Androgen Deficiency In Aging Male Questionnaire Research Articles

Androgen Deficiency in Aging Males: Translation and Validation Study of the Iranian Version.

Background:Considering the importance of psychometric evaluation of the male sex hormone deficiency questionnaire by Iranian nurses, this study aimed to determine the translation and validation of the Iranian version of the Androgen Deficiency in Aging Males (ADAM) questionnaire.Materials and Methods:This study was cross-sectional. After obtaining permission from the instrument maker, translating it into Farsi, retranslated it into English, and determining validity and reliability. The study population was 200 Iranian men who admitted to hospitals affiliated with Iran University of medical science and were older than 50 years and selected by convenience sampling method. They were evaluated and monitored based on the Iranian version of the ADAM questionnaire. Sensitivity and specificity were assessed and analyzed by Rock Chart analysis. Descriptive and analytical statistical tests were used at a significant level of 0.05.Results:Findings showed that the Iranian version of the ADAM questionnaire had good face validity. Results showed that Cronbach's alpha in this questionnaire was 0.93, which indicates high reliability, and all the valid questionnaires were reported for the Scale-Content Validity Index (SCVI) calculation. Hence, the questionnaire has good content validity. The Iranian version of the ADAM questionnaire has a sensitivity of 93.85% and a specificity of 77.14% at the cut-off point of 2.2, indicating high sensitivity and specificity.Conclusions:The Iranian version of the ADAM questionnaire is valid and reliable and has high sensitivity and specificity. Nurses can also use it as an adjunctive scale to screen andropause men over 50 years of age.

A study on hypogonadism in male HIV patients in northeastern part of India.

Context:After the introduction of highly active antiretroviral therapy (ART), the prevalence of hypogonadism among human immunodeficiency virus (HIV)-infected males is decreasing.Aims:The aim of this study was (i) to estimate the prevalence of hypogonadism among HIV-infected males and (ii) to determine the risk factors for hypogonadism.Settings and Design:This was a cross-sectional study undertaken at ART center of a medical Institute.Subjects and Methods:The study recruited HIV-infected males aged 18–65 years receiving ART. Patients with any debilitating chronic illness, diabetes mellitus, chronic smokers or alcoholic, currently on opioids, or methadone were excluded from the study. Androgen Deficiency in Aging Male (ADAM) questionnaire was used to screen patients for the possible presence of hypogonadism. For those screened positive on ADAM questionnaire underwent biochemical evaluation for serum total testosterone, luteinizing hormone (LH), and CD4 count.Statistical Analysis Used:The Chi-square test was used to compare different parameters. Pearson's correlation coefficient was used to assess any relationship between CD4 count, LH, and testosterone. P < 0.05 was considered statistically significant.Results:In the study, 426 were initially screened and 120 patients who had probable hypogonadism were further evaluated. The mean age of the patients was 41.61 years. The mean body mass index (BMI) of the patients was 22.47 kg/m2. The mean duration of ART was 6.13 years and the mean CD4 count was 442.63 cells/mm3. Hypogonadism was seen in 20 (23.3%) and majority (85.7%) had secondary hypogonadism. There was significant association between hypogonadism and CD4 count, but no association was found with BMI and duration of ART.Conclusions:Hypogonadism is seen in 23.3% of HIV-infected males. Majority (85.7%) had secondary hypogonadism. There was significant association of hypogonadism with lower CD4 count.

