This check is based on the ADAM questionnaire, developed at Saint Louis University to screen for androgen deficiency in ageing men. It asks about the symptoms most consistently associated with low testosterone.
It is a screening tool, and its properties are worth knowing before you act on the result. ADAM is sensitive but not specific: it catches most men who do have low testosterone, and it also flags many who do not. Fatigue and low mood are common for reasons that have nothing to do with hormones.
So a high score means the question is worth asking, not that the answer is yes.
Among all the questions, one carries more weight than the rest: loss of morning erections.
Sexual symptoms, particularly reduced morning erections, low libido and erectile difficulty, are more specific to low testosterone than the general symptoms. The European Male Ageing Study found these three sexual symptoms clustered with genuinely low testosterone, while fatigue, poor concentration and low mood did not discriminate nearly as well.
If you scored high mainly on tiredness and mood, the odds that hormones are responsible are lower than if you scored high on the sexual symptoms.
Before assuming testosterone, four alternatives are more common and all are treatable.
Sleep apnoea. Fragmented sleep suppresses testosterone directly, and untreated apnoea is the most frequently missed explanation in men presenting with these symptoms.
Depression. The symptom overlap is almost complete, and the two conditions can coexist.
Thyroid dysfunction. A cheap blood test that many men have never had.
Iron deficiency. Produces fatigue and reduced exercise capacity well before anaemia appears.
Ask for blood tests, and ask for the right ones.
Two morning testosterone samples taken before 11am on separate days. Levels vary through the day and between days, so a single afternoon reading proves nothing.
SHBG and free testosterone. A normal total with high SHBG can leave very little available.
LH and FSH. These separate a testicular problem from a signalling problem, and they change what treatment makes sense.
Prolactin, thyroid function and ferritin to cover the alternatives above.
Take the score with you. A specific complaint with a screening result behind it is harder to dismiss than a general sense of feeling flat.
Related reading: What causes low testosterone · Blood test: what to check · Sleep apnoea and testosterone · Low testosterone and depression
Educational only, not medical advice. This is a screening questionnaire, not a diagnosis.