ADAM Questionnaire About Symptoms of Low Testosterone

Name

Date

Age

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

YesNo

2. Do you have a lack of energy?

YesNo

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

YesNo

4. Have you lost height?

YesNo

5. Have you noticed a decreased "enjoyment of life?

YesNo

6. Are you sad and/or grumpy?

YesNo

7. Are your erections less strong?

YesNo

8. Have you noticed a recent deterioration in your ability to play sports?

YesNo

9. Are you falling asleep after dinner?

YesNo

10. Has there been a recent deterioration in your work performance?

YesNo

If you Answer Yes to number 1 or 7 or if you answer Yes to more than 3 questions, you may have low Testosterone.