loss, muscle growth, and metabolic health.

About the Experts:

Lester Lee, M.D., is a regenerative medicine physician specializing in hormone replacement therapy.

Taylor Kohn, M.D., is a fellow in male reproductive medicine and surgery at Baylor College of Medicine

James Staheli, D.O., is the medical director for Broad Health and a family medicine doctor specializing in hormone treatment for men.

The Link Between Fat Loss and Testosterone Levels

Losing body fat can help raise testosterone levels. One reason is that fat tissue contains aromatase, an enzyme that converts testosterone into estrogen. The more body fat a man carries, the more this conversion can occur. As body fat drops, aromatase activity also tends to decrease, leaving more testosterone in circulation.¹

“Testosterone is converted to estrogen in peripheral fat,” explains Taylor Kohn, a fellow in male reproductive medicine and surgery at Baylor College of Medicine. “So the less fat you have,  more of your testosterone stays as testosterone and doesn’t convert to estrogen.”

With semaglutide, the relationship is a little more complicated. Research suggests GLP-1s are associated with increased total testosterone in men with obesity, type 2 diabetes, or borderline low testosterone levels.² But that doesn’t mean more testosterone is available for use. Here’s why:

• Free testosterone, the form the body can use, can sometimes decline with semaglutide use. 
• As blood sugar control improves, levels of sex hormone-binding globulin (SHBG), a protein that attaches to testosterone, can increase. 
• When SHBG increases, more testosterone is bound up and less is circulating freely.³

Can You Safely Combine Ozempic and Testosterone?

For men with clinically confirmed low testosterone and obesity or weight-related metabolic concerns, combining semaglutide and TRT is generally considered safe. Some experts believe pairing the two could lead to more weight loss than either treatment alone.

“[Using TRT and semaglutide together] seems to be a nice combination for the person who has low testosterone and is trying to lose weight, but just doesn’t necessarily have the energy to be able to go and do workouts,” says Kohn.

This combination isn’t recommended for men with normal testosterone levels. If you have a condition that makes either medication risky, including a history of pancreatitis, medullary thyroid cancer, a family history of thyroid cancer, or a heart attack or stroke within the last six months, your physician will likely advise against it.

While physicians frequently prescribe semaglutide and TRT together, they typically start patients on one treatment before adding the second.

“When a man has both low testosterone and weight concerns, the initial treatment often targets the most pressing issue,” says James Staheli, D.O., a family medicine doctor who specializes in hormone health. “Severe low testosterone symptoms may necessitate starting with TRT, while significant weight loss goals might prioritize a GLP-1 like semaglutide.”

Starting both simultaneously has a practical complication: if a side effect occurs, it can be difficult to know which drug caused it, says Staheli.

Does Ozempic Improve Testosterone?

GLP-1’s effects on testosterone haven’t been extensively researched, and early studies show mixed results.

Research showing testosterone increase:

• Men with obesity or type 2 diabetes who used GLP-1 medications saw significant weight loss and improved testosterone levels in a 2025 retrospective study presented at the Endocrine Society’s annual meeting.⁴ After roughly 18 months, participants lost about 10% of their body weight and average total testosterone increased by 18%, suggesting that weight reduction from GLP-1 therapy may help reverse obesity-related low testosterone.
• Across a group of 25 men taking semaglutide with low testosterone and type 2 diabetes,  total testosterone increased by an average of 27%.⁵ The study authors suspect weight loss drives this effect, though GLP-1 agonists may also influence testosterone through their impact on inflammation and hormone signaling in the brain.

Research showing testosterone decrease: 

While research suggests an increase in testosterone for men with type 2 diabetes, results are different for men without diabetes: 

• Non-diabetic men using semaglutide were slightly more likely to develop low testosterone than those who weren’t. The risk was small, less than 1.5%.⁶ Kohn, an author of this study, says men who take semaglutide are likely to see testosterone rise over time as they shed fat and produce less estrogen in their fat cells.

Semaglutide and SHBG

Total testosterone may increase with semaglutide use in men with type 2 diabetes, but free testosterone can sometimes decline. As blood sugar control improves with weight loss, SHBG levels may rise, binding more testosterone and reducing the amount that circulates freely.⁷

The Benefits of Combining Treatments: Muscle Mass Preservation

Pairing semaglutide with TRT may help men with low testosterone lose fat while preserving muscle mass. While semaglutide reduces appetite, one study found that 45 percent of the weight people lost on the medication came from lean muscle mass.⁸ TRT helps build muscle and gives you the energy to make healthier food and exercise choices, says Kohn.

“You need a certain amount of testosterone to be able to maintain the turnover of your muscles,” says Kohn. “So in theory, people who have low testosterone and take semaglutide experience less muscle mass.” Resistance training and a high-protein diet are essential for preserving muscle, whether you’re on TRT, semaglutide, or both, says Lester Lee, a regenerative medicine physician specializing in hormone replacement therapy.

