- Semaglutide (Ozempic) can influence hormones indirectly, primarily through weight loss and improved insulin sensitivity.
- Hormone-related changes, including sex hormones and thyroid markers, are usually secondary to metabolic effects.
- Evidence is still emerging, especially regarding long-term reproductive and thyroid outcomes in otherwise healthy midlife women.
If you've been considering Ozempic or heard about it in headlines, you may be wondering: Does Ozempic affect hormones? This is a common question for women in midlife who want to be proactive about hormonal health.
In this article, we'll summarize what current research shows, what is still unknown, and what women should discuss with their clinician.
At Fem Excel, we partner with leading medical experts, like Dr. Lorna Brudie, our Chief Medical Officer, to ensure hormone care is evidence-informed and patients get the answers they deserve.
What Is Ozempic and How Does It Work?
Ozempic is the brand name for semaglutide, a glucagon-like peptide-1 (GLP-1) receptor agonist. It slows stomach emptying, increases feelings of fullness, and enhances insulin secretion when blood glucose is elevated. It is FDA-approved for type 2 diabetes, and higher-dose formulations are also approved for weight management.
GLP-1 receptor agonists act primarily on metabolic pathways. Many of the hormone-related changes reported in studies are indirect, arising from weight loss, improved insulin sensitivity, or changes in sex hormone-binding globulin rather than a direct effect on endocrine organs.
This distinction is important: Ozempic is not a hormone therapy, but it can influence the hormonal environment through metabolic effects.
Sex Hormones and Menstrual Health
GLP-1 receptor agonists have been studied for effects on sex hormones, particularly in women with polycystic ovary syndrome (PCOS).
Research in these populations shows that:
- Androgen levels often decrease after treatment.
- Sex hormone-binding globulin levels may rise, reducing the activity of androgens.
- Menstrual regularity can improve as a result of metabolic changes.
These hormone changes are usually secondary to weight loss and improved insulin sensitivity, not a direct suppression of ovarian hormone production. In women without PCOS, evidence for meaningful or lasting changes in estrogen, progesterone, or testosterone remains limited.
It's important to note that semaglutide is not recommended during pregnancy. Women using GLP-1 drugs for metabolic purposes should coordinate with their clinician regarding fertility planning, cycle monitoring, and timing of conception.
Thyroid and Other Endocrine Considerations
Concerns about thyroid safety originated in rodent studies, where GLP-1 receptor agonists increased thyroid C-cell tumors. As a result, regulatory labeling includes warnings for people with certain rare thyroid cancers or genetic syndromes.
Human observational studies show variable effects on thyroid markers such as TSH, but clinically significant thyroid dysfunction has not been established. For women with a thyroid condition or a family history of thyroid cancer, discussing the risks and monitoring plan with a clinician is recommended before starting therapy.
Other hormonal effects, such as on cortisol or growth hormone, are minor and largely mediated by metabolic changes rather than direct drug action. This is particularly relevant for women in midlife, when hormonal fluctuations are more pronounced and sensitive to weight and insulin changes.
How Weight Loss Drives Hormone Changes
Weight loss itself drives many hormonal improvements. Adipose tissue influences insulin resistance, sex hormone-binding globulin, and peripheral conversion of androgens and estrogens. When people lose weight, insulin sensitivity improves, which can lower free and total androgens in insulin-resistant states such as PCOS.
This explains why studies often report improved androgen profiles in women taking GLP-1 receptor agonists. The metabolic changes from weight loss, rather than a direct hormonal effect of the drug, are the primary drivers of observed hormone changes.
For midlife women, modest weight loss can also improve estrogen balance, energy metabolism, and overall endocrine function. This interplay highlights why personalized monitoring of hormones is important when using Ozempic or similar medications.
Evidence Strength and Remaining Questions
Stronger evidence:
- GLP-1 receptor agonists reliably reduce body weight and improve metabolic markers, including insulin sensitivity.
- In women with PCOS, these improvements are often associated with better androgen profiles and more regular menstrual cycles.
Emerging or uncertain evidence:
- Direct, long-term effects of semaglutide on ovarian reserve or subtle sex steroid balance in otherwise healthy midlife women remain unclear.
- Large registries and ongoing trials are helping clarify long-term reproductive and endocrine outcomes.
- Evidence in women without metabolic disorders is limited, though no clinically concerning hormonal disruptions have been reported.
Overall, GLP-1 medications like Ozempic appear safe from a hormonal perspective in healthy midlife women, with most effects mediated through weight loss and improved metabolism rather than direct endocrine disruption.
Recommendations for Women in Midlife
Fem Excel emphasizes individualized, evidence-informed plans. Women in their 40s to 60s using or considering Ozempic should:
- Share their full reproductive and thyroid history with their clinician.
- Discuss baseline labs for thyroid, sex hormones, and metabolic markers if symptoms suggest a change.
- Coordinate hormone therapy or fertility planning with a medical provider when appropriate.
Frequently Asked Questions About GLP-1s and Hormones
Does Ozempic lower testosterone in women?
Studies in women with PCOS or insulin resistance report reductions in circulating androgens, usually secondary to improved insulin sensitivity and weight loss. Evidence in healthy women is limited.
Will Ozempic affect fertility?
Current research does not indicate permanent infertility. Semaglutide should be stopped during pregnancy or when planning conception, unless advised by a clinician. Women should discuss family planning with their provider before starting therapy.
Should I adjust my hormone therapy?
Do not change or stop prescription hormone therapy without medical supervision. Fem Excel clinicians tailor adjustments based on labs, symptoms, and personal goals.
Are thyroid warnings serious?
Rodent studies prompted regulatory warnings, but clinically significant thyroid issues in humans remain uncertain. Women with a thyroid condition or family history should discuss individual risk and monitoring strategies with their clinician.
Conclusion
So, does Ozempic affect hormones? Semaglutide can be associated with hormone-related changes, often as a secondary effect of weight loss and metabolic improvements. In women with PCOS, improvements in androgen profiles and menstrual regularity are possible.
For most midlife women without reproductive disorders, evidence of direct hormonal disruption is limited, but research is ongoing.
Sources:
Highlights of Prescribing Information | FDA
Implications Of Glp-1 Receptor Agonist On Thyroid Function: A Literature Review Of Its Effects On Thyroid Volume, Risk Of Cancer, Functionality And Tsh Levels| National Library Of Medicine
