This paper proposes to prepare hydrophobic alkali-activated slag (AAS) mortars with methyl-terminated polydimethylsiloxane (PDMS), a hydrophobic polymer with low surface energy, to minimize its water sorptivity and efflorescence. To depict the efflorescence process of PDMS-modified AAS mortars, visual inspections of efflorescence features, the leaching behavior of sodium ions, water absorption characteristics of mortars and contact angle tests were conducted. Additionally, the hydration process, microscopic morphology, and chemical structure of PDMS-modified AAS mortars and pastes were examined by compressive strength, isothermal calorimetry, TEM, SEM, FT-IR, 29Si NMR, enabling the explanation of PDMS working mechanisms. The results demonstrated that the addition of PDMS successfully mitigated esthetic issues and the spalling of mortars caused by efflorescence. Furthermore, PDMS reduced the risk of long-term durability issues of AAS mortars by restricting the loss of sodium ions after efflorescence. At the same time, the introduction of PDMS with dosage below 5 % did not significant retarder the hydration reaction process or the development of strength of AAS. However, it did alter the micromorphology and chemical structure of the hydration product. PDMS linked to the hydration products through covalent bonds and acted as a bridging role to alter the micromorphology of the hydration products. The resulting multi-structured material exhibited micropapillary and nano-coating layers with hydrophobic methyl functional groups, imparting hydrophobicity to the PDMS-AAS hydration product.