A simple questionnaire for the detection of testosterone deficiency in men with late-onset hypogonadism

Abstract

The Aging Males' Symptoms (AMS) score, developed to screen for late-onset hypogonadism (LOH), contains 17 questions regarding mental, physical, and sexual parameters. In the Japanese guidelines, a free testosterone (FT) <8.5 pg/mL is recommended for testosterone treatment. However, previous studies have shown no correlation between total AMS scores and testosterone concentration. We aimed to develop a better questionnaire for the detection of testosterone deficiency in men, for the diagnosis of LOH. In 234 Japanese men, aged 40-64 years, we analyzed the relationships of AMS with serum total testosterone (TT), FT, calculated FT (cFT), and calculated bioavailable testosterone (cBT), and identified useful questions for the detection of testosterone deficiency. Four scores, a decrease in muscular strength, a decrease in ability to perform sexually or the frequency, a decrease in the number of morning erections, and a decrease in sexual desire/libido, were negatively associated with two or more of the above four testosterone parameters, and the sum of these four scores (named the selective score) correlated with TT and cFT, independent of age. Statistical analysis revealed an association between insulin resistance and testosterone deficiency, and a higher selective score in smokers than non-smokers. Cubic function model analysis and logistic regression analysis revealed that selective scores ≥10 corresponded with the testosterone concentrations recommended for the diagnosis of LOH, including FT <8.5 pg/mL, independent of age, insulin resistance, and smoking. Thus, the selective score represents a simple and useful means for screening of testosterone deficiency in Japanese men, as an indicator of LOH.

Correlation between Higher Aging Males’ Symptoms Scores and a Higher Risk of Lower Urinary Tract Symptoms

“…The Aging Males' Symptoms (AMS) scale, which is also validated in Japanese individuals, is widely accepted for the assessment and monitoring of symptoms of LOH; however, patients with an AMS score of 17-26 are not diagnosed with LOH [13]. In 1999, the Aging Males' Symptoms (AMS) scale was developed as a symptom-profiling approach in Germany [14] In the AMS, the severity of the symptoms of LOH is evaluated using the total score derived from all 17 questions, which assess parameters on a five-point scale [14,15]. The International Prostate Symptom Score (IPSS), which includes seven domains and a QOL score, is widely used to assess the symptoms of male LUTSs [16].…”