ADAM Questionnaire for Low Testosterone Screening

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

Yes No

2. Do you have a lack of energy?

Yes No

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

Yes No

4. Have you lost height?

Yes No

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

Yes No

6. Are you sad and/or grumpy?

Yes No

7. Are your erections less strong?

Yes No

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

Yes No

9. Are you falling asleep after dinner?

Yes No

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

Yes No