Chapter 01 · The screen
What the ADAM questionnaire measures
The Androgen Deficiency in Aging Males (ADAM) questionnaire was developed at Saint Louis University and published by Morley and colleagues in 2000 as a quick way to flag symptoms that can accompany low testosterone in adult men.1 It is 10 yes-or-no questions covering sex drive, energy, strength, mood, erections, and daytime sleepiness.
The scoring rule is simple. The screen is positive if you answer yes to question 1 (libido) or question 7 (weaker erections), or yes to any 3 of the remaining questions. The ADAM is deliberately sensitive: it catches most men who turn out to have low testosterone, but it also flags many men who do not, because the same symptoms have many causes.
| Result | What it means | Reasonable next step |
|---|---|---|
| Positive screen | Symptoms consistent with low testosterone are present | A morning blood test and a clinician visit |
| Negative screen | Symptoms are below the screening threshold | Re-check if symptoms develop or persist |
A positive screen is not a diagnosis. Low testosterone is confirmed with blood tests, not a questionnaire.
Chapter 02 · The overlap
Why these symptoms are not specific
Fatigue, low mood, reduced sex drive, and poor sleep are common, and most of the time they are not caused by testosterone. Poor sleep, high stress, depression, thyroid problems, anemia, certain medications, alcohol, and untreated sleep apnea all produce the same picture. That is why guidelines recommend confirming a low reading with a blood test before considering treatment, rather than treating symptoms alone.
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The Endocrine Society recommends diagnosing low testosterone only in men who have both consistent symptoms and unequivocally low morning total testosterone on at least two separate measurements.2 Testosterone is highest in the morning, so the timing of the draw matters.
Fertility goals can change the treatment discussion. Clomiphene (Clomid®) is sometimes used off-label for men with low testosterone who want to preserve fertility because it can support the body's own testosterone production rather than replace it. It is not FDA-approved for male hypogonadism, and whether it fits is a clinician decision.3
Chapter 03 · The fine print
What this screen does not do
The ADAM does not diagnose low testosterone, measure your hormone levels, or decide whether treatment is right for you. It is a starting point for a conversation. A clinician interprets your symptoms alongside blood work and your medical history, weighs the benefits and risks of any treatment, and decides what, if anything, to do. Individual results vary.
A positive screen is a prompt to get tested, not a result you can act on by itself. A licensed physician confirms the diagnosis with blood work before any treatment is considered.
