Marriage and Desire in the Ozempic Era
How weight loss drugs are reshaping intimacy and connection.
Welcome to Lust in Translation, a newsletter exploring what ignites your pleasure, confidence, and desire—by yours truly, sexologist Natassia Miller. If you’re new here, now’s the perfect time to subscribe!
Between 8 to 10 percent of Americans are currently taking GLP-1 medications like Ozempic and Mounjaro, with another 30 to 35 percent interested in trying them, according to a 2024 PwC study.
While we’ve heard plenty about the medical benefits—improved insulin production, blood sugar regulation, significant weight loss for conditions ranging from diabetes to fatty liver disease—there’s a quieter revolution happening in bedrooms across the country.
Earlier this year, The New York Times profiled Jean and Javier, married for 15 years, whose relationship fundamentally shifted after Jean started taking Zepbound for fatty liver disease.
After losing 60 pounds, something more profound changed: Jean, a self-described people pleaser, found her “no”.
She stopped drinking, leaving early from the weekly, booze-filled game night with friends that used to run until 1 AM. She established boundaries with her husband, extended family and colleagues.
And perhaps most significantly, she stopped having sex.
“She hasn’t wanted to have sex for at least five years, she told me, but until last March, she complied,” reports the NYT.
“I felt like it was my responsibility, and I wanted to solve this problem,” said Jeanne in the interview.
While the rest of the article speculated about the impact of GLP-1s on sexual desire, it failed to expand on this important data point.
Zepbound didn’t kill her desire; it gave her permission to finally be honest about its absence and say no to her husband.
When sex becomes another job
This reminded me of the Fifth Shift, a term coined by writer
that I recently learned about in her latest podcast episode.Building on Dr. Arlie Russell Hochschild’s Second Shift—the unpaid caregiving and domestic labor women shoulder after their paid workday ends—Montei traces the evolution through:
the Third Shift (emotional and social labor),
the Fourth Shift (night caregiving and the digital mental load of managing school apps and social calendars),
to this Fifth frontier: the sexual labor women are expected to perform in their straight marriages.
More specifically, women are expected to educate and equip themselves, with little involvement from men, because sex is easy for them.
“Most models of sexual desire begin with men and end with women not quite measuring up,” writes Dr. Gina Ogden in her book Return of Desire.
So when desire predictably wanes under the weight of all these shifts, we’ve been trained to view ourselves through a male lens, to pathologize our own bodies and minds as somehow deficient.
I fully understand the irony of me–an intimacy coach who works with couples on overcoming sexual disconnection–writing this, but if you have ever worked with me, you know that division of labor and mental load is a core part of my coaching.
Without tending to this, I know the rest won’t progress.
This also raises a longer and more tender conversation on what to do when one or both of you have changed, and even about monogamy itself. But that’s not what today’s writing is about.
Which brings me to my next point:
The impact of GLP-1s on sexual desire
Because GLP-1s work by modulating impulse control and pleasure-seeking behaviors (which is why they’re so effective for weight loss), they can dampen other pleasure centers too.
Jackie Giannelli, a New York City-based nurse practitioner specializing in longevity, GLP-1s, and hormones, has found some of her clients to be experiencing “anhedonia” or “flattening”—a loss of pleasure, motivation, and vitality.
Research suggests that GLP-1 receptors in brain regions associated with reward and motivation may interact with serotonin pathways, particularly the 5-HT2C receptor, which is linked to decreased sexual desire.
A 2025 study by Tveit et al. published in The Journal of Sexual Medicine proposed this serotonergic mechanism could reduce sexual desire, and social media data analysis by Arillotta et al. in 2024 found some users reporting decreased libido. However, other studies have found no evidence of negative impacts on sexual desire, making the findings decidedly mixed.
The biological picture is further complicated by what some experience as positive effects: GLP-1 agonists can increase total testosterone, improve vascular reactivity, and elevate mood—all factors that could theoretically enhance desire.
Some research even shows users reporting increased libido after weight loss and improved sexual arousal.
The reality seems to be that GLP-1s affect different people differently, and the biopsychosocial context matters enormously.
What can help navigate the changes
If you’re on a GLP-1 medication and experiencing reduced desire–and most importantly, if this reduced desire bothers you–there are practical steps worth considering.
Lowering the dose or microdosing can help. Giannelli has found that many women are simply on too high a dose.
Having other hormones optimized, including testosterone, can make a difference.
But here’s what might matter more: looking honestly at the other “shifts” in your life.
If you’re carrying a disproportionate load of household labor, childcare, emotional work, and mental planning, no amount of toys or techniques will restore desire that’s been buried under exhaustion and resentment.
Sometimes, it’s not the medication. Sometimes, it’s finally giving you the voice to say what’s been true all along.
And that’s not a side effect—that’s clarity. Where you go from there is yours to choose.
The couples who best weather these transformations, The New York Times reminds us, are those who stay flexible about “the silent expectations of coupledom.”
“They didn’t hold dinnertime as sacrosanct. They didn’t cling too tightly to preconceived ideas about frequency of sex. They could prepare a prized lasagna without feeling affronted that a formerly voracious partner only nibbles,” writes the author, Lisa Miller.
This flexibility isn’t about lowering standards or settling—it’s about recognizing that people and relationships are living, evolving systems.
When one partner changes significantly, the entire dynamic shifts, and the couples who do well are those willing to renegotiate rather than resist.
If you have taken GLP-1, or are partnered with someone who has, I would love to know how this has impacted your relationship. Feel free to share it in the comments, or hitting reply.
If you learned something new, please share this with anyone who could benefit from it.
If you want support on your intimacy journey, here’s how else I can help you:
Couples Intimacy Card Deck - Turn each other on, one question at a time. I created this deck for you and your partner to have fun talking about sex, exploring your desires and deepening your connection. Read the reviews and shop here. Get 10% off with code LUST10.
Private Intimacy Coaching - I work with couples to help them build a sex life and relationship they look forward to. Book your free 25-minute strategy session and learn 1-3 takeaways to improve your intimacy right away.
My wife used this for weight reduction. As she lost weight and saw herself as being more desirable. Our sex life has exploded, you can’t be sexy if you don’t feel sexy. My wife handles one hundred percent of all household duty’s. Why, because I work in Egypt and only come home twice a year. Other than the sixty days at home we use FaceTime for our sexual pleasure’s. I’m not saying that the meds can affect you sex drive. Just not in my wife’s case.
Following this post... As a Couples Therapist, I have seen weight loss drugs impact relationships in all sorts of ways. It can also require an adaptation in the "ritual of connection" that dining together was vs. is as its place in one's life shifts.