The PGspot - Beyond the Scale: GLP-1's, Libido, and Identity

In this episode of The PGspot, we explore the complex and often overlooked effects of GLP-1 medications beyond weight loss. While these treatments are transforming the landscape of obesity care, their impact doesn’t stop at the number on the scale. We dive into the nuanced connections between GLP-1 use, changes in libido, and the evolving sense of identity that can accompany rapid physical transformation.

How do shifting hormones, body image, and self-perception influence intimacy and relationships? What happens when the external changes outpace the internal adjustment? This conversation unpacks the psychological, emotional, and relational layers of weight loss in a way that goes far deeper than before-and-after photos.

If you’ve ever wondered how weight loss medications intersect with sexuality, confidence, and identity, this episode offers insight, validation, and a more holistic perspective on what it really means to change your body, and yourself.

If you want to learn more about sexual health, sexual dysfunction, or how to improve your sex life, follow me on Instagram at @thepgspot or check out my website at doctorpattyj.com for blogs and resources related to sex positivity and real talk about sexuality.  As as always, stay curious, stay empowered, and stay you.

Transcript

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Welcome to the PG spot where our goal is to take the X outta sex by breaking down the barriers that prevent open communication about sexual health. I'm Dr. Patty Jalomo. A dual certified nurse practitioner, pelvic floor therapist, and certified sexual counselor. I'm here to provide expert insights, debunk myths, and empower you to embrace your sexual wellbeing. Whether you're looking for answers or simply curious, join us as we open up the conversation around sex, intimacy and everything in between. I want to take this opportunity to acknowledge that some content may not be appropriate for all listeners. I'm a huge proponent of honest and accurate information regarding sexuality, but I'm also mindful that this should be age appropriate. Therefore, if you are under 18, this may not be the podcast. For you. Additionally, some of the language used in this podcast may be offensive to some listeners. Please take these things into consideration before going forward with your consensual participation in this podcast. The opinions expressed by myself or my guests are just that, and these opinions are neither expected nor required to be shared by all listeners. The information that is provided is for educational and entertainment purposes only, and should not be mistaken for individual medical advice. If you would like to schedule a virtual visit for individual or couples sexual counseling or menopause management, you can contact me via my website@thepgspot.com. Thanks for listening, and let's get on with the show. Welcome back to the PG spot. I'm your host, Dr. Patty Jalomo. Today we're diving into a topic that sits at the intersection of medicine, psychology, and relationships. It's something that's rarely discussed in clinical visits, but increasingly relevant as more patients begin GLP one based medical weight loss therapy. You may be wondering why we're talking about medical weight loss therapies on a podcast about sexual health, but I promise you it's so much more relevant than you might think. As some of you may know, I offer counseling for individuals and couples struggling with sexual health issues through my virtual clinic, the Sexual Health Collective. Additionally, I also work with many clients, both in person and virtually for hormone management. Recently, I added medical weight loss therapy to my practice because I started to realize that weight gain is one of the most common complaints in midlife. What's becoming increasingly clear in both clinical practice and emerging literature is that weight loss is not just metabolic. It's deeply psychosocial As patients experience rapid changes in body size, appetite and energy balance, they often also experience shifts in self perception, identity, and relationships. And this is where today's conversation comes in. We are going to talk about something that doesn't always make it into the prescribing conversation. How GLP one associated weight loss can influence body image, libido, and intimacy. These are not just side topics, they're core components of quality of life and overall wellbeing. yet they are often underdressed in routine care. The goal here is not to pathologize these changes, but to normalize them because as clinicians, understanding the full impact of these therapies helps us better support patients beyond the scale. I'd like to spend a few moments discussing the history of the GLP one receptor agonist medications and their importance to overall longevity and healthcare dollars. GLP stands for glucagon-like peptide. This is a natural hormone that your body makes in the gut after you eat. GLP one plays several important roles, especially in regulating blood sugar and appetite. GLP one stimulates insulin release, which helps lower blood sugar, reduces glucagon a hormone that raises blood sugar. Slows stomach emptying so you feel full longer and decreases appetite, and that helps control food intake. So when did we figure out that we could use this naturally occurring hormone to treat things like obesity and diabetes? Well, that's kind of an interesting story. In 1992, an endocrinologist and researcher at the Bronx VA Medical Center in New York named Dr. John Eng isolated two compounds from the venom of a Gila monster lizard. One of the compounds in the venom caused pancreatitis to its victims, and appeared to have properties similar to the gut peptide GLP one. In 2005, this compound