The ADAM (Androgen Deficiency in Aging Males) questionnaire consists of 10 questions that help determine if a male patient suffers from androgen deficiency (low testosterone) and whether or not further testing and follow-up are needed.
Low testosterone affects almost 40% of men aged 45 and over. It is difficult to define normal levels, because levels vary throughout the day and are affected by body mass index (BMI), nutrition, alcohol consumption, certain medications, age and illness. As a man ages, the amount of testosterone in his body gradually drops. This natural decline starts after age 30 and continues (about 1% per year) throughout his life.
Symptoms of low testosterone depend on the age of the person, and include the following: Low sex drive, increased body fat, erectile dysfunction, depressed mood, difficulties with concentration and memory, fatigue, loss of muscular strength, a decrease in body hair and thinning of the bones (osteoporosis).
Male hypogonadism is a condition in which the body doesn't produce enough testosterone — the hormone that plays a key role in masculine growth and development during puberty — or has an impaired ability to produce sperm or both.
You may be born with male hypogonadism, or it can develop later in life, often from injury or infection. The effects — and what you can do about them — depend on the cause and at what point in your life male hypogonadism occurs. Some types of male hypogonadism can be treated with testosterone replacement therapy.
In an adult, the testicles have two main functions: to make testosterone and sperm. These activities are controlled by a part of the brain called the pituitary. The pituitary sends signals (called gonadotropins) to the testicles that, under normal conditions, cause the testicles to produce sperm and testosterone. The pituitary signals can change based on the feedback signals that the brain receives from the testicle.
Hypogonadism can therefore be divided into two main categories:
- A problem within the testicle itself
- A problem with the signals from the brain to the testicles
- Primary - also known as primary testicular failure — originates from a problem in the testicles.
- Secondary - indicates a problem in the hypothalamus or the pituitary gland — parts of the brain that signal the testicles to produce testosterone. The hypothalamus produces gonadotropin-releasing hormone, which signals the pituitary gland to make follicle stimulating hormone (FSH) and luteinizing hormone (LH). Luteinizing hormone then signals the testes to produce testosterone.
Either type of hypogonadism may be caused by an inherited (congenital) trait or something that happens later in life (acquired), such as an injury or an infection. At times, primary and secondary hypogonadism can occur together. Yet, both groups of patients have all of the same symptoms. “Relative” hypogonadism is the term we use to describe a level of testosterone that has decreased over the previous few years. This declining testosterone level results in the symptoms many men experience as they age.
Testosterone therapy may contribute to sleep apnea, limited sperm production, enlarge breasts and could cause acne or other skin reactions.