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Questionnaire for male patients

Birthday
Day
Month
Year
ADAM score
(Androgen deficiency in the aging male)

This basic questionnaire can be very useful for men to describe the kind and severity of their low testosterone symptoms

Do you have a decrease in libido (sex drive)
Yes
No
Do you have a lack of energy
Yes
No
Do you have a decrease in strength and/or endurance
Yes
No
Have you lost height
Yes
No
Have you noticed a decreased 'enjoyment of life'
Yes
No
Are you sad and/or grumpy
Yes
No
Are your erections less strong
Yes
No
Have you noticed a recent deterioration in your ability to play sports
Yes
No
Are you falling asleep after dinner
Yes
No
Has there been a recent deterioration in your work performance
Yes
No

You may have low testosterone if:

You answer YES to number 1 or 7

You answer YES to more than 3 questions

Other Medical History:
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