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?

摘要

Background: Androgen Deficiency in Aging Male (ADAM) questionnaire is increasinglypopular for the evaluation of testosterone deficiency (TD) in Sub-Saharan African men with type 2diabetes mellitus (T2DM). However, its reliability in this population is unknown.Objective: To evaluate the reliability of the ADAM questionnaire for the clinical detection of testosteronedeficiency in Sub-Saharan African men with T2DM.Methods: Total testosterone < 8nmol/L was used as gold standard for diagnosis of TD in a crosssectionalsurvey of 200 males with T2DM aged 30-69 years. Participants also completed the SaintLouis 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 ADAMtool were computed.Results: The mean age of the participants was 58.0 ± 8.8 years. 142 subjects (71.0) had TD based onthe ADAM questionnaire. However, TD was biochemically confirmed in 59 subjects (29.5). ADAMquestionnaire rendered sensitivity of 88.1, specificity of 44.7, PPV of 50.0, NPV of 85.7 andaccuracy of 61.4. Low libido alone had better specificity (75.5) and accuracy (73.2) than the entirequestionnaire.Conclusion: Despite an impressive sensitivity, the low specificity and overall accuracy of the ADAMquestionnaire 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 testosteronedeficiency requiring biochemical confirmation.