Adding to the controversy: Pitfalls in the diagnosis of testosterone deficiency syndromes with questionnaires and biochemistry

Figures & data

Figure 1. Disposition of participants.

Table I.  Mean AMS scores.

AMS	Andropausic (n = 30) ± SD	Non-andropausic (n = 29) ± SD
Psychological symptoms	11.3 ± 4.0^☆	6.2 ± 1.9^☆
Somatovegative Symptoms	17.5 ± 5.1^☆	10.35 ± 3.6^☆
Sexual symptoms	14.5 ± 3.0^☆	6.5 ± 1.7^☆

^☆p < 0.001.

Table II.  Mean CAS scores.

CAS	Andropausic (n = 30) ± SD	Non-andropausic (n = 29) ± SD
Energy	6.5 ± 2.9^☆; p < 0.001	9.9 ± 2.5^☆
Performance	2.0 ± 1.1^☆; p = 0.002	3.1 ± 1.1^☆
Intercourse	3.8 ± 2.5^☆; p < 0.001	7.1 ± 1.8^☆
Masturbation	2.5 ± 2.3	3.6 ± 3.5
Sexual Interest	9.3 ± 3.1	9.0 ± 2.7
Mood	27.6 ± 11.1^☆; p < 0.001	38.6 ± 9.8^☆
Sleep	7.2 ± 2.5 p < 0.001	10.5 ± 1.8^☆
Physical	9.2 ± 1.1	8.7 ± 1.1
Memory	16.9 ± 3.4^☆; p = 0.032	18.8 ± 2.9

^☆Asterisk indicates that the values are statistically significant.

Table III.  ADAM ‘positive’ and hormone levels.

	ADAM Q1	ADAM Q7	ADAM total >3
BioT	Yes 3.7 ± 2.4	Yes 3.7 ± 2.3	Yes 3.7 ± 2.3
	No 3.6 ± 1.3	No 3.6 ± 1.2	No 3.6 ± 1.3
	p = 0.497	p = 0.734	p = 0.791
LH	Yes 7.6 ± 5.3	Yes 7.2 ± 4.6	Yes 7.5 ± 5.1
	No 5.6 ± 3.3	No 5.8 ± 4.1	No 5.6 ± 3.4
	p = 0.162	p = 0.129	p = 0.187
IGF-1	Yes 161.6 ± 59.7	Yes 161.8 ± 66.2	Yes 159.3 ± 66.4
	No 195.6 ± 71.2	No 198.8 ± 65.7	No 199.8 ± 64.5
	p = 0.056	p = 0.036^☆	p = 0.021^☆
TSH	Yes 1.9 ± 0.9	Yes 1.8 ± 0.9	Yes 1.8 ± 0.9
	No 1.9 ± 1.3	No 1.9 ± 1.3	No 1.9 ± 1.3
	p = 0.240	p = 0.856	p = 0.595
Prolactin	Yes 5.5 ± 3.1	Yes 5.6 ± 3.0	Yes 5.7 ± 3.1
	No 6.1 ± 2.2	No 6.1 ± 2.2	No 6.0 ± 2.1
	p = 0.365	p = 0.497	p = 0.607
Total T	Yes 15.3 ± 9.5	Yes 15.0 ± 9.0	Yes 14.8 ± 9.2
	No 13.5 ± 3.7	No 13.6 ± 3.9	No 13.9 ± 3.9
	p = 0.345	p = 0.447	p = 0.632
SHBG	Yes 31.3 ± 14.5	Yes 29.4 ± 12.9	Yes 30.3 ± 13.2
	No 28.3 ± 10.8	No 29.9 ± 12.3	No 29.0 ± 12.0
	p = 0.473	p = 0.802	p = 0.671
DHEAS	Yes 2.7 ± 1.7	Yes 2.8 ± 1.7	Yes 2.5 ± 1.7
	No 3.6 ± 2.6	No 3.6 ± 2.7	No 3.8 ± 2.6
	p = 0.127	p = 0.219	p = 0.024

Note: IGF-1 levels were significantly lower in those participants that responded ‘yes’ to ADAM question 7 or had a total ADAM score >3, and lower levels, close to significance (p = 0.056), in those participants that responded ‘yes’ to ADAM question 1. DHEAS levels were significantly lower in participants that scored a total ADAM score >3 than those that did not.

Table IV.  AMS and CAS Questionnaire domain correlations with hormone levels.

