Purpose <p>Hypogonadotropic hypogonadism is a frequent manifestation of prolactinomas in men. Dopamine agonists can restore gonadal function; however, the timeline and predictors of recovery are not well defined. This study focuses on hypogonadotropic hypogonadism exclusively among men with prolactinomas.</p> Methods <p>We retrospectively analyzed 84 men with prolactinomas treated with cabergoline (CAB) for at least 12 months, without prior pituitary surgery or radiotherapy. Hypogonadotropic hypogonadism was defined as morning testosterone &lt; 300 ng/dL with low or inappropriately normal luteinizing hormone (LH). Recovery was defined as testosterone ≥ 300 ng/dL.</p> Results <p>At baseline, 75 patients (89.3%) had hypogonadotropic hypogonadism. Gonadal recovery was observed in 30.7% at 6 months, 44% at 12 months, and 59.5% at 24 months. Mean testosterone increased from 142 ng/dL at baseline to 352.5 ng/dL at 24 months, with continued improvement between 12 and 24 months (<i>p &lt;</i> 0.001). Independent predictors of recovery at 12 months were smaller baseline tumor diameter (OR = 0.934, 95%CI: 0.894–0.977, <i>p =</i> 0.003) and higher baseline testosterone (OR = 1.009, 95%CI: 1.000-1.018, <i>p =</i> 0.042). When 6-month parameters were included, only testosterone at 6 months remained predictive (OR = 1.030, 95%CI: 1.014–1.047, <i>p &lt;</i> 0.001). Optimal cut-offs for persistent hypogonadism at 12 months were tumor diameter &gt; 2.3&#xa0;cm (sensitivity 64.3%, specificity 63.6%), baseline testosterone &lt; 144.5 ng/dL (sensitivity 63.6%, specificity 61.9%), and 6-month testosterone &lt; 234.0 ng/dL (sensitivity 87.9%, specificity 88.1%).</p> Conclusion <p>Gonadal function recovers in a substantial proportion of men with prolactinomas during CAB therapy, often within the first year. Six-month testosterone levels, along with baseline tumor size, are strong predictors of recovery and may help guide testosterone replacement timing.</p>