The ADAM Questionnaire: A Self-Check for Low Testosterone Symptoms

Many men over 40 come to see me with a similar line: "I get tired easily, I'm not really in the mood any more. Am I going through male menopause, doctor?" It's a very good question, but the answer can't come from feelings alone. The ADAM questionnaire is a simple starting point that helps you organise your symptoms before talking to a doctor, and it takes less than two minutes.

What is ADAM?

ADAM stands for Androgen Deficiency in the Aging Male. It was developed by Professor John E. Morley and colleagues at Saint Louis University in the United States and published in the journal Metabolism in 2000.

Its purpose is screening: identifying men whose symptoms fit testosterone deficiency and who should have a blood test. It is not meant to make a diagnosis, and it doesn't tell you your hormone level. If you're not sure what testosterone actually does, start with Testosterone basics every man should know.

The 10 questions (plain-language paraphrase)

Think about how you have felt recently and answer yes or no.

1. Has your sex drive (libido) decreased?
2. Do you feel a lack of energy?
3. Has your muscle strength or endurance decreased?
4. Have you lost height?
5. Have you noticed that you enjoy life less than before?
6. Do you feel sad, or get irritable easily?
7. Are your erections less firm than they used to be?
8. Has your ability to play sport or exercise got worse recently?
9. Do you tend to fall asleep after dinner?
10. Has your work performance got worse recently?

How to interpret the result

The result is positive if any of the following applies:

• You answered "yes" to question 1 (reduced sex drive), or
• You answered "yes" to question 7 (weaker erections), or
• You answered "yes" to three or more of the other questions in total.

Questions 1 and 7 carry extra weight because reduced sex drive and weaker erections are the symptoms most clearly linked to low testosterone. If you answered yes to question 7, try the IIEF-5 erectile function test as well; together they give a clearer picture of your erections.

Why a positive result doesn't mean low testosterone

In Morley's original study (in men aged 40–62), ADAM had a sensitivity of about 88% but a specificity of only about 60%, and several later studies have found specificity lower still.

In plain language:

• If you really do have low testosterone, ADAM will usually pick it up (good sensitivity).
• But many men with a positive ADAM result have normal testosterone (low specificity).

That's because many of the questions describe symptoms with other causes, for example:

• Depression and stress can cause low energy, loss of interest and lower libido. See Depression or low testosterone: how to tell the difference.
• Not enough sleep, or sleep apnoea can make you drowsy after meals and less effective at work.
• Chronic conditions such as diabetes, thyroid disease, obesity or anaemia.
• Some medicines, such as antidepressants and opioid painkillers.
• Getting older, without true hormone deficiency.

This is why the questionnaire is good for "screening" but can't be used to "decide".

From questionnaire to real diagnosis

The American Urological Association (AUA, 2018, with its validity reconfirmed in 2024) and the European Association of Urology (EAU) agree that a man can only be said to have testosterone deficiency when both of these are present:

1. Symptoms or signs that fit, such as reduced libido, poor erections, fatigue or loss of muscle mass. Read more in Symptoms of low testosterone: what to look for.
2. Low total testosterone in blood taken in the morning, on at least two separate days. The AUA guideline uses a level below 300 ng/dL (about 10.4 nmol/L) as a reasonable cut-off.

Why the morning, and why twice? Testosterone rises and falls with your body clock and is highest in the morning. It can also drop temporarily with poor sleep, illness or after a meal, so a single reading can mislead us.

Your doctor will usually check other things too, such as SHBG and, in some men, free testosterone; LH/FSH to see whether the problem lies in the testes or the pituitary gland; haematocrit (blood thickness); and PSA depending on your age. See the full list in Blood tests before starting TRT, and if you're curious about SHBG, read What is SHBG?.

Other questionnaires worth knowing

• qADAM (Quantitative ADAM) uses questions similar to ADAM but scores each item from 1 to 5 instead of yes/no. This helps show how severe symptoms are and is better for tracking change over time (Mohamed and colleagues, 2010).
• AMS (Aging Males' Symptoms Scale) has 17 items grouped into three areas: psychological, physical (somatic) and sexual. It is widely used in research and for following quality of life (Heinemann and colleagues, 1999).

All of them share the same limitation: they screen and track symptoms; they do not diagnose. I use these questionnaires as a tool to guide the conversation and to measure how much symptoms improve after care.

What to do after a positive result

• Don't buy hormones or supplements and start them yourself. Unnecessary testosterone suppresses sperm production and has side effects that need monitoring. See TRT side effects and how to monitor safely.
• Book a morning blood test, and write down the questions you answered "yes" to so you can discuss them with your doctor.
• In the meantime, look after the basics that genuinely help hormones: enough sleep, weight loss if you are overweight, resistance exercise and less alcohol. Read Supporting testosterone through sleep, food and exercise.
• If blood tests confirm truly low levels and you have symptoms, your doctor will discuss treatment options, including whether testosterone replacement therapy (TRT) suits you, taking into account plans for children, existing health conditions and risks.

When to see a doctor, and how the clinic can help

See a doctor if your ADAM result is positive, if symptoms have lasted for months, or if they are affecting your work, relationships or quality of life. Seek help urgently if:

• You feel very low or hopeless, or have thoughts of harming yourself. Call 1323, Thailand's free 24-hour mental-health hotline (Thai language; ask for English support), or your local emergency number.
• Your breasts are enlarging quickly, you have headaches with blurred vision, or your testes have clearly become smaller. These can point to a problem with the pituitary gland or testes.
• You have chest pain or unusual breathlessness. Go to hospital or call 1669 (Thailand's medical emergency number).

At Dr. Kris Clinic you can bring your ADAM answers straight to your consultation, either at the clinic in Surat Thani or online, with English-speaking consultations available. I'll assess both physical and emotional symptoms, rule out look-alike causes, arrange morning blood tests in line with the guidelines, and plan your care with you safely.