Abstract Objective Testosterone concentrations, albeit rarely, may be in the normal range (>3.0ng/mL) in men with a prolactin-secreting pituitary adenoma (PSPA-nt). The evolution of total, bioavailable testosterone, gonadotropin levels and that of graded symptoms of testosterone deficiency (TD) are uncertain in these patients. Design Retrospective case-control longitudinal study at a tertiary referral center. Methods From 287 men, we selected 25 PSPA-nt undergoing prolactin normalization (<20.0 ng/mL) during the follow-up. Graded symptoms of TD were investigated by structured interviews. Biochemical changes and TD symptoms were compared to those of a matched cohort of 61 men with pituitary neoplasms and normal testosterone levels (PA-nt). Results Baseline testosterone levels were similar between PSPA-nt and PA-nt subjects. The prevalence of specific and suggestive symptoms of TD was higher in PSPA-nt (20 and 68%) than in PAnt (3.3 and 29.5%, p=0.02 and p=0.0015, respectively). At the follow-up, total and bioavailable testosterone levels increased in PSPA-nt but not in PA-nt patients (Δ change: 1.28±2.1 vs.0.03±1.5 ng/mL, +0.33±0.55 vs.-0.26±0.60 ng/mL, p=0.0028 and p=0.0088, respectively). LH and FSH levels also increased in PSPA-nt men (p<0.05). Specific and suggestive, but not nonspecific symptoms of TD, improved only in PSPA-nt men (p<0.05 for both). Baseline testosterone and LH were the strongest predictors of testosterone improvement in PSPA-nt patients. Conclusion Despite having normal testosterone levels at baseline, patients with PSPA-nt experience a relief of TD symptoms and an improvement of their pituitary-gonadal axis function following prolactin normalization, especially when baseline TT and LH levels are in the low-normal range.