Men's Health Questionnaire - Birmingham Direct Primary Care™

Take the Men's Health Test

Quantitative Androgen Deficiency in the Aging Male (QADAM) Form

This is the quantitative Androgen Deficiency in the Aging Male that can help screen for low testosterone and assess treatment. Please answer 1-5 for each of the questions.

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

Yes

How would you rate your libido (sex drive)? (1=terrible, 5=great)

Do you have a decrease in strength and/or endurance

Yes

How would you rate your strength/endurance? (1=terrible, 5=great)

Do you have a lack of energy

Yes

How would you rate your energy level? (1=terrible, 5=great)

Have you noticed a decreased “enjoyment of life”?

Yes

How would you rate your enjoyment of life? (1=terrible, 5=great)

Are you sad and/or grumpy?

Yes

How would you rate your happiness level? (1=terrible, 5=great)

Are your erections less strong?

Yes

How strong are your erections? (1=terrible, 5=great)

Has there been a recent deterioration in your work performance?

Yes

How would you rate your work performance over the past 4 weeks? (1=terrible, 5=great)

Are you falling asleep after dinner?

Yes

How often do you fall asleep after dinner? (1=very often, 5=rarely)

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

Yes

How would you rate your sports ability over the past 4 weeks? (1=terrible, 5=great)

Have you lost height?

Yes

How much height have you lost? (1=2" or more, 5=0")

Are you falling asleep after lunch?

Yes

How often do you fall asleep after lunch? (1=very often, 5=rarely)

Contact Information

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Last Name

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info@birminghamdpc.com

* Our patients always have access to our physician via multiple modalities at all times. Prospective patients without appointments are recommended to call our office prior to stopping by as the doctor’s availability may vary.

Take the Men's Health Test

Quantitative Androgen Deficiency in the Aging Male (QADAM) Form

Contact Information

info@birminghamdpc.com

(205) 582-3322

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