Combining semaglutide and TRT may also support emotional well-being, says Lee. TRT boosts mood on its own, and losing weight while gaining muscle may help you feel better about your body.

What Are the Monitoring and Dosing Considerations?

When combining semaglutide and TRT, your Hone physician will track 50+ biomarkers tested every few months as you continue treatment. The following markers are important to watch closely on a GLP-1:

• Total testosterone: If you’re combining semaglutide with testosterone, it’s particularly important to monitor testosterone levels every three months, says Kohn. This approach aligns with Hone’s TRT membership, which emphasizes regular testing to ensure levels remain stable.⁹ 
• Free testosterone: Free testosterone, the form that isn’t bound so it’s available to the body to use, may decline even when total testosterone rises, because semaglutide-related weight loss can increase SHBG levels, which bind more testosterone and reduce the freely circulating amount.¹⁰
• Hematocrit: Testosterone increases the risk of polycythemia (excess red blood cells) —  condition that increases the risk for dangerous blood clots, including heart attacks and strokes — so hematocrit must be measured before starting TRT. During treatment, a hematocrit at or above 54% requires medical attention, which typically involves therapeutic phlebotomy and dose adjustment.¹¹
• PSA: Your physician will also monitor PSA levels throughout TRT to screen for prostate health changes.¹² Because low testosterone can suppress PSA, baseline levels before TRT may be artificially low — so your physician will monitor for any significant rise during treatment, which can signal prostate cancer.¹³
• Glucose: Both semaglutide and TRT lower blood sugar — semaglutide by triggering insulin release and suppressing glucagon; TRT by improving insulin sensitivity. Taking both together raises the risk of hypoglycemia (dangerously low blood sugar), so your physician will monitor your glucose levels closely.
• HbA1c: HbA1c captures your average blood sugar over the past three months. A 2015 study of men taking testosterone therapy and the GLP-1 liraglutide identifies HbA1c as the primary marker showing whether men’s metabolic health improved on these medications.¹⁴
• Fasting Insulin: Low testosterone is associated with insulin resistance, and TRT has been shown to improve insulin sensitivity.^{15 16} Since semaglutide also lowers insulin resistance, tracking your fasting insulin helps your Hone physician monitor the combined effect of the medications and watch for complications such as hypoglycemia. 
• hs-CRP: High-sensitivity C-reactive protein (hs-CRP) is a marker of systemic inflammation, and both TRT and semaglutide reduce it. A study in hypogonadal men found that nine months of TRT cut hsCRP levels by more than half (from 1.49 to 0.70 mg/L; p < 0.05), and separate randomized clinical trials show that semaglutide produces a significant decrease in CRP in obese patients with or without type 2 diabetes.^{17 18}
• Uric Acid: Elevated uric acid is common in men with metabolic syndrome, and semaglutide has been shown to modestly improve it.¹⁹ Tracking uric acid is useful because rapid weight loss — which semaglutide can accelerate — can temporarily spike levels and increase gout risk before they normalize.²⁰

Who Shouldn’t Combine TRT and Semaglutide?

TRT should only be used if you have hypogonadism, meaning clinically low testosterone. “If someone has a normal testosterone level and is starting on semaglutide, it would not be advisable to add TRT,” says Kohn.

Your body can only use so much testosterone. If you have normal levels, adding more doesn’t add benefits; it only introduces the risk of side effects, says Kohn.

TRT is not recommended if you have:²¹

• Uncontrolled heart failure*
• A recent heart attack (within six months)
• Untreated high blood pressure
• Sleep apnea
• A history of prostate cancer
• Plans to start a family (TRT suppresses fertility)

*”Patients with other cardiac issues, if well managed, may be treated for low testosterone but require close cardiac monitoring,” says Staheli.

Avoid semaglutide if you have a history of:

• pancreatitis
• medullary thyroid cancer
• a family history of thyroid cancer

If your BMI is under 27

Semaglutide is FDA-approved for weight management in people with a BMI of 30 or higher, or 27 or higher with at least one weight-related condition such as high blood pressure or high cholesterol. It’s also approved for type 2 diabetes. Nearly half of Americans meet these criteria.²² Taking semaglutide for other conditions carries risk. Off-label use was one of the top factors in adverse event reports about semaglutide.²³

TRT and semaglutide must be prescribed by a licensed physician who reviews your health history first. Both have potential for side effects, but if you’re eligible for both medications, using them together is unlikely to add extra risk, says Lee.

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About the author

Julie Stewart is a writer, editor, content strategist, and NASM-certified personal trainer. Her work has been published by leading consumer brands like Men’s Health, AARP The Magazine, EatingWell, Prevention, SELF, Everyday Health, Shape, WebMD, Medscape, and more.

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