was formulated into the drug exenatide as Byetta. Since then, other drugs have been FDA approved, including liraglutide, a brand name, Victoza and Saxena. dulaglutide or Trulicity and semaglutide, which is Ozempic and Wegovy. Additionally, GLP one has been combined with another peptide called gastric inhibitory peptide, or GIP, to form the medication tirzepatide, which we know as Mounjaro and Zepbound. There is yet another medication that I believe is still in phase three clinical trials called retatrutide that is referred to as a triple agonist because it combines the GLP one GIP, and glucagon peptide receptor agonists all in one medication. GLP one based therapies have rapidly reshaped the landscape of obesity treatment, Providing a powerful and evidence-based tool in addressing one of the most pressing public health challenges in the U.S. Obesity is a chronic condition that has reached epidemic proportions, particularly in the United States. According to data from the National Health and Nutrition Examination Survey or nhanes, nearly one in three adults or 30.7% are overweight and more than two in five or 42.4% meet the criteria for obesity. These figures represent well over a million adults and likely have continued to rise. Additionally, approximately one in 11 adults or 9.2% has severe obesity among individuals assigned female at birth. About one in four 27.5% are overweight. The annual healthcare costs associated with obesity are estimated at $147 billion. underscoring the significant economic burden of this disease. In this context, GLP one receptor agonists have emerged as a pivotal advancement offering, an effective evidence-based approach to weight loss and long-term weight management. However, their rise in popularity did not occur overnight. These medications have been approved by the US Food and Drug Administration for the treatment of type two diabetes for over two decades. Medications like Semaglutide and Tirzepatide, which act on the GLP one receptor pathways were initially developed for type two diabetes, but are now widely used for weight management. Due to their effects on appetite regulation, satiety, and metabolic health. Large clinical trials have demonstrated significant weight reduction with these therapies, which has understandably made them a major tool in obesity treatment. But it really goes deeper than that. The Step One trial was a major study published in the New England Journal of Medicine in 2021. This research demonstrated that GLP one receptor agonists produce substantial weight loss, reinforcing their role in metabolic treatment, but also highlighting the importance of monitoring broader patient-centered outcomes beyond weight alone. For example, a consistent theme that can be seen clinically with GLP one based weight loss is that the body often changes faster than the mind can keep up. Patients may lose a significant amount of weight in a relatively short period of time, but their internal self-image doesn't always update at the same pace. So even when the scale is moving, the mirror experience or how they see themselves. And more importantly, the internal narrative can lag behind. This mismatch between physical change and psychological identity is something we see across weight loss research more broadly. Body image is not just a reflection of current size. It's shaped by years of lived experience, reinforcement and self-perception. Because of that, even meaningful weight reduction doesn't automatically resolve longstanding body image concerns. Some patients describe feeling more confident almost immediately, especially as mobility improves or physical symptoms decrease. Others describe something more complex, almost a sense of unfamiliarity with their body or difficulty integrating that new version of themselves into how they move through the world. This complexity highlights why weight loss should not be viewed as a purely physical intervention, even when outcomes are medically beneficial. The psychological adjustment to body changes can lag behind physiologic progress, and in some cases may even introduce new sources of distress without intentional assessment. These experiences can go unrecognized in clinical practice, Particularly when weight loss is assumed to correlate directly with improved wellbeing. Incorporating routine discussions about body image identity, and emotional adaption into follow-up care is therefore essential, allowing clinicians to better support patients as they navigate not only how their body changes, but how they come to understand themselves within those changes. This mismatch doesn't just affect how someone sees themselves. It can also begin to shape how they show up in their relationships, especially intimate ones. Body image is closely linked not only to self-perception, but also to interpersonal relationships and intimacy with changes in weight and appearance influencing psychosocial functioning and relationship dynamics. Body image is also deeply tied to vulnerability. When that internal sense of self is shifting, patients may notice changes in comfort with physical intimacy being seen by their partner or even initiating closeness for some increased confidence enhances connection for others, there can be a period of uncertainty, feeling both different and not fully adjusted yet. Partners may not always understand what's happening. They may notice changes in behavior, confidence, or boundaries without having the context for it, which can unintentionally create distance or miscommunication. Research in obesity and psychology supports the idea that body image is not just about appearance, but about identity, self-concept, and interpersonal functioning. Because of that, even positive physical changes can come with complex emotional and relational adjustments. obesity. Research