Derlis Ayala of Paraguay broke away from the start, and led the race until he was caught by a pack consisting of Desisa, Geremew, Geoffrey Kirui, Kipruto, Stephen Mokoka and Zersenay Tadese just before the halfway mark.

[1] Alternatively, a top-10 finish at an IAAF Gold Label marathon, or a wild card entry as the reigning world champion would ensure qualification.

[2] Due to the hot conditions in Doha, the World Championships were scheduled in October, rather than the traditional August, and instead of holding the marathon during the day, it started just before midnight local time to minimise the impact that the heat would have on the race,[3] making it the first-ever World Championships to feature night marathons; first the women's on 27 September, and then the men's on 5 October.

[9] In his preview for World Athletics, Mike Rowbottom suggested that the winner was "likely to be Kenyan, Ethiopian or Bahraini", and he concurred that Geremew and Wasihun were the two "clear favourites".

[12] The race was officially scheduled to start at 23:59 local time (UTC+3) on 5 October 2019;[13] temperatures had cooled since the women's marathon,[6] at 29.1 °C (84.4 °F) and 48.6 per cent humidity.

At the start of the race, Derlys Ayala of Paraguay broke away from the front of the field and established a 150 metre-lead over the other runners by the end of the first kilometre.

[14] Behind Ayala, who had run the Buenos Aires Marathon twelve days earlier and was not considered a genuine contender in the race, a pack consisting of Lelisa Desisa, Mosinet Geremew, Geoffrey Kirui, Amos Kipruto, Stephen Mokoka and Zersenay Tadese formed.

In contrast, Callum Hawkins, who had been in ninth place after 30 km, closed the gap on the leaders to around 14 seconds by the 37 kilometres (23 mi) point.

"[14] Kipruto was also unable to keep up with the fast finish, and when Desisa accelerated to a sprint for the final 150 metres (490 ft), he also broke clear of Geremew to claim the gold medal.