Effect of Roux‐en‐Y Gastric Bypass and Sleeve Gastrectomy on Male Sexual Function: A Systematic Review and Meta‐Analysis

Abstract

ABSTRACT Background Obesity negatively impacts male sexual function and fertility through hormonal imbalances, endothelial dysfunction, and psychosocial factors. Metabolic and bariatric surgery (MBS) constitutes an effective intervention; however, procedure‐stratified changes in male reproductive parameters after Roux‐en‐Y gastric bypass (RYGB) and sleeve gastrectomy (SG) remain incompletely synthesized. Methodology A systematic search of PubMed, Embase, Cochrane Library, Scopus, and Web of Science was conducted in November 2024. Sexual function, testosterone levels, and semen quality were included. Risk of bias was assessed using MINORS criteria. Random‐effects meta‐analyses were performed separately for each surgical modality, with heterogeneity quantified via I 2 statistics. Results Twenty‐one studies comprising 848 patients were included. Meta‐analysis of pre–post data demonstrated that both RYGB and SG were independently associated with improvements in sex hormone–binding globulin and testosterone levels. In studies examining SG, significant improvements were observed in erectile function (SMD: 1.38, 95% CI: 0.66–2.10, p = 0.0002) and sperm concentration (SMD: 0.91, 95% CI: 0.56–1.26, p < 0.00001). Studies evaluating RYGB did not demonstrate statistically significant changes in erectile function (SMD: 0.62, 95% CI: −0.06 to 1.30, p = 0.07) or sperm concentration (SMD: −0.01, 95% CI: −0.45 to 0.42, p = 0.95). Conclusion The meta‐analytical findings suggest beneficial effects of both RYGB and SG on male hormonal parameters. Studies of SG demonstrated significant improvements in erectile function and sperm concentration. However, direct comparative analyses between the two procedures were not performed, precluding definitive conclusions regarding their relative efficacy. Future research necessitates head‐to‐head comparisons with standardized reproductive endpoints and extended follow‐up periods.