highlights that body image disturbance can persist after weight loss and is associated with emotional wellbeing and social interactions, reinforcing the need to address these factors in clinical care. This is where it becomes important to normalize the psychological adjustment process. Weight loss isn't just a physical transformation, it's an identity shift. So in practice, it's important to prepare patients for this early, not just what their body may do on these medications, but how their perception of self may evolve alongside it. Now let's shift into another area that patients don't always expect, but often notice, which is changes in libido and sexual function. Sexual function is influenced by both metabolic health and psychosocial factors and improvements in obesity related conditions are often associated with changes in sexual desire and function. One of the most interesting things here is that. There isn't just one pattern. Some patients report an increase in sexual desire while others notice a decrease, especially early on in treatment, and both responses can make sense when you look at what's happening. Physiologically and psychologically, obesity has been linked to sexual dysfunction. While weight loss and improved metabolic parameters may lead to improvements in sexual health outcomes. From a physiologic standpoint, weight loss, especially when it improves insulin resistance, can positively influence hormonal balance, energy levels, and overall metabolic health. In some individuals, this translates into improved sexual function and increased desire. At the same time, GLP one medications can come with side effects like nausea. Early satiety or fatigue, particularly during dose escalation. And when someone doesn't feel well physically, it's very common for libido to decrease temporarily. There's also a central physiologic component to consider. GLP one receptors are present in areas of the brain involved in reward and appetite regulation, Researchers believe that GLP one receptor agonists may act on these brain reward pathways, thereby affecting dopamine signaling. This is why researchers are now studying their effects, not just on food intake, but also on alcohol use and other addictive behaviors. in fact, a 2025 systematic review and meta-analysis found that GLP one receptor agonists were associated with a significant reduction in alcohol use, severity scores and drinking behavior Compared with controls. So while we know that these medications modulate food related reward pathways and there's early evidence of influence on other reward driven behavior, it makes sense that there's growing discussion about whether they may also influence sexual desire. although this is still an evolving area of research, it's certainly something to be cognizant of when discussing the use of GLP one. And then there's a psychological layer. As body image shifts, confidence may increase, but so can vulnerability. patients may feel more visible, more noticed, or even unsure of how they want to express themselves in intimate settings. All of that can influence desire in ways that aren't strictly hormonal. Research supports that sexual function is closely tied to both physical health and psychosocial factors, particularly in the context of weight and metabolic disease. Improvements in metabolic health can enhance sexual functioning, but emotional and relational factors play an equally important role. Weight loss can influence relationship dynamics, including satisfaction, communication, and partner interactions reflecting the broader psychosocial impact of obesity treatment. So what I tell patients is this, if your libido changes during treatment, either up or down, that's not unusual. The key is to look at the full picture, how you're feeling physically, how your body's changing, and what's happening in your emotional and relational world. At the same time as we've discussed, weight loss, especially when it's significant or relatively rapid, doesn't just affect one person. It can shift the dynamic between partners in a way that's sometimes subtle and sometimes very noticeable. For some couples, these changes are positive. Improved energy, confidence, and physical comfort can enhance connection and intimacy. Patients may feel more engaged, more present, and more open in their relationships, but that's not the only experience. Sometimes a partner may feel uncertain or even threatened by the changes. Roles within the relationship can shift, especially if weight health or caregiving dynamics were part of the relationship identity. Increased attention from others or changes in confidence can also introduce feelings like jealousy or insecurity. And from the patient's perspective, there can be internal shifts in boundaries, attraction, or how they relate to their partner. They may be renegotiating how they see themselves, while also trying to maintain stability in the relationship, which isn't always straightforward. What's important to recognize is that these changes are often unintentional. No one is doing anything wrong, but the relationship is adapting to a new reality. That's why communication becomes so important during this process. Naming what's changing both individually and as a couple can help prevent misinterpretation and disconnection. From a clinical standpoint, this is another area where we can better support patients. In addition to preparing patients for physical changes, it's important to acknowledge and discuss that their relationship may evolve as well. Comprehensive care includes addressing psychological, behavioral, and social factors alongside medical treatment, reinforcing the importance of holistic patient-centered approaches. I think the first step is recognizing that potential changes in body image, libido, and