Performance of the Androgen Deficiency in Aging Male questionnaire for the clinical detection of androgen deficiency in black sub-Saharan African men with Type-2 diabetes mellitus

Background: The Androgen Deficiency in Aging Male (ADAM) questionnaire is increasingly popular for evaluation of androgen deficiency (AD) in sub-Saharan African men with type 2 diabetes mellitus (DM). However, its reliability in this population is unknown.Methods: Total testosterone < 8 nmol/L was used as the gold standard for diagnosis of AD in this cross-sectional survey of 200 type 2 DM males aged 30–69 years. Participants also completed the Saint Louis University ADAM questionnaire whereby AD was diagnosed by a ‘yes’ answer to question 1 (reduced libido) or 7 (erectile dysfunction) or any other three questions. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and overall accuracy of the ADAM tool were computed.Results: The mean age of the participants was 58.0 ± 8.8 years. A total of 142 subjects (71.0%) had AD based on the ADAM questionnaire. However, AD was biochemically confirmed in 59 subjects (29.5%). The ADAM questionnaire rendered a sensitivity of 8...

Comparing calculated free testosterone with total testosterone for screening and diagnosing late-onset hypogonadism in aged males: A cross-sectional study.

The aim of this study is to compare calculated free testosterone (cFT) and total testosterone (T) in predicting late-onset hypogonadism (LOH) in middle-aged and elderly males. We surveyed a random sample of 608 males between the ages of 45 and 87years from Shanghai, China. The Aging Male Symptoms (AMS) questionnaire and the Androgen Deficiency in Aging Male (ADAM) questionnaire were completed by the subjects. Testosterone (T), sex hormone-binding globulin (SHBG), albumin, and other blood biochemical indexes were measured in 332 males. The corresponding cFT was obtained using the Vermeulen formula and the correlations between T and cFT were analyzed by SPSS statistical software. Among the 332 males who underwent biochemical evaluation, 289 males (87.0%) was positively screened by the ADAM questionnaire and 232 males (69.9%) by the AMS questionnaire. As suggested by linear regression, cFT exhibited a negative correlation with age in both ADAM+ and AMS+ group, whereas T did not appear to have significant correlation with age. Besides, there were statistically significant differences in cFT (P<.001) in the AMS questionnaire. Calculated free testosterone levels are more reliable than T levels for diagnosing LOH in middle-aged and elderly males.

PD37-05 THE IMPACT OF TESTOSTERONE SUPPLEMENTATION THERAPY ON THE INTERNATIONAL INDEX OF ERECTILE FUNCTION: BEYOND THE LEVELS OF TESTOSTERONE

INTRODUCTION AND OBJECTIVES: To investigate the association between hypogonadal symptoms and calculated free testosterone levels in men with near normal total testosterone levels (250 e 350ng/dL). We also attempted to determine whether there exists a clear-cut discriminatory threshold of free testosterone below which hypogonadal symptoms become more prevalent. METHODS: We retrospectively reviewed the charts of 3,167 men who presented to an outpatient men’s health clinic. Of these men, 231 men had a T value between 250 e 350 ng/dL with a chief complaint of “low testosterone”. Men using testosterone or other androgenic anabolic steroids (AAS) within 6 months of the time of the survey were excluded. We also excluded men who had presented with a primary diagnosis of infertility, Kleinfelter syndrome, or secondary hypogonadism after appropriate assessment of history and endocrine evaluation with gonadotropins. We evaluated hypogonadal symptoms using the Androgen deficiency in Aging Male (ADAM) questionnaire and quantitative ADAM questionnaire. Serum levels of total testosterone, sexhormone binding globulin (SHBG) were collected on the same day that men completed their questionnaires. FT levels were calculated using the Vermeulen formula. We used locally weighted linear regression to identify threshold levels of FT below which the probability of a symptom increased above the background prevalence in the overall study population. We subsequently performed univariate (t test, chi-square) and multivariate analyses (ordinal logistic regression) to evaluate factors that predicted a low free testosterone level. RESULTS: The mean age of the 231 men was 48.4 þ 16.2 y, and the mean T level and FT levels were 292 þ 36 ng/dL, and 6.7 þ 1.26 ng/dL respectively. Significant associations between free testosterone levels and a number of androgen deficiency symptoms were seen at FT levels of 5.0 e 7.0 ng/dL, but multiple logistic regression analysis revealed confounding effects with age. Of the 10 hypogonadal symptoms, the probability of having psychological (decreased energy and sadness) and physical (decreased strength, falling asleep after dinner and deterioration of work performance) symptoms was associated with FT on a univariate analysis. However, on multivariable analysis, only younger age correlated positively with higher FT. CONCLUSIONS: Hypogonadal symptoms in men with near normal total testosterone levels can be associated with a free testosterone level. Symptom-specific free testosterone thresholds could not be defined, as age remains an important confounder.

