Androgen Deficiency in Aging Male Questionnaire for the Clinical Detection of Testosterone Deficiency in a Population of Black Sub-Saharan African Men with Type 2 Diabetes Mellitus: Is it a Reliable Tool?

BACKGROUND: Androgen Deficiency in Aging Male (ADAM) questionnaire is increasingly popular for the evaluation of testosterone deficiency (TD) in Sub-Saharan African men with type 2 diabetes mellitus (T2DM). However, its reliability in this population is unknown.

OBJECTIVE: To evaluate the reliability of the ADAM questionnaire for the clinical detection of testosterone deficiency in Sub-Saharan African men with T2DM.

METHODS: Total testosterone < 8nmol/L was used as gold standard for diagnosis of TD in a crosssectional survey of 200 males with T2DM aged 30-69 years. Participants also completed the Saint Louis University ADAM questionnaire whereby TD was diagnosed by a "yes" answer to question 1 (reduced libido) or 7 (erectile dysfunction) or any other three questions. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and overall accuracy of the ADAM tool were computed.

RESULTS: The mean age of the participants was 58.0 ± 8.8 years. 142 subjects (71.0%) had TD based on the ADAM questionnaire. However, TD was biochemically confirmed in 59 subjects (29.5%). ADAM questionnaire rendered sensitivity of 88.1%, specificity of 44.7%, PPV of 50.0%, NPV of 85.7% and accuracy of 61.4%. Low libido alone had better specificity (75.5%) and accuracy (73.2%) than the entire questionnaire.

CONCLUSION: Despite an impressive sensitivity, the low specificity and overall accuracy of the ADAM questionnaire makes it unreliable for the detection of AD in Sub-Saharan African men with type 2 DM. However, presence of a sustained low libido appears to be a reliable pointer to underlying testosterone deficiency requiring biochemical confirmation.