GLP-1 and its analogues: Does sex matter?

While obesity and diabetes are prevalent in both men and women, some aspects of these diseases differ by sex. New blockbuster class of therapeutics, Glucagon-like peptide 1 (GLP-1) analogues (e.g. semaglutide), shows promise at curbing both diseases. This review will address the topic of sex differences in the endogenous and therapeutic actions of GLP-1 and its analogues. Work on sex differences in human studies and animal research will be reviewed. Preclinical data on mechanisms of potential sex differences in the endogenous GLP-1 system as well as the therapeutic effect of GLP-1 analogues, focusing on the effects of the drugs on the brain and behavior relating to appetite and metabolism, will be highlighted. Moreover, recent clinical evidence of sex differences in the therapeutic effects of GLP-1 analogues in obesity, diabetes, and cardiovascular disease will be discussed. Lastly, we will review evidence for the role of GLP-1 analogues in mood and reproductive function, with particular attention to sex differences. Overall, while we did not find evidence for many qualitative sex differences in the therapeutic effect of clinically approved GLP-1 analogues, a growing body of literature highlights quantitative sex differences in the response to GLP-1 and its analogues as well as an interaction of these therapeutics with estrogens. What also clearly emerges is the paucity of data in female animal models or women in very basic aspects of the science of GLP-1, gaps that should be urgently mended, given the growing popularity of these medications especially in women.