Sugar, sex and your health: The connection you might be ignoring
When most of us think about sugar, I bet we're not thinking about our sex lives. We're thinking about dessert. I'm writing this with the help of a bowl of vanilla ice cream by my side.
Sugar makes us feel good in the moment, but over time, too much of it may cause us to lose out on some of life's most intimate moments.
In 2025, everyone's been buzzing about GLP-1 injections to help control sugar and lose weight. This new class of medication has helped many achieve meaningful health gains — including improved blood sugar, weight loss — and even improvements to people's sex lives (because they could be getting better sleep, too).
My goal here isn't to discount the use of GLP-1 drugs or suggest people are taking them unnecessarily (although some people may be). My intent is to spark a broader conversation: What if we also paid more attention to the root cause: our love for sugar and its downstream effects on mood, metabolism, sex and more?
Most people associate blood sugar with diabetes, but few know what is 'normal.'
Blood sugar levels can be checked in real time with a simple finger stick, via home glucose monitor or through wearable devices such as continuous glucose monitors (those coin-size devices you may see on people's upper arms), which provide feedback on glucose levels throughout the day.
What do we see when this test is done? Following is the American Diabetes Association range of reference for blood glucose levels, but they are not meant for you to diagnose yourself with diabetes. In many instances, your provider may double- or even triple-check these numbers before labeling you with 'diabetes.'
All numbers should be evaluated by your health care provider.
Fasting blood sugar (no food for at least eight hours prior):
Normal: below 100 mg/dL (milligrams per deciliter)
Prediabetes: 100 to 125 mg/dL
Diabetes: 126 mg/dL or higher
Random blood sugar (taken any time of day):
Diabetes is often diagnosed if levels are 200 mg/dL or higher with symptoms.
The point-of-care glucose test gives a snapshot, but there's one lab that tells the full story — the hemoglobin A1c.
This blood test measures the percentage of hemoglobin proteins in your blood that have glucose attached to it — giving you and your health care providers a picture of your average blood sugar over the past two to three months. This makes it a reliable indicator of how well your body manages glucose over time.
Here's how the American Diabetes Association breaks it down:
Normal: A1c below 5.7%
Prediabetes: 5.7% to 6.4%
Diabetes: 6.5% or higher
In my work as a surgeon, checking A1c before any procedure — especially those involving implants — is standard practice. Elevated A1c levels are strongly linked to poor recovery, infection risks and surgical complications. So, whether it's a major urologic procedure or something else, keeping your glucose in check matters more than most people realize.
Sexual health is rarely the first thing people associate with blood sugar, but chronically high glucose levels can have an impact on intimacy — for everyone.
In men, high blood sugar can damage the nerves and blood vessels essential for achieving and maintaining erections. Over time, this can present as erectile dysfunction, before a man is ever diagnosed with or thought to be at risk for diabetes. High blood sugar can also lower testosterone levels, which then reduce libido and energy.
Many of my patients who do not get routine screenings from their primary care providers come to see me because of changes in sexual performance — only to later discover their blood sugar is out of control. For these patients, their first clue that something was wrong wasn't thirst, weight changes or fatigue (the more common early signs of diabetes) — it was trouble in the bedroom.
In women, high blood sugar can lead to reduced blood flow and hormone imbalances, which may cause vaginal dryness, painful sex or problems with orgasm. It can also increase the risk of recurrent urinary tract infections, which can make intimacy painful or less appealing. Many women can feel frustrated and confused about whether these changes are expected from aging, post-menopause, stress or something else. A poor sugar level is usually the last thing on their mind.
Diabetes is incredibly common — about 38 million Americans have it — and nearly 1 in 4 don't even know it, according to the US Centers for Disease Control and Prevention.
Traditionally, diabetes treatment started with oral medications like metformin, which helps lower glucose by reducing sugar production in the liver. Other classes of pills work in different ways, either by increasing insulin release or helping the kidneys flush out excess sugar. These medications are typically prescribed for people in the earlier stages of diabetes or with mildly elevated A1c.
Injectable medications may be necessary when oral pills aren't enough to treat the disease. For years, that often meant daily insulin injections, which many patients found to be burdensome but necessary. Insulin needs to be carefully timed with meals, and dosing can be tricky. There's also a real fear of low blood sugar episodes, which can make some people hesitant to start or stick with the therapy.
Over the past few years, GLP-1 receptor agonist drugs have become part of many people's treatment regimens. This class of medication is known by names like semaglutide, liraglutide and tirzepatide. These injections mimic a natural hormone in your body that helps regulate blood sugar, slows down digestion and make you feel fuller faster.
While they were originally developed to treat type 2 diabetes, they've gained worldwide attention for helping people lose weight. In fact, many patients now ask and get these medications before any other option — not just to manage blood sugar, but to lose weight.
These medications also may help normalize testosterone levels in men with obesity or type 2 diabetes, according to preliminary research presented at the Endocrine Society's annual meeting this week.
Researchers tracked 110 men who were prescribed GLP-1 injections but were not taking any testosterone therapy. Over the course of 18 months, as participants lost on average about 10% of their body weight, the number of men with normal testosterone levels increased from 53% to 77%. This rise highlights how medications originally designed for diabetes and weight loss also may improve hormone levels in men.
While this abstract has not yet been peer-reviewed and more research is needed, these findings add to a growing body of evidence that managing weight and blood sugar can have ripple effects across nearly every aspect of health — including testosterone, energy and sexual function.
Before turning immediately to medications, don't underestimate what consistent lifestyle changes can do, not just for your blood sugar but for your whole life.
Regular exercise improves insulin sensitivity, supports weight loss, boosts energy and even enhances sexual function by improving blood flow and hormone balance. A balanced diet — one that's rich in whole foods, fiber and lean protein — can stabilize blood sugar and reduce inflammation that contributes to chronic disease. Better sleep, reduced alcohol and managing stress all play a role, too.
So, if you're debating between an injection or a new routine, maybe this time reach for the gym bag before you try anything else. You might just find it changes more than your labs. It might change how you feel about yourself.
As for me, the next time I help myself to that scoop of ice cream while writing, I'll remember that it's not just about my waistline — it's about my energy, my heart and my sexual health. And now that I'm done with this article, I'll pick up my gym bag and walk the walk (to the gym) that I'm talking here.
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