Can you take semaglutide and testosterone together?

More people are exploring how semaglutide and testosterone might work together to support weight loss and hormone health. But is it safe to use GLP-1 receptor agonists (such as  Ozempic, Wegovy, and Mounjaro) alongside testosterone replacement therapy?

Here’s what the research says about combining semaglutide and testosterone, why some people consider it, and who is — and isn’t — a good candidate.

For most people, taking semaglutide and testosterone replacement therapy (TRT) together is considered safe — there are no known direct drug interactions between the two medications. In some cases, the combination may offer additional benefits. That said, always discuss with a healthcare provider before combining semaglutide and testosterone.

Semaglutide is a GLP-1 receptor agonist that regulates blood sugar and appetite, while testosterone is a hormone that influences muscle mass, fat distribution, energy, and sex drive. 

Low testosterone can also contribute to weight gain, and research suggests it is associated with excess belly fat. And, obesity can also lower testosterone levels, creating a cycle that both medications may help address.

Research suggests that weight loss can improve testosterone levels, and researchers are beginning to understand the ways GLP-1 medications may increase testosterone in men with obesity or type 2 diabetes.

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Semaglutide and TRT address weight loss and hormone health differently, but in ways that can work well together. GLP-1 medications slow gastric emptying (the rate at which food moves through the digestive tract) and promote satiety; they also cross the blood-brain barrier, where they can reduce cravings and food noise. TRT has many potential benefits, including supporting muscle mass and energy levels.

• Improved fat loss while maintaining muscle: While semaglutide can produce rapid weight loss, it can also lead to loss of lean muscle mass. TRT may help boost muscle protein synthesis — the process by which the body repairs muscle. One study found that men ages 65 and older with low testosterone levels who were taking TRT lost significantly less lean body mass than those on placebo, despite similar weight loss.

• Better blood sugar control: Semaglutide lowers blood sugar by stimulating insulin secretion when glucose levels are elevated; TRT may reduce insulin resistance and enhance glucose uptake in muscle tissue, meaning sugar is used for energy rather than accumulating in the bloodstream. 

• Cardiovascular risk reduction: Both semaglutide and testosterone may support heart health. One study that looked at over 17,000 people found that people taking semaglutide had fewer serious cardiovascular events, including heart attack and stroke. TRT has been associated with lower levels of total cholesterol and LDL.

• Better mood and energy levels: Low testosterone and excess weight can both affect mental health and energy levels. A clinical trial found that TRT improved mood and energy in men with hypogonadism (low testosterone). Research also suggests that GLP-1 medications may reduce the risk of worsening anxiety and depression, though any effects may be indirect.

• Improves sex drive: Research on semaglutide and libido is mixed — some people report a decrease in desire, while others experience an increase, which may be tied to improvements in body image and confidence. TRT has been shown to improve libido and erectile function in people with low testosterone, and may help offset any unwanted changes in sex drive while taking semaglutide.

It's worth noting that semaglutide may boost testosterone indirectly. A 2026 systematic review found that GLP-1 receptor agonists were associated with increases in testosterone levels, particularly in people with obesity, type 2 diabetes, or functional hypogonadism. While this may improve hormonal balance in some cases, it does not necessarily replace testosterone therapy.

There are no known drug interactions between semaglutide and TRT; however, each carries some potential side effects to be aware of.

• Muscle loss: TRT may help preserve muscle, but appetite suppression from semaglutide can still contribute to muscle loss. Prioritizing protein and strength training while taking GLP-1 medications can help mitigate this risk.

• Fertility issues: TRT is generally contraindicated for people in couples attempting to conceive, as it can significantly reduce sperm count.

• Thickening of the blood: TRT stimulates red blood cell production, which can increase blood thickness. A review found that men on TRT have a significantly greater risk of developing erythrocytosis (elevation in red blood cell concentration), which could raise the risk of blood clots.

Semaglutide and testosterone therapy are intended for people with clinically confirmed hypogonadism (low testosterone), not as part of a weight loss “stack.” The following groups should generally not combine these medications unless specifically directed by a healthcare provider.

• Men with normal testosterone levels:  The American Urological Association defines healthy testosterone levels as falling between 450 and 600 ng/dL, with anything below 300 ng/dL considered low. Adding testosterone when levels are already normal can disrupt hormonal balance and potentially suppress the body's natural production.

• People who are trying to conceive. Supplementing with testosterone can reduce fertility.

• Men with a history of pancreatitis or thyroid cancer. Semaglutide is not recommended for those with a history of pancreatitis, medullary thyroid carcinoma (MTC), or a personal or family history of MTC or multiple endocrine neoplasia syndrome type 2 (MEN 2).

• People with high hematocrit (thick blood) or clotting issues: TRT stimulates red blood cell production, which can thicken the blood and increase the risk of clotting.

• People with sleep apnea. Testosterone may worsen sleep apnea by affecting airway muscle tone and reducing blood oxygen levels.

The combination of semaglutide and testosterone isn't right for everyone, but for some people, it may be an effective approach to losing weight while preserving muscle mass. Consulting with a healthcare provider is recommended before combining them.

• Men with obesity-related low testosterone. Low testosterone and excess body fat are closely linked — each can worsen the other. Excess fat suppresses testosterone, and low testosterone promotes weight gain. Combining semaglutide and testosterone may help address both sides of this cycle.

• Men who are losing weight but not retaining muscle. Semaglutide is highly effective for fat loss, but calorie restriction can also contribute to muscle loss. TRT may help ensure that more of the weight lost comes from fat rather than lean tissue.

• Men who struggle to lose weight with lifestyle changes. Low testosterone can undermine weight-loss efforts by slowing metabolism, making it harder to build muscle, and reducing energy levels. Combining semaglutide and testosterone may help curb appetite and support energy levels, making physical activity more manageable.

• Men with metabolic syndrome. Metabolic syndrome — a cluster of conditions including elevated blood sugar, excess belly fat, and high blood pressure — is closely associated with low testosterone. Research suggests that TRT in men with hypogonadism may improve markers of metabolic syndrome, including blood sugar and cholesterol, which semaglutide also targets.

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Many people wonder whether semaglutide and testosterone can be taken together. The combination isn't right for everyone, but for people with clinically low testosterone and excess weight, combining the two under medical supervision may be worth discussing with a healthcare provider.

• TRT helps protect muscle during weight loss. Rapid fat loss carries a risk of losing lean muscle mass — TRT may help direct weight loss toward fat rather than lean tissue.

• Losing fat may raise testosterone on its own. As semaglutide reduces body fat, less testosterone gets converted to estrogen, meaning fat loss may help restore healthier testosterone levels over time.

• Healthy habits still matter. Combining testosterone and semaglutide is just one part of the equation — healthy habits like following a balanced eating plan and regular exercise will support long-term results.