Type 2 diabetes (T2D) often leads to significant microvascular and macrovascular complications. Erectile dysfunction (ED) is a common yet frequently underdiagnosed complication of T2D, affecting up to 60 % of men with T2D, substantially diminishing quality of life.1 The true prevalence of ED in this population may be even higher due to underreporting by patients.2 In recent studies, glucagon-like peptide-1 receptor agonist (GLP-1 RA) have been associated with improvements in ED.3, 4, 5, 6, 7 Given that ED is primarily driven by endothelial dysfunction, vascular disease, neuropathy and metabolic dysregulation, it is biologically plausible that GLP-1 RAs may offer a novel therapeutic potential in alleviating ED in men.6 Whether a class effect exists with GLP-1 RAs on ED remains unknown. Given the high prevalence and significant impact of ED among men with T2D, discovery of drug therapy options with such non-glycemic benefits is needed.

Emerging drug therapies for T2D are being studied beyond their ability to manage glycemia, forming the basis for how treatment regimens are chosen.8 Tirzepatide, the first GLP-1 RA/glucose dependent insulinotropic polypeptide (GIP) combination has high glycemic and weight loss efficacy.8 Though it's cardiovascular outcomes trial is ongoing, myriad of non-glycemic benefits have been associated with tirzepatide. Notably, across the SURMOUNT and SURPASS clinical trial programs, tirzepatide has been associated with improved metabolic outcomes, benefit against nonalcoholic fattly liver disease, and slowing kidney function decline.9,10 To date, the impact of tirzepatide on ED is unknown. Given it's high efficacy on improving metabolic factors that worsen ED, our objective was to evaluate the risk of developing ED with tirzepatide in men with T2D compared with several contemporary treatments used in the management of T2D.