ORIGINAL ARTICLE Validation of the German version of the ‘Hypogonadism Related Symptom Scale’ (HRS) in andrological patients with infertility, HIV infection and metabolic syndrome J. Alidjanov 1,2 , J. Wolf 1 , H.-C. Schuppe 1 , W. Weidner 1 , T. Diemer 1 , T. Linn 3 , I. Halefeldt 1 , F. Wagenlehner 1 , J. Wiltink 4 & A. Pilatz 1 1 Department of Urology, Pediatric Urology and Andrology, Justus Liebig University, Giessen, Germany; 2 Outpatient Department, The Republican Specialized Center of Urology, Tashkent, Uzbekistan; 3 Clinical Research Unit, 3rd Medical Clinic and Policlinic, Justus Liebig University, Giessen, Germany; 4 Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg University, Mainz, Germany Keywords Andrology—hypogonadism—metabolic syndrome—questionnaires—validation Correspondence Dr Jakhongir Alidjanov, Department of Urol- ogy, Pediatric Urology and Andrology, Justus Liebig University, Rudolf-Buchheim-Str. 7, 35392 Giessen, Germany. Tel.: +49 641 99 56362; Fax: +49 641 99 44519; Outpatient Department, The Republican Specialized Center of Urology, Shifokorlar street, Olmazor district, 1, 100109 Tashkent, Uzbekistan. Tel.: +998 71 246 03 79; Fax: +998 71 150 65 68; E-mail: dr.alidjanov@gmail.com Accepted: November 11, 2013 doi: 10.1111/and.12215 Summary As commonly used self-reported screening instruments for male hypogona- dism demonstrated lack of specificity, a Hypogonadism Related Symptom Scale (HRS) was developed in 2009 as a novel self-rating screening tool. As the questionnaire has not been validated, the purpose of our study was to perform a validation in patients presenting with different disorders (e.g. infer- tility, HIV infection or metabolic syndrome) and disease-related risk to develop hypogonadism. Two hundred and eighteen patients aged 19–71 years (40.1 Æ 9.5) who completed the HRS and other common questionnaires [International Index Of Erectile Function (IIEF), National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI), Hospital Anxiety and Depression Scale (HADS), short form (SF)-12] were included. In all patients, blood levels of total testosterone, luteinizing hormone, follicle-stimulating hormone, oestradiol and sex hormone-binding globulin were determined and free testosterone was calculated. Cronbach’s a for the scale was 0.896, split- half 0.871 for the 1st half and 0.807 for the 2nd half. Spearman–Brown coef- ficient was 0.767, and Guttman split-half coefficient was 0.759. Consistent correlations were found between HRS and IIEF5 (q = 0.57, P < 0.001), and HADS (q = À0.6, P < 0.001). In addition, HRS was significantly correlated with total testosterone (q = 0.135, P < 0.05), free testosterone (q = 0.148, P < 0.05) and oestradiol (q = À0.134, P < 0.05). Our validation study con- firms the data from the initial development of the HRS questionnaire. Clini- cians might have an additional advantage from the HRS when investigating males with suspected hypogonadism. Introduction Male hypogonadism is defined as ‘a clinical syndrome caused by androgen deficiency which may adversely affect multiple organ functions and quality of life’ (Nieschlag et al., 2010). It is associated with a variety of symptoms and signs caused by androgen deficiency (Wang et al., 2004; Rosner et al., 2007, 2010; Hall et al., 2008; Bhasin et al., 2010). Here, reduced testosterone levels are respon- sible for decreased muscle mass and strength, reduced bone density, abdominal obesity and fatigue (Feldman et al., 2002; Kaufman & Vermeulen, 2005; Nieschlag et al., 2006). Testosterone deficiency usually manifests with reduced sexual desire, reduced sexual activity, erec- tile dysfunction and hot flushes (Hall et al., 2008). All aspects may significantly reduce the quality of life and lead to depression (Tostain & Blanc, 2008; Hintikka et al., 2009; Bercea et al., 2012), accompanied by a reduc- tion in activity, motivation and health satisfaction (Beutel et al., 2002). As low serum testosterone levels are further considered to interfere with other pathological conditions in men, such as obesity, type 2 diabetes, metabolic syn- drome and other pathologic conditions (Corona et al., 2006, 2008; Kaplan et al., 2006), hypogonadism-like © 2014 Blackwell Verlag GmbH 1189 Andrologia 2014, 46, 1189–1197