Hypogonadal symptoms in young men are associated with a serum total testosterone threshold of 400 ng/dL.

To investigate the association between hypogonadal symptoms and serum total testosterone (TT) levels in young men (aged <40 years), in an attempt to determine whether there exists a clear-cut discriminatory threshold of TT below which hypogonadal symptoms become more prevalent. We retrospectively reviewed the charts of 352 men who presented to an outpatient Men's Health Clinic with chief complaint of 'low testosterone'. Sexual, psychological and physical symptoms were evaluated using the Androgen deficiency in Aging Male (ADAM) questionnaire. Serum levels of TT were collected on the same day that men completed their ADAM questionnaires. We subsequently performed univariate (t-test, chi-square) and multivariate analyses (ordinal logistic regression) to evaluate factors that predicted a low TT level. The probability of hypogonadal symptoms increased at a serum TT level of 400 ng/dL. A cluster of symptoms: two psychological ('decreased energy', 'sadness'), and three physical ('decreased strength and endurance', 'decreased ability to play sports', and 'deterioration in work performance') were most strongly associated with serum TT levels of <400 ng/dL. On multivariable analysis, only 'lack of energy' predicted a TT level of <400 ng/dL. Hypogonadal symptoms in men aged <40 years can be associated with a TT level of <400 ng/dL. Of the hypogonadal symptoms evaluated with the ADAM questionnaire, 'lack of energy' appears to be the most important symptom that predicts a TT level of <400 ng/dL.

MP48-06 HYPOGONADAL MEN TAKING CLOMIPHENE CITRATE REPORT SIMILAR SATISFACTION COMPARED TO MEN ON TESTOSTREONE REPLACEMENT THERAPY

You have accessJournal of UrologySexual Function/Dysfunction/Andrology: Medical and Non-surgical1 Apr 2014MP48-06 HYPOGONADAL MEN TAKING CLOMIPHENE CITRATE REPORT SIMILAR SATISFACTION COMPARED TO MEN ON TESTOSTREONE REPLACEMENT THERAPY Ranjith Ramasamy, Jason Scovell, Jason Kovac, James Dupree, Gavin Langille, Dolores Lamb, and Larry Lipshultz Ranjith RamasamyRanjith Ramasamy More articles by this author , Jason ScovellJason Scovell More articles by this author , Jason KovacJason Kovac More articles by this author , James DupreeJames Dupree More articles by this author , Gavin LangilleGavin Langille More articles by this author , Dolores LambDolores Lamb More articles by this author , and Larry LipshultzLarry Lipshultz More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.1480AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail Introduction and Objectives The efficacy of oral clomiphene citrate (CC) in the treatment of male hypogonadism has been reported. We compared satisfaction and treatment efficacy in men with symptomatic hypogonadism taking CC, testosterone gel (T gel), and testosterone injections (T injections). Methods Men receiving CC or T gel or T injections for symptomatic hypogonadism (total testosterone < 300 ng/dl) were asked to report satisfaction with their current treatment regimen with ADAM and qADAM scores. Serum testosterone levels were collected on the same day that men filled out the ADAM questionnaire. Treatment efficacy was evaluated using pre- and post-treatment serum testosterone, and satisfaction was assessed using androgen deficiency in aging male (ADAM) and quantitative ADAM (qADAM) questionnaire scores. Results The charts of 451 men on testosterone supplementation (51 on CC, 265 on T injections, and 135 on T gel) were reviewed. The mean serum total T levels in men on CC (525 ng/dL) was lower (p<0.01) than men taking T injections (1015 ng/dL), but similar to serum total T in men on gels (453.3 ng/dL, p=0.07). Post-treatment testosterone levels were higher in men taking CC, T injections and T gels compared to pre-treatment levels (227 ng/dL, 221 ng/dL, 211 ng/dL p<0.01) Despite differences in serum T, men on CC, T injection, and T gel reported similar satisfaction levels. Both the ADAM scores (2.37, 2.81, and 3.17) and quantitative ADAM scores (37.2, 36.8, and 35.6) for the men on different testosterone supplementation regimens were similar. Men taking CC were younger (38.5y) than men taking T injections (46.8y) or T gels (59.4, p< 0.01). Conclusions Testosterone supplementation regimens including CC, T gels and T injections are efficacious in improving serum total testosterone levels. However, men taking clomiphene citrate or testosterone gels report similar satisfaction levels compared to men taking testosterone injections despite lower serum total testosterone levels. © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e529 Advertisement Copyright & Permissions© 2014MetricsAuthor Information Ranjith Ramasamy More articles by this author Jason Scovell More articles by this author Jason Kovac More articles by this author James Dupree More articles by this author Gavin Langille More articles by this author Dolores Lamb More articles by this author Larry Lipshultz More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Hypogonadotropic hypogonadism among a population of obese men: Prevalence, risk factors and reversibility after weight loss induced by bariatric surgery

