Identifying the symptoms of TDS

The signs and symptoms of TDS are often non-specific, or may be ascribed to other conditions, or simply put down to the effects of aging.

This may explain why this condition is not diagnosed more often. Indeed, it has been described as one of the most frequent, but also most underdiagnosed, endocrinopathies 37.

Testosterone Deficiency Syndrome (TDS) describes patients with low serum testosterone levels (below 12 nmol/L) who experience one or more of the following features 36, 1, 46, 9:

  • Erectile dysfunction (ED)
  • Diminished sexual desire/libido
  • Lethargy and fatigue
  • Increased abdominal fat (waist circumference >102cm)
  • Depressed mood or irritability
  • Decreased cognitive function
  • Hot flushes or sweating
  • Decreased lean body mass and muscle volume/strength
  • Decreased body hair and skin alterations
  • Sleep disturbances
  • Low sperm count
  • Low bone mineral density or increased incidence of fractures

The ADAM test

The ADAM test is useful to establish whether your patients have any of the features of TDS 33:

  1. Do you have reduced libido (sex drive)?
  2. Do you have a lack of energy?
  3. Do you have a decrease in strength and endurance?
  4. Have you lost height?
  5. Have you noticed less enjoyment of life?
  6. Are you sad and/or grumpy?
  7. Are your erections less strong?
  8. Have you noticed a recent deterioration in your ability to play sports?
  9. Are you falling asleep after dinner?
  10. Is your work performance suffering?

'No' to all questions: Your patient is not likely to need further tests for testosterone deficiency.

'Yes' to question 1 or 7, or at least three of the other questions: Your patient may have low testosterone 33.

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All men with ED should have their testosterone measured, especially those who are less responsive or have failed to respond to treatment with a PDE5i 18.

After taking a general medical and drug history, a physical examination should be carried out.

This may include:

  • BMI, waist circumference
  • Testicular size/consistency
  • Secondary sexual characteristics
  • Visual fields

Testosterone levels should be measured between 8 and 11am 18. You may also wish to consider testing for LH, FSH, SHBG and Prolactin.