ADAM Low Testosterone Screening Questionnaire

Self-assessment · Takes about a minute

The ten-question screen for low testosterone — and an honest account of how often it is wrong.

The ADAM questionnaire (Androgen Deficiency in the Aging Male) was developed at Saint Louis University and published in 2000. Ten yes-or-no questions, no arithmetic, and a result in under a minute. It is the instrument most commonly handed to men who ask their doctor about low testosterone, and the one most online testosterone clinics put in front of you before they offer to sell you anything.

We are going to give it to you straight, run it properly, and then tell you the part those clinics leave out.

This is a screening questionnaire, not a diagnosis. Low testosterone can only be diagnosed with a blood test. Every symptom on this list has other common explanations — poor sleep, depression, thyroid problems, anaemia, medication side effects, alcohol, or simply being unwell. Nothing you enter is sent anywhere; the result is worked out in your browser.

The Ten Questions

Answer for how you have been feeling recently, compared with how you used to feel.

Question 1 · Key item

Do you have a decrease in libido (sex drive)?

Question 2

Do you have a lack of energy?

Question 3

Do you have a decrease in strength and/or endurance?

Question 4

Have you lost height?Yes, height — not weight. Loss of bone density can compress the spine over years, so a man who has lost an inch or more may notice it in the way his clothes hang.

Question 5

Have you noticed a decreased “enjoyment of life”?

Question 6

Are you sad and/or grumpy?

Question 7 · Key item

Are your erections less strong?

Question 8

Have you noted a recent deterioration in your ability to play sports?

Question 9

Are you falling asleep after dinner?

Question 10

Has there been a recent deterioration in your work performance?

Answer all ten

Your result appears here as you answer. Nothing is stored or sent.

How It Is Scored

The rule from the original paper is not a points total. A screen counts as positive if you answer yes to question 1 (sex drive) or question 7 (erections), or yes to any three of the other eight questions.

Read that again and you will see the problem coming. Two of the ten items can trigger a positive result on their own, and both are about sexual function — which is also affected by stress, relationship strain, alcohol, blood pressure medication, depression and sleep. Everything else needs only three yeses out of eight items that describe a fairly ordinary bad stretch: tired, grumpy, not enjoying things, dozing off after dinner.

How Often Is It Actually Right?

This is the section the testosterone clinics do not show you, and it is the reason we built this page.

ADAM is good at catching men who do have low testosterone — sensitivity runs 81–97% across studies. What it is bad at is ruling anyone out. Here is every published evaluation we could verify, including the ones run by the questionnaire's own author:

Study	Men	Sensitivity	Specificity
Morley et al., 2000 — the original validation	316	88%	60%
Tancredi et al., 2004	5,028	81%	21.6%
Morley et al., 2006 — the author's own follow-up	148	97%	30%
Blümel et al., 2009	96	83.3%	19.7%
Naz et al., 2020	255	90.1%	41.3%

Specificity is the number that matters here. A specificity of 21.6% means that of the men with perfectly normal testosterone, roughly four in five still screened positive. In the largest study — 5,028 men aged 50 to 70 — ADAM classified men correctly 44.5% of the time. A coin does better.

In Blümel's study, 81.3% of the men screened positive. Only 28.1% actually had low testosterone on a blood test. That means roughly seven out of ten men who got a positive result were not deficient at all. Naz and colleagues reported the figure directly: a positive predictive value of 45.3%, so fewer than half of positive screens were correct.

Even the original 2000 validation, which put specificity at its most flattering 60%, works out to about 58% of positive screens being false — and it was run on 316 Canadian physicians aged 40 to 62, which is not a general population.

Why a supplement company is telling you this. A questionnaire that returns positive for four men in five is a marketing instrument as much as a clinical one, and we sell a testosterone support product. If we put this tool in front of you without the specificity table, we would be using a near-universal “yes” to sell bottles. The honest version is more useful to you and less useful to us, so that is the one on this page. Your result below is a prompt to get a blood test, not a reason to buy anything from us.

What Guidelines Actually Say

No major guideline endorses ADAM, or any symptom questionnaire, as a way of deciding who has low testosterone.

The Endocrine Society recommends against routine screening of men in the general population for hypogonadism at all, and in its earlier guideline suggested clinicians not use case-finding instruments like this one in men attending for unrelated reasons. The American Urological Association states that validated questionnaires are not recommended for deciding who is a candidate for testosterone therapy. The Canadian Urological Association is the most permissive of the three and still says that, because of their lack of specificity — it names the figure as approximately 20% — screening questionnaires alone should not substitute for a history, an examination and biochemical testing.

The CUA does allow that a questionnaire can act as an initial screen to open a conversation and point at what to look into. That is exactly what this page is for, and it is the only thing it is for.

What Would Actually Confirm It

A diagnosis of testosterone deficiency requires a blood test, and the details matter more than people expect:

Total testosterone, drawn in the morning — between 7 and 11 am. Testosterone follows a daily rhythm and an afternoon sample can read low in a man who is entirely normal.
Fasting, per the Endocrine Society.
Twice. The AUA makes this a strong, Grade A recommendation: the diagnosis should be made only after two separate early-morning measurements. A single low reading is not a diagnosis.
Thresholds differ slightly by guideline — the AUA uses below 300 ng/dL as a reasonable cut-off, the CUA uses below 10 nmol/L — and free or bioavailable testosterone is used to settle borderline results.
If levels are genuinely low, LH and FSH are usually checked next to work out why.

A questionnaire score appears nowhere in that pathway. Its only legitimate job is to get you to ask for the test.

See a doctor rather than self-managing if you have:

Loss of morning erections together with reduced sex drive — the combination most associated with genuinely low testosterone
Breast tenderness or enlargement
Shrinking testicles, or a testicular lump
Infertility, or difficulty conceiving
Hot flushes or sweats
Low mood that is persistent, or any thoughts of harming yourself — this is a reason to seek help now, not to fill in a questionnaire

What This Screen Cannot Tell You

It cannot distinguish causes. Poor sleep suppresses testosterone and produces every symptom on this list; so does depression, which overlaps with items 2, 5, 6, 9 and 10 almost perfectly. Obesity, type 2 diabetes, thyroid disease, anaemia, obstructive sleep apnea, opioid painkillers, some antidepressants and heavy drinking all belong on the same list. Several of those are more treatable than low testosterone and none of them are helped by a supplement.

It also cannot tell you anything about severity, and there is no meaningful difference between a man who answered yes three times and one who answered yes eight times. The output is binary by design.

ADAM Low Testosterone Screening Questionnaire

The Ten Questions