Background and aims: Obesity in men is frequently associated with low levels of testosterone, loss of libido and/or erectile dysfunction. Our goal was to estimate the prevalence of hypogonadism among obese men and to determine its risk factors and reversibility after bariatric surgery. Methods: Seventy-five obese men were studied at baseline. Metabolic and hormonal parameters were measured, body composition was assessed by bioelectrical impedance and hypogonadism was evaluated by the ADAM (Androgen Deficiency in Aging Males) questionnaire. Twenty-one patients were re-evaluated after bariatric surgery. Results: At baseline, 39% of obese men had hypotestosteronemia, while symptoms of androgen deficiency were present in 93%. Total Testosterone (TT) was inversely related to body mass index (BMI) (. P<. 0.05), waist circumference (. P=. 0.012) and body fat mass (. P=. 0.022). Bariatric surgery was associated with an increase in TT (. P=. 0.001) and decreases in estradiol (E2) (. P=. 0.008) and in the E2/TT ratio (. P=. 0.001). Conclusions: Low testosterone levels are frequently observed among morbidly obese men and are correlated with the degree of abdominal adiposity, but not strongly with the presence of sexual dysfunction. Bariatric surgery leads to normalized TT and to decreased E2 and E2/TT ratio, suggesting a role of excessive aromatization in the hypotestosteronemia associated with obesity.

Serum total testosterone level and identification of late-onset hypogonadism: a community-based study.

PurposeLate-onset hypogonadism (LOH) in aging males is a clinical and biochemical syndrome characterized by a decline in serum testosterone levels. LOH results in various physical and mental disabilities. We evaluated the relationship between serum testosterone levels and symptoms of LOH.Materials and MethodsDuring an andropause screening program, we examined responses to the Saint Louis university androgen deficiency in aging males (ADAM) questionnaire and results on the International Index of Erectile Function (IIEF-5) in terms of clinical symptoms and evaluated serum total testosterone levels for a biochemical diagnosis of LOH in healthy community-living volunteers aged over 40 years.ResultsThe mean age of the 534 men was 59.1 years (range, 40 to 79 years), and their mean serum testosterone level was 464.1±171.9 ng/dL. The serum testosterone level decreased significantly with age. There was a 92.5% positive response rate to the ADAM questionnaire. The percentage of patients whose serum testosterone level was <350 ng/dL among those with a positive response to the ADAM questionnaire was 25.6% (137 patients). The mean serum testosterone level among patients with a positive or negative ADAM questionnaire was 472.4±198.5 ng/dL and 487.3±165.7 ng/dL, respectively (p>0.05). There was no significant correlation between IIEF-5 scores and serum testosterone levels.ConclusionsAmong men over 40 years of age, 25.6% met the clinical and biochemical diagnostic criteria for LOH. There was no relationship between serum testosterone levels and symptoms of LOH.

