Construction and field validation of a self-administered screener for testosterone deficiency (hypogonadism) in ageing men

OBJECTIVES To design a self-administered screening questionnaire to inform men about their risk for testosterone deficiency. DESIGN The screener was developed in two phases. First was a construction p hase in which relevant risk factors and a scoring algorithm were defined fr om multiple logistic regression analyses of survey data, In the second phas e, the screener's accuracy (based on sensitivity, specificity, and Receiver Operating Characteristic (ROC) curves) was tested using patients from a pr imary care clinic. All subjects provided blood samples for endocrine testin g. SUBJECTS Survey data from 1660 men aged 40-79 years participating In the Ma ssachusetts Male Ageing Study (MMAS) were analysed in the first phase. The clinic sample consisted of 304 men aged 40-79 years presenting at a large M assachusetts primary health care clinic for routine checkups or minor medic al problems, MEASUREMENTS The primary outcome was testosterone deficiency, defined as se rum total testosterone below 12.1 nmol/l. Self-reported variables considere d as potential risk factors included age, obesity, chronic diseases, health behaviour, the Jackson dominance scale, and symptoms of stress. RESULTS The prevalence of testosterone deficiency was 20.4% in the MMAS and 42.1% in the clinic sample. An eight-item screener was developed based on age, body mass index, diabetes, asthma, headaches, sleep patterns, dominanc e preferences, and smoking status. The screener performed significantly bet ter than chance in identifying men with low testosterone levels; the area u nder the ROC curve was 0.66 in the MMAS sample and 0.67 in the clinic sampl e. CONCLUSIONS The self-scored screener developed in this study reliably detec ts men at risk of hypogonadism. The screener encourages at risk men to seek professional evaluation of their testosterone levels.