relationship dynamics are not side effects in the traditional sense, but they are very real outcomes of treatment. And if we're not asking about them, patients often won't bring them up on their own. Research consistently shows that patients may hesitate to discuss sensitive topics like sexual health or relationship concerns unless clinicians initiate the conversation, but it doesn't have to be that way. In fact, that's a big part of what this podcast is about. So, if you're a patient and listening to this, don't be afraid to bring up these topics. If you feel uncomfortable or nervous, keep notes on your phone so that you don't forget anything important. It's completely reasonable to have questions or concerns about how your weight loss journey is affecting your relationships. And if you're a clinician, this means that it's on us to create space for those discussions in a way that feels normal and non-judgmental. In addition to asking about side effects, be sure to inquire about how your patients are feeling in their bodies as things are changing. Ask if they've noticed any changes in energy, mood, or desire. And follow that up with an interest in how things are feeling in their relationship. Even brief check-ins like this signal to patients that these experiences are valid and worth discussing. I also think expectation setting is key. When I start patients on GLP one therapy, I talk not only about potential physical side effects, but also the possibility of emotional and relational shifts. Framing it this way helps patients feel less caught off guard if these changes come up. while this may not happen on the first visit, it's just as important as monitoring the numbers on the scale during follow-up appointments. Ongoing follow up provides an opportunity to evaluate evolving interpersonal dynamics that may impact overall wellbeing as well as the physical impacts. And finally, knowing when to expand support is important. Some patients may benefit from therapy, couples counseling, or more in-depth conversations around identity and self-image, especially if changes feel distressing or disruptive. Guidelines from the American Association of Clinical Endocrinology emphasize a comprehensive patient-centered approach to obesity care, including attention to psychological and behavioral factors alongside medical treatment. At the end of the day, this is about treating the whole person, not just the weight. So if you're someone who is on A GLP medication or considering starting one, what do you actually do with all of this? first. Understand that changes in body image, desire, or even your relationships are not unusual. Weight loss is not just a physical process. It's an emotional and psychological journey too. Giving yourself permission to adjust over time is important. Second, pay attention to your internal experience, not just the number on the scale. How do you feel in your body? Has your confidence shifted? Has your interest in intimacy changed? These are all meaningful data points, not just side notes. Third, communication matters. If you're in a relationship, sharing what you're noticing, especially if things feel different, can help prevent misunderstandings. Even simple conversations can create a lot more alignment and support. And finally, don't hesitate to bring these topics into your medical visits. Your provider should be someone that you can talk to about the full picture. they should be asking not just about weight, but about how your life and relationships are evolving alongside it. Okay. Patient-centered care models, including those supported by the American Association of Clinical Endocrinology, emphasize that successful weight management includes attention to emotional wellbeing, behavior, and quality of life, not just clinical outcomes. Because at the end of the day, the goal isn't just weight loss. It's feeling well, functioning well and living well. As we wrap up today's conversation, I want to bring this back to something very simple but also very important. GLP one. Medications have changed the landscape of medical weight loss in a powerful way. We're seeing meaningful improvements in weight, metabolic health, and chronic disease risk, but as we've talked through today, the impact doesn't stop at the physical body. Changes in body image, intimacy, libido, and relationships are all part of the broader experience of transformation. And for many people, those changes can be just as significant as the number on the scale. What I hope you take away from this episode is that none of these experiences are unexpected problems. They're human responses to change and when we acknowledge them early, we can navigate them with far more awareness, support, and intention. If you're currently on a GLP one medication, considering starting one or supporting someone who is, I encourage you to think beyond weight alone. Ask yourself how you're feeling, how you're relating to yourself, and how your connections with others may be evolving. and if you want more personalized support with medical weight loss, whether that's starting GLP one therapy, optimizing your treatment plan, or navigating the emotional and relational aspects of this journey, I offer consultations through my practice. Feel free to reach out to me via the contact area on my website. At thepgspot.com, you don't have to go through this process focusing only on the scale you deserve care that looks at the full picture, your body, your mind, and your relationships. That's it for today's episode. Thanks for listening, and be sure to rate and review the podcast on whatever platform you're listening from and share it with your friends. That's a great way to help reach new listeners and make this a more sex positive world. Until next time, stay curious, stay empowered, and stay you.