Copyright @ 2007 The North American Menopause Society. Unauthorized reproduction of this article is prohibited. Menopause: The Journal of The North American Menopause Society Vol. 14, No. 6, pp. 999/1005 DOI: 10.1097/gme.0b013e318057786b * 2007 by The North American Menopause Society Testosterone correlated to symptoms of partial androgen deficiency in aging men (PADAM) in an elderly Swedish population Anna-Clara E. Spetz, MD, PhD, 1 Lennart Palmefors, MD, 1 R. Staffan P. Skobe, MD, 1 Martin T. Stro ¨mstedt, MD, 1 Mats G. Fredriksson, PhD, 2 Elvar Theodorsson, MD, PhD, 3 and Mats L. Hammar, MD, PhD 1 Abstract Objective: To investigate the prevalence of different symptoms of partial androgen deficiency in aging men (PADAM) and to correlate them with blood concentrations of testosterone and bioavailable testosterone. Design: A total of 370 men, aged 55 to 75 years, were invited to one of three primary healthcare centers in Sweden. They were asked to complete a questionnaire regarding demographic data, medical history, mood status, medication, castration therapy and smoking, exercise and alcohol habits, as well as different symptoms of PADAM. The 10 questions from a previously used questionnaire (the ADAM questionnaire) were included. The men were offered blood tests for analyses of testosterone, follicle stimulating hormone, luteinizing hormone, steroid hormoneYbinding globulin, and albumin. From these test results, we calculated the bioavailable testosterone. Results: Of the questionnaires sent out, 81.6% were returned and eligible for evaluation. Blood samples were obtained from 85.8% of men answering the questionnaire. Many of the symptoms, including five from the ADAM questionnaire, were more common in older age groups (P G 0.05). Three symptoms, deterioration in work performance, decreased strength and/or endurance, and bothersome hot flushes, were associated with low bioavailable testosterone and/or testosterone (P G 0.05). Testosterone and bioavailable testosterone did not differ between age groups, but bioavailable testosterone was higher in men with three or fewer symptoms on the ADAM questionnaire. Conclusions: Symptoms associated with PADAM often occur in an elderly population, but we could only find an association between three symptoms and blood testosterone concentrations, one being bothersome hot flushes. It is likely that these symptoms have a more complex background than only PADAM. Key Words: Men Y Andrology Y Climacteric Y Questionnaires Y Testosterone Y Androgens. M enopause in women is an unquestionable condi- tion caused by ovarian failure, with a number of symptoms related to decreased sex steroid pro- duction, 1 hot flushes being the most common symptom. 2 For many years it has been debated whether otherwise healthy men, as a consequence of the normal age-related decrease in androgen production, can develop a clinically relevant hormonal deficit, a male climacteric. 3,4 In comparison with clinically well-defined female menopause, the symptoms of such a condition would be rather subtle, including gradual loss of muscle strength and bone density as well as decrease in libido, memory, enjoyment of life and mood; erectile dysfunction; asthenia; and cognitive dysfunction. 5<8 Hence, its recognition might be obscured by the normal aging process, which would simply be enhanced by Bmale climacteric^ factors. We have earlier reported that hot flushes, similar to those in women, are quite common in a population of aging Swedish men and that they cause significant discomfort for those men who report them. 9 The production of testicular testosterone (T) gradually decreases with age in men, but this decrease is not as readily evident, nor is it as abrupt, as the estrogen decrease in women, and in men there is greater individual variations. 8 In normal aging men, total T and albumin-bound T concentrations in serum decrease, whereas sex hormoneYbinding globulin (SHBG) increases. 10 This leads to a more readily observable decrease in free or bioavailable T (BT) than in total T. 11 Because the decline in androgens is gradual, the terminology for such a process has been suggested to be partial androgen deficiency in aging males (PADAM) or androgen deficiency in aging males (ADAM). 12 Received December 8, 2006; revised and accepted February 20, 2007. From the Divisions of 1 Obstetrics and Gynaecology