Outcomes of clomiphene citrate treatment in young hypogonadal men

Study Type - Therapy (case series) Level of Evidence 4. What's known on the subject? and What does the study add? Hypogonadism is a prevalent problem, increasing in frequency as men age. It is most commonly treated by testosterone supplementation therapy but in younger patients this can lead to testicular atrophy with subsequent exogenous testosterone dependency and may impair spermatogenesis. Clomiphene citrate (CC) may be used as an alternative treatment in these patients with hypogonadism when maintenance of fertility is desired. This study shows that CC is a safe and efficacious drug to use as an alternative to exogenous testosterone. Not only have we validated previous findings of other papers but have proven our findings over a much longer period (mean duration of treatment 19 months). This prospective study is the largest to date assessing both the objective hormone response to CC therapy as well as the subjective response based on a validated questionnaire. • To prospectively assess the andrological outcomes of long-term clomiphene citrate (CC) treatment in hypogonadal men. • We prospectively evaluated 86 men with hypogonadism (HG) as confirmed by two consecutive early morning testosterone measurements <300 ng/dL. • The cohort included all men with HG presenting to our clinic between 2002 and 2006 who, after an informed discussion, elected to have CC therapy. CC was commenced at 25 mg every other day and titrated to 50 mg every other day. The target testosterone level was 550 ± 50 ng/dL. • Testosterone (free and total), sex hormone binding globulin, oestradiol, luteinizing hormone and follicle stimulating hormone were measured at baseline and during treatment on all patients. Once the desired testosterone level was achieved, testosterone/gonadotropin levels were measured twice per year. • To assess subjective response to treatment, the androgen deficiency in aging males (ADAM) questionnaire was administered before treatment and during follow-up. • Patients' mean (standard deviation [sd]; range) age was 29 (3; 22-37) years. Infertility was the most common reason (64%) for seeking treatment. The mean (sd) duration of CC treatment was 19 (14) months. • At the last evaluation, 70% of men were using 25 mg CC every other day, and the remainder were using 50 mg every other day. • All mean testosterone and gonadotropin measurements significantly increased during treatment. • Subjectively, there was an improvement in all questions (except loss of height) on the ADAM questionnaire. More than half the patients had an improvement in at least three symptoms. • There were no major side effects recorded and the presence of a varicocele did not have an impact on the response to CC. • Long-term follow-up of CC treatment for HG shows that it appears to be an effective and safe alternative to testosterone supplementation in men wishing to preserve their fertility.

Clomiphene Citrate and Testosterone Gel Replacement Therapy for Male Hypogonadism: Efficacy and Treatment Cost

