Questionnaires are used as part of the clinical diagnosis of testosterone deficiency, in addition to blood testing of testosterone levels.
The most widely researched and accepted questionnaires are the Androgen Deficiency in the Aging Male (ADAM)  and the Aging Male Symptoms (AMS) Rating Scale.
Androgen Deficiency in the Aging Male (ADAM) questionnaire
The ADAM (figure 1) is a self-administered 10 item questionnaire which is answered by yes/no. Answering “yes” to the 2 items related to sexual function of any 3 other of the remaining 7 items provides an indication of prevalent hypogonadism.
More recently, the standard ADAM questionnaire tool has been modified by adding weight to the answers, in order to provide information about the severity/frequency of the symptoms/signs of hypogonadism. This qADAM questionnaire (figure 2) consists the same 10 questions as in the original ADAM questionnaire, but has "yes" and "no" replaced by a scale of 1–5, in which 5 represents the absence of a given symptom and 1 represents maximal symptoms. All questions are weighted equally. The summation of responses yields a total qADAM score between 10 and 50, with 10 being most symptomatic and 50 being least symptomatic. Because the responses are quantified it is supposed to be more useful in assessing results of testosterone therapy over time.
Aging Male Symptoms (AMS) questionnaire
The AMS (figure 3) is also a self administered questionnaire designed to assess the symptoms of aging in males, to evaluate quality of life over time, and to measure effects of testosterone therapy.[2, 4, 5] Subjects rate symptoms from none (0) to extremely severe (5) for 17 items in 3 domains: psychological (5 items), somatic (7 items), and sexual (5 items). Total scores range from 17 (minimum) to 85 (maximum).
Important to know about questionnaires
Due to its simplicity, the standard ADAM is more widely used in clinical practice while the AMS and qADAM are primarily employed as a research tools. Both have a high degree of sensitivity (i.e. are good at detecting presence of symptoms/signs) but both also perform poorly in regard to specificity (i.e. the detected symptoms/signs can be caused by factors other than testosterone deficiency).[6, 7] The same applies to other questionnaires. Therefore, questionnaires on their own are not good diagnostic tools for testosterone deficiency, and cannot replace blood testing of testosterone levels.[8, 9] This is why most clinical guidelines require that questionnaire results be combined with blood testing for testosterone levels for diagnosis.[10, 11]
However, questionnaires are useful for screening and giving an indication of a possible prevailing sub-optimal testosterone level, and prominent clinicians and medical researchers emphasize the primacy of symptoms for the diagnosis of testosterone deficiency. They are also a helpful tool to “break-the-ice” at the initial doctor visit. Questionnaires that provide a degree rating of symptoms (like qADAM and ASM) can also be used to monitor treatment effectiveness of testosterone therapy.[3, 13]
1. Morley, J.E., et al., Validation of a screening questionnaire for androgen deficiency in aging males. Metabolism, 2000. 49(9): p. 1239-42.
2. Heinemann, L.A.J., et al., A New 'Aging Male's Symptoms' (AMS) Rating Scale. The Aging Male, 1999. 2: p. 105-114.
3. Mohamed, O., et al., The quantitative ADAM questionnaire: a new tool in quantifying the severity of hypogonadism. Int J Impot Res, 2010. 22(1): p. 20-4.
4. Daig, I., et al., The Aging Males' Symptoms (AMS) scale: review of its methodological characteristics. Health Qual Life Outcomes, 2003. 1: p. 77.
5. Heinemann, L.A., et al., The Aging Males' Symptoms (AMS) scale: update and compilation of international versions. Health Qual Life Outcomes, 2003. 1: p. 15.
6. Morley, J.E., et al., Comparison of screening questionnaires for the diagnosis of hypogonadism. Maturitas, 2006. 53(4): p. 424-9.
7. Blumel, J.E., et al., Is the Androgen Deficiency of Aging Men (ADAM) questionnaire useful for the screening of partial androgenic deficiency of aging men? Maturitas, 2009. 63(4): p. 365-8.
8. Morales, A., Testosterone Deficiency Syndrome: An overview with emphasis on the diagnostic conundrum. Clin Biochem, 2014. 47(10-11): p. 960-966.
9. Cabral, R.D., et al., Performance of Massachusetts Male Aging Study (MMAS) and androgen deficiency in the aging male (ADAM) questionnaires in the prediction of free testosterone in patients aged 40 years or older treated in outpatient regimen. Aging Male, 2014.
10. Bhasin, S., et al., Testosterone therapy in men with androgen deficiency syndromes: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab, 2010. 95(6): p. 2536-59.
11. Wang, C., et al., Investigation, treatment, and monitoring of late-onset hypogonadism in males: ISA, ISSAM, EAU, EAA, and ASA recommendations. J Androl, 2009. 30(1): p. 1-9.
12. Morgentaler, A., et al., Commentary: who is a candidate for testosterone therapy? A synthesis of international expert opinions. J Sex Med, 2014. 11(7): p. 1636-45.
13. Moore, C., et al., The Aging Males' Symptoms scale (AMS) as outcome measure for treatment of androgen deficiency. Eur Urol, 2004. 46(1): p. 80-7.