	Symptom tool	Bio T	LT	IGF-1	TSH	Prolactin	Total T	SHBG	DHEAS
AMS	Psychological Symptoms	−0.208	0.0605	−0.147	−0.05	−0.06	−0.251	−0.091	−0.172
		p = 0.114	p = 0.648	p = 0.265	p = 0.719	p = 0.652	p = 0.056	p = 0.491	p = 0.195
	Somatovegative Symptoms	−0.198	0.0106	−0.171	−0.018	−0.141	−0.251	−0.071	−0.215
		p = 0.131	p = 0.936	p = 0.194	p = 0.891	p = 0.285	p = 0.055	p = 0.593	p = 0.105
	Sexual complaints	−0.098	0.185	−0.313^☆	0.035	−0.161	−0.057	0.0772	−0.180
		p = 0.461	p = 0.161	p = 0.016	p = 0.793	p = 0.224	p = 0.668	p = 0.560	p = 0.176
CAS	Energy	0.191	0.0405	0.061	0.0176	0.094	0.176	0.0868	0.141
		p = 0.148	p = 0.760	p = 0.646	p = 0.894	p = 0.478	p = 0.181	p = 0.512	p = 0.289
	Performance	0.199	−0.0686	0.279^☆	−0.074	0.067	0.223	−0.0622	0.188
		p = 0.131	p = 0.605	p = 0.033	p = 0.578	p = 0.614	p = 0.09	p = 0.639	p = 0.157
	Intercourse	0.0732	−0.127	0.383^☆	−0.209	0.130	0.078	−0.147	0.174
		p = 0.58	p = 0.335	p = 0.003	p = 0.112	p = 0.324	p = 0.558	p = 0.265	p = 0.191
	Masturbation	0.124	−0.195	0.105	−0.110	−0.008	0.071	−0.053	0.0397
		p = 0.347	p = 0.139	p = 0.427	p = 0.408	p = 0.953	p = 0.592	p = 0.687	p = 0.766
	Sexual interest	−0.0634	0.0402	−0.273^☆	0.163	0.0235	0.0246	0.143	−0.0662
		p = 0.632	p = 0.762	p = 0.036	p = 0.217	p = 0.852	p = 0.852	p = 0.279	p = 0.620
	Mood	0.163	0.123	0.0045	0.0489	0.144	0.138	0.02	0.086
		p = 0.215	p = 0.352	p = 0.973	p = 0.712	p = 0.275	p = 0.296	p = 0.881	p = 0.518
	Sleep assessment	0.249	−0.072	0.285^☆	−0.113	0.034	0.243	0.0138	0.180
		p = 0.06	p = 0.586	p = 0.029	p = 0.393	p = 0.8	p = 0.063	p = 0.917	p = 0.175
	Physical assessment	−0.245	−0.133	0.022	0.067	0.161	−0.254	−0.0307	−0.0905
		p = 0.062	p = 0.315	p = 0.866	p = 0.611	p = 0.221	p = 0.052	p = 0.817	p = 0.498
	Short term memory	0.076	−0.089	0.116	0.190	0.072	0.143	−0.0445	0.052
		p = 0.56	p = 0.504	p = 0.379	p = 0.150	p = 0.586	p = 0.278	p = 0.737	p = 0.697

^☆Significant correlation.

Table

At work	0	1	2	Can't answer
Around the house	0	1	2	Can't answer
For my hobbies	0	1	2	Can't answer
For friends	0	1	2	Can't answer
Sexually	0	1	2	Can't answer

Table

1. Down, Low	____	____	____	____	____	____	____	Up, High
	Very	Moderate	Little	NEUTRAL	Little	Moderate	Very
2. Irritable	____	____	____	____	____	____	____	Patient
	Very	Moderate	Little	NEUTRAL	Little	Moderate	Very
3. Sad	____	____	____	____	____	____	____	Happy
	Very	Moderate	Little	NEUTRAL	Little	Moderate	Very
4. Uninterested	____	____	____	____	____	____	____	Enthusiastic
	Very	Moderate	Little	NEUTRAL	Little	Moderate	Very
5. Hopeless	____	____	____	____	____	____	____	Hopeful
	Very	Moderate	Little	NEUTRAL	Little	Moderate	Very
6. Unmotivated	____	____	____	____	____	____	____	Motivated
	Very	Moderate	Little	NEUTRAL	Little	Moderate	Very
7. Nervous	____	____	____	____	____	____	____	Calm
	Very	Moderate	Little	NEUTRAL	Little	Moderate	Very

Table

1. Have you noticed that you are less tall?	□1 Yes	□2 No
2. Have you noticed that you have gained weight?	□1 Yes	□2 No
3. Have you noticed that you are more forgetful?	□1 Yes	□2 No
4. Are you receiving treatment for diabetes?	□1 Yes	□2 No
5. Are you receiving treatment for asthma?	□1 Yes	□2 No
6. Are you bothered by headaches?	□1 Yes	□2 No
7. Do you smoke cigarettes?	□0 Yes	□1 Formerly	□2 Never Smoked

Table

1. 2–7–8	Score:	1	0
9–2–6
2. 6–7–1–3	Score:	1	0
4–2–9–7
3. 3–5–2–8–4	Score:	1	0
4–9–7–2–5
4. 6–2–5–9–3–1	Score:	1	0
4–7–1–8–5–2
5. 7 –1–5–9–2–4–8	Score:	1	0
6–9–2–4–3–1–5
6. 9–6–2–5–8–7–1–4	Score:	1	0
5–8–2–4–1–9–3–6

Table

1. 2–5	Score:	1	0
3–6
2. 9–3–7	Score:	1	0
6–2–4
3. 5–2–9–1	Score:	1	0
4–7–6–3
4. 8–3–9–1–5	Score:	1	0
4–7–2–9–8
5. 7–1–5–4–9–2	Score:	1	0
6–3–8–1–4–7