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Proc Nutr Soc (2004) 63(4):597603.10.1079/PNS2004390 90 McNultyHPentievaKHoeyLWardM

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However, starting with an SGLT2 inhibitor or a GLP-1 RA in an individual who is intolerant to metformin (primarily diarrhea) is a good choice, and even in the future we may see large diabetes organizations recommending these two classes as first line therapy once they get less expensive.

Experimental studies in animals provide additional insight: GLP-1 analogs increased testosterone synthesis and improved sperm mitochondrial integrity in diabetic and obese models