ADAM Questionnaire

ADAM Questionnaire: Assessing Symptoms of Low Testosterone

This brief self-assessment helps identify symptoms that may be associated with low testosterone (Androgen Deficiency in the Aging Male). It’s designed to support discussions with your healthcare provider.
Name*

First NameLast Name
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
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
Disclaimer: This questionnaire is for informational purposes only and does not constitute a medical diagnosis. Your responses will be reviewed by a licensed provider at Euphoria Wellness. If you answer “Yes” to question 1 or 7, or to more than three questions total, you may be experiencing symptoms of low testosterone.
Should be Empty:

ADAM Questionnaire: Assessing Symptoms of Low Testosterone