Long-term follow-up of medically treated prolactinomas in men: effect on tumor size, hyperprolactinemia, and erectile dysfunction

Abstract Background Prolactinomas in men frequently present with erectile dysfunction, infertility, and hypogonadism. Dopamine agonists offer a non-surgical alternative capable of reversing hyperprolactinemia and associated symptoms. This study evaluated the effects of medical therapy on sexual function, hormonal profile, and tumor size in male patients with prolactinomas. Methods In this retrospective cohort, 50 men treated with dopamine agonists between August 2015 and August 2022 were analyzed. Baseline and post-treatment data included sexual function (IIEF-5 scores), semen parameters, hormone levels, and tumor measurements on MRI. Statistical analysis involved paired t-tests (α = 0.05) to assess treatment efficacy. Results Mean age was 35.2 ± 5.7 years. Erectile dysfunction was the most common presenting complaint (96%). Post-treatment, significant improvements were observed: IIEF-5 scores increased from 11.7 to 21.3, sperm count from 7.59 to 17.68 million/ml, and testosterone levels from 175.2 to 364.6 ng/dl (all p < 0.001). Prolactin dropped from 197.9 to 28.2 ng/ml, and tumor diameter reduced markedly from 25.0 to 3.8 mm ( p < 0.001). Conclusion Dopamine agonist therapy achieves rapid and significant restoration of sexual and reproductive function, hormonal normalization, and tumor shrinkage in men with prolactinomas. It remains an effective, first-line treatment option with robust clinical outcomes.