Contact Us for Wellness Consultation

16321 Main St., Suite 210, #38
Chino, CA 91708
4235 S. Fort Apache, Unit 100
Las Vegas, NV 89147
(949) 368-5010
[email protected]

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16321 Main St., Suite 210, #38
Chino, CA 91708
4235 S. Fort Apache, Unit 100
Las Vegas, NV 89147
(949) 368-5010

[email protected]

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ADAM Questionnaire: Assessing Symptoms of Low Testosterone

This brief self-assessment helps identify symptoms that may be associated with low testosterone (Androgen Deficiency in the Aging Male). It’s designed to support discussions with your healthcare provider.

Name(Required)

Phone(Required)

Email(Required)

1. Do you have a decrease in libido (sex drive)?

Yes

2. Do you have a lack of energy?

Yes

3. Do you have a decrease in strength and/or endurance?

Yes

4. Have you lost height?

Yes

5. Have you noticed a decreased "enjoyment of life"?

Yes

6. Are you sad and/or grumpy?

Yes

7. Are your erections less strong?

Yes

8. Have you noticed a recent deterioration in your ability to play sports?

Yes

9. Are you falling asleep after dinner?

Yes

10. Has there been a recent deterioration in your work performance?

Yes

Disclaimer: This questionnaire is for informational purposes only and does not constitute a medical diagnosis. Your responses will be reviewed by a licensed provider at Euphoria Wellness. If you answer “Yes” to question 1 or 7, or to more than three questions total, you may be experiencing symptoms of low testosterone.

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