Your Complete Testosterone Assessment

Note: based on the ADAM questionaire

1.1 Check all symptoms that apply to you:

• Decreased sex drive or libido
• Weaker erections or fewer morning erections
• Over 40 with diabetes, bodyfat >25%, or waist >102cm (40inches)
• Lack of energy or persistent fatigue
• Decreased muscle strength or endurance
• Loss of height (more than 2cm / 0.8inches)
• Decreased enjoyment of life
• Feeling sad, grumpy, or irritable
• Decreased ability to play sports or exercise
• Falling asleep after dinner regularly
• Recent deterioration in work performance
• Increased body fat, especially around the waist
• Hot flushes or night sweats

1.2 How strong is the clinical indication for andropause?

• Checked fewer than 3 boxes and no bold boxes: weak or absent

  You are fine. Testosterone measurements are optional.

• Checked 3-4 boxes total: moderate

  Evaluate your lifestyle (below). Testosterone measurements are optional.

• Checked 5 or more boxes: strong

  You must now measure your testosterone and discuss the result with your general physician.

• Checked 1 or more bold boxes: strong

  You must now measure your testosterone and discuss the result with your general physician.

2.1 Measure these blood markers on a morning after 2 days of rest:

• Total testosterone
• Free testosterone

2.2 Evaluate your testosterone:

2.3 Result:

• Total testosterone > 16 nmol/L or 460 ng/dL: testosterone is fine (abort this test)
• Total testosterone < 9.2 nmol/L or 264 ng/dL OR Free testosterone < 420 pmol/L or 121 pg/mL: low-T
• Total testosterone 9.2-16 nmol/L or 264-460 ng/dL: threshold-T

Note: based on the US/EU harmonized reference values

2.4 Confirmation test

If the first test indicated low-T or threshold-T you need to do a confirmatory test after 2 weeks with the same laboratory. This time you need to measure extra markers that are needed for defficiency checks and when you decide to start TRT:

• Total testosterone
• Free testosterone
• Hematocrite^*
• Estradiol (E2)^*
• PSA^*
• Zinc^*
• 25(OH)D^*
• Magnesium^*
• LDL-C^*
• LDL-H^*

3.1 Check what applies to you:

• Confirmed threshold-T

  You should optimize your lifestyle and check again after 6 months. If your testosterone did not improve after 6 months TRT could be a risk management strategy.

• Confirmed low-T but no strong clinical indication

  You are low-T and at immediate risk of andropause and must optimize your lifestyle and check again after 6 months. If your testosterone did not improve after 6 months TRT could be a risk management strategy.

• Confirmed low-T and strong clinical indication

  You have andropause and you must optimize your lifestyle. If your health does not improve, you need TRT.

Check your Testosterone Risk →

4.1 Check all boxes that apply to your lifestyle:

• Regular heavy drug use (e.g., opioids) — 3 points
• Overweight or high body fat (BMI > 30 or bodyfat > 25%) — 3 points
• Undernutrition or restrictive dieting (energy deficiency) — 2 points
• Regular heavy alcohol consumption — 2 points
• Overtraining or excessive endurance exercise — 2 points
• Poor sleep quality or sleep deprivation — 2 points
• Untreated obstructive sleep apnea (OSA) — 2 points
• Sedentary lifestyle (little or no exercise) — 1 point
• High stress levels or chronic stress — 1 point

4.2 Is your lifestyle the cause of low-T (=functional hypogonadism)?

(Add the points for each checked box, then select your result)

• 0–2 points: low likelihood of lifestyle‑related low testosterone
• 3–5 points: moderate likelihood; address factors and recheck
• 6–9 points: high likelihood; prioritize lifestyle changes before TRT
• 10+ points: very high likelihood; correct factors and consider medical evaluation

5.1 Is nutrient deficiency the cause of your low-T (=functional hypogonadism)

Some deficiencies can up to half your testosterone level in some cases (e.g. zinc). Take the measurements from the confirmatory test above and do the deficiency check. Fix deficiencies first before starting TRT.

Check for Nutrient Deficiency →