BackgroundThe effect of bariatric surgery on impaired semen parameters, hormonal profile and sexual function remains controversial to some extent.The context and purpose of the studyTo look at the long-term effects of sleeve gastrectomy on hormonal profiles, sperm parameters, and sexual function in infertile men with severe obesity. This prospective study included fifty-four obese patients with primary or secondary infertility who were scheduled for sleeve gastrectomy between February 2018 and March 2021. All participants were given a sperm analysis and a serum hormone profile before, 12, and 18 months after surgery. We used the International Index of Erectile Function questionnaire to assess sexual function.ResultsThere was a significant correlation between weight loss after sleeve gastrectomy and improvement in lipid profile (p< 0.05). No significant detectable effect of post-gastrectomy weight loss on patients with diabetes mellitus, hypertension, or obstructive sleep apnea. As regards the hormonal profile, sex hormone binding globulin, total and free testosterone improved significantly after 12- and 18-months following sleeve gastrectomy. There was a significant increase in sperm count and total sperm number during the follow-up after sleeve gastrectomy (p< 0.05), however, there were no significant changes in other semen parameters. Concerning sexual function, sexual desire, erectile function, and satisfaction improved significantly at 12 and 18 months after surgery.ConclusionWeight loss through sleeve gastrectomy surgery significantly improves testosterone deficiency, sexual performance, and Sperm count in obese infertile men.