The efficacy of oral clomiphene citrate (CC) in the treatment of male hypogonadism and male infertility (MI) with low serum testosterone and normal gonadotropin levels has been reported. The aim of this article is to evaluate CC and testosterone gel replacement therapy (TGRT) with regard to biochemical and clinical efficacy and cost. The main outcome measures were change in serum testosterone with CC and TGRT therapy, and change in the androgen deficiency in aging male (ADAM) questionnaire scores with CC therapy. Men receiving CC or TGRT with either Androgel 1% or Testim 1% for hypogonadism (defined as testosterone < 300 ng/mL) or MI were included. Serum values were collected 1-2 months after treatment initiation and semi-annually thereafter. Retrospective data collection was performed via chart review. Subjective follow up of patients receiving CC was performed via telephone interview using the ADAM questionnaire. A hundred and four men (65 CC and 39 TGRT) were identified who began CC (50 mg every other day) or TGRT (5 g). Average age (years) was 42(CC) vs. 57 (TGRT). Average follow up was 23 months (CC, range 8-40 months) vs. 46 months (TGRT, range 6-149 months). Average posttreatment testosterone was 573 ng/dL in the CC group and 553 ng/dL in the TGRT group (P value < 0.001). The monthly cost of Testim 1% (5 gm daily) is $270, Androgel 1% (5 gm daily) is $265, and CC (50 mg every other day) is $83. Among CC patients, the average pretreatment ADAM score was 4.9 vs. 2.1 at follow up (P < 0.05). Average pretreatment ADAM sexual function domain score was 0.76 vs. 0.23 at follow up (P < 0.05). There were no adverse events reported. CC represents a treatment option for men with hypogonadism, demonstrating biochemical and clinical efficacy with few side effects and lower cost as compared with TGRT.

Risk factors for idiopathic intracranial hypertension in men: A case–control study

Objective To identify risk factors for idiopathic intracranial hypertension (IIH) in men. Design Case–control study. A 96-item telephone questionnaire, answered retrospectively, with cases recalling at the age of their diagnosis and controls recalling at the age of their corresponding case's diagnosis. Setting Outpatient clinics in two US tertiary care centers. Participants The characteristics of 24 men with IIH were compared to those of 48 controls matched for sex, age, race, and World Health Organization body mass index (BMI) category. Main outcome measures Two previously validated questionnaires: the ADAM (Androgen Deficiency in Aging Males) questionnaire for testosterone deficiency and the Berlin questionnaire for obstructive sleep apnea (OSA), embedded within the telephone questionnaire. Analysis with Mantel–Haenszel odds ratios and mixed-effects logistic regression models accounted for matching. Results Cases and controls had similar enrollment matching characteristics. Although matching was successful by BMI category, there was a small difference between BMI values of cases and controls (cases: median 31.7, controls: median 29.9; p = 0.03). After adjustment by BMI value, men with IIH were significantly more likely than controls to have a positive ADAM questionnaire for testosterone deficiency (OR: 17.4, 95% CI: 5.6–54.5; p < 0.001) and significantly more likely to have either a positive Berlin questionnaire for OSA or history of diagnosed OSA (OR: 4.4, 95% CI: 1.5–12.9; p = 0.03). Conclusions Men with IIH are more likely than controls to have symptoms associated with testosterone deficiency and OSA. These associations suggest a possible role for sex hormones and OSA in the pathogenesis of IIH in men.

Correlation between Androgen Deficiency on the Aging Males Questionnaire and the Aging Males' Symptoms Scale and Their Relationship with Serum Testosterone

Purpose: The aim of this study is to analyze the correlation between the Androgen Deficiency in Aging Males (ADAM) questionnaire and the Aging Males’ Symptoms (AMS) scale and to determine their relationship with the serum testosterone level. Materials and Methods: We retrospectively reviewed the medical records of the patients who took the self-administered ADAM questionnaire, the AMS scale and the International Index of Erectile Function (IIEF) questionnaire. We enrolled a total of 265 patients older than 40 years who presented a positive result for the ADAM questionnaire (defined as a ‘yes’ answer to question 1 or 7, or a ‘yes’ answer to at least three of the other questions). Blood tests were performed, including the total testosterone, prolactin, the lipid profiles and the fasting glucose level. Results: The psychological subscale of the AMS scale was correlated with ADAM questions 2, 3, 5, 7, 8 and 10 (p＜0.005) and the somato-vegetative subscale was correlated with questions 2, 3, 5, 6, 8 and 10 (p＜0.05). The sexual subscale was correlated with questions 1, 2, 5, 6, 7, 8 and 10 (p＜ 0.05). Statistically significant differences were found for the IIEF questionnaire scores between the patients with ‘yes’ and ‘no’ answer to ADAM question 1 and 7 (p＜0.05). The IIEF questionnaire scores were significantly lower for the men with a sexual subscale score 11-25 on the AMS scale (p＜0.05). The total testosterone was not correlated with the ADAM, AMS and IIEF questionnaire but the total testosterone demonstrated a significantly negative correlation with weight, abdominal circumference, body mass index (BMI) and triglyceride (p＜0.05). Conclusions: This analysis revealed that the ADAM questionnaire and the AMS scale have a significant relationship, and especially the sexual function domain of the two questionnaires showed correlation with the IIEF questionnaire. Serum testosterone was related with weight, abdominal

No major month to month variation in free testosterone levels in aging males. Minor impact on the biological diagnosis of ‘andropause’

The measurement of bioavailable testosterone (BT) or free testosterone (FT) levels is currently considered the gold standard for the diagnosis of androgen deficiency in elderly men. While the impact of age on circulating testosterone levels (total, bioavailable and free) has been strongly documented, the existence of seasonal variations in testosterone levels remains debated. We investigated whether seasonal variations in serum calculated free testosterone (cFT) levels may translate into variations in the prevalence of low testosterone levels. Diagnosis was on the basis of biochemical determinations and was cross-checked with the prevalence of clinical signs and symptoms of 'andropause', as assessed by the Androgen Deficiency in Aging Males (ADAM) questionnaire. The study recruited 5028 men aged 50 years and over from September 2000 to January 2003. Their serum FT levels were assessed and they completed the French ADAM test. Men were considered eugonadal when cFT was > or =70 ng/l. The ADAM test was scored as described originally. The prevalence of 'andropause', diagnosed by the two methods, was compared throughout the year, on a month by month basis. The percentage of subjects with cFT levels below 70 ng/l increased significantly with age (P<0.001). Serum cFT levels (mean [SD]) varied significantly with the month of sampling (P<0.0001), the highest (88.1 [30.2] ng/l) and lowest (76.9 [28.0] ng/l) mean values occurring in April and in October, respectively. Conversely, the prevalence of testosterone deficiency (cFT<70 ng/l) reached a peak in October (45.7%) and a nadir in April (29.7%). Although the prevalence of 'andropause', based on the ADAM questionnaire, increased significantly with age (P<0.0001), no influence of the month of the year was noticed. Our results confirm a progressive age-related decline in FT levels. The monthly variations in serum FT values, observed throughout the year, do not show a major seasonal rhythm in elderly community-dwelling males, since the magnitude of the variations (<15%) remains marginal. This slight variation may, however, have an impact on the number of elderly men diagnosed with Partial Androgen Deficiency in Aging Males (PADAM).

Validation of a screening questionnaire for androgen deficiency in aging males

It is now well established that testosterone levels decline with age. What has not been established is whether the decline in testosterone is associated with a symptom complex. This study examined whether certain symptoms are more commonly present in males with low bioavailable testosterone (BT) levels. These were used to evaluate a questionnaire for androgen deficiency in aging males (ADAM). The validity of the ADAM questionnaire to screen for low BT was tested in 316 Canadian physicians aged 40 to 62 years. Low BT levels were present in 25% of this population. None had elevated luteinizing hormone (LH) levels. The ADAM questionnaire had 88% sensitivity and 60% specificity. When the questionnaire was administered twice 2 to 4 weeks apart to 10 men, it was determined that the coefficient of variation was 11.5%. In a second study of 34 ADAM-positive patients, 37% of those with clearly normal BT levels demonstrated some evidence of dysphoria. Finally, in 21 patients who were treated with testosterone, improvement on the ADAM questionnaire was demonstrated in 18 (P .002). These data support the concept of a symptom complex associated with low BT levels in aging males. In addition, the ADAM questionnaire appears to be a reasonable screening questionnaire to detect androgen deficiency in males over 40 years of age.