Based on the validated Ageing Males’ Symptoms (AMS) scale used in clinical practice. Rate each symptom on a 1–5 scale. Takes approximately 3 minutes. Results indicate whether a morning testosterone blood test is warranted.
Basic Information
Domain 1 — Somatic (Physical) Symptoms
Somatic
1. Decline in your general sense of wellbeing — do you feel generally unwell, fatigued, or run-down?
1 None
2 Mild
3 Moderate
4 Severe
5 Very Severe
Somatic
2. Joint pain or muscular aches, back pain, or general bodily pain (not from a known injury or arthritis)?
1 None
2 Mild
3 Moderate
4 Severe
5 Very Severe
Somatic
3. Excessive sweating, hot flushes, or sudden waves of heat — even without exertion?
1 None
2 Mild
3 Moderate
4 Severe
5 Very Severe
Somatic
4. Sleep problems — difficulty falling asleep, staying asleep, or feeling unrefreshed in the morning?
1 None
2 Mild
3 Moderate
4 Severe
5 Very Severe
Somatic
5. Reduced physical stamina and endurance — you tire more quickly than you used to during exercise or activity?
1 None
2 Mild
3 Moderate
4 Severe
5 Very Severe
Domain 2 — Psychological Symptoms
Psychological
6. Decreased motivation or drive — loss of interest in goals, work, or activities you previously enjoyed?
1
2
3
4
5
Psychological
7. Feeling depressed, low mood, or emotionally flat — less able to experience positive emotions?
1
2
3
4
5
Psychological
8. Irritability, feeling tense or easily frustrated — reacting more strongly than situations warrant?
1
2
3
4
5
Psychological
9. Anxiety or nervousness — a persistent sense of unease or worry that is hard to explain?
1
2
3
4
5
Psychological
10. Cognitive difficulties — forgetting names, poor concentration, or a general feeling of “brain fog”?
1
2
3
4
5
Domain 3 — Sexual Symptoms
Sexual
11. Reduced libido — a decline in your desire for sexual activity compared to earlier in your life?
1
2
3
4
5
Sexual
12. Reduction in morning erections — less frequent, less firm, or complete absence of erections on waking?
1
2
3
4
5
Sexual
13. Erectile difficulties — problems achieving or maintaining an erection adequate for intercourse?
1
2
3
4
5
Sexual
14. Reduced ejaculatory volume or sensation — orgasms feel less intense than they used to?
1
2
3
4
5
Domain 4 — Body Composition Changes
Body Composition
15. Loss of muscle mass or strength — noticing your muscles are smaller or weaker despite similar activity levels?
1
2
3
4
5
Body Composition
16. Increased body fat, particularly around the abdomen — gaining fat more easily despite unchanged diet or exercise?
1
2
3
4
5
Body Composition
17. Reduction in body hair (chest, armpit, pubic, or facial hair becoming thinner or sparser)?
1
2
3
4
5
AMS Score
—/85
—
—
Somatic
–/25
Psychological
–/25
Sexual
–/20
Blood Tests to Request — Morning Sample Before 10 AM
Total Testosterone
Measured 7–11 AM. Below 8 nmol/L warrants consideration of replacement; below 12 nmol/L with symptoms is clinically relevant.
Essential
LH and FSH
Distinguishes primary hypogonadism (testicular failure) from secondary hypogonadism (pituitary/hypothalamic origin).
Essential
Prolactin
Elevated prolactin suppresses testosterone production and can indicate a pituitary adenoma.
Essential
SHBG (Sex Hormone Binding Globulin)
High SHBG reduces bioavailable (free) testosterone even when total testosterone appears normal.
Recommended
Fasting glucose / HbA1c
Type 2 diabetes and insulin resistance are independent causes of low testosterone — and are reversible with treatment.
Recommended
Thyroid function (TSH)
Hypothyroidism mimics low testosterone symptoms precisely. Must be excluded before attributing symptoms to hypogonadism.
Recommended
Full blood count + ferritin
Anaemia and iron deficiency cause fatigue, cognitive symptoms, and reduced exercise tolerance that overlap significantly with hypogonadism.
Consider
📋 What to Do Next
Dr. Muhammad Khalid
MBBS · FCPS (Urology) · MCPS (Gen. Surgery) · IMC #539472 — AMS scale validated by Heinemann et al., The Ageing Male 2003. Testosterone thresholds from Endocrine Society Guidelines 2018 and EAU Guidelines on Sexual & Reproductive Health 2024.
This symptom score identifies men who may benefit from testosterone blood testing. It does not diagnose hypogonadism — diagnosis requires a confirmed low testosterone on two separate morning blood samples alongside clinical assessment. Always consult your GP or urologist before starting or stopping any hormonal treatment.
What total testosterone level is considered “low”?
The Endocrine Society guidelines (2018) define biochemical hypogonadism as a total testosterone consistently below 10.4 nmol/L (300 ng/dL), though many guidelines use 8 nmol/L (231 ng/dL) as the threshold for TRT consideration. Crucially, two separate morning blood samples (drawn between 7–11 AM when testosterone is highest) must both be below threshold before a diagnosis is confirmed. A single low reading, or an afternoon sample, is insufficient for diagnosis. Read more about low testosterone in men over 40 →
Can I have symptoms but a “normal” testosterone level?
Yes. Sex Hormone Binding Globulin (SHBG) binds testosterone and makes it unavailable to tissues. High SHBG — common in older men, thin men, and men with liver disease — means your “free” (bioavailable) testosterone may be low even when your total testosterone appears normal. This is why measuring SHBG alongside total testosterone is important. Free testosterone can be calculated or measured directly.
Why must testosterone blood tests be done in the morning?
Testosterone follows a diurnal rhythm — levels are typically 25–35% higher between 7–11 AM than in the afternoon. An afternoon sample may appear artificially low in a man with genuinely normal morning levels. Most guidelines require morning samples for both initial testing and any confirmatory repeat. An afternoon reading that is “low” is not diagnostic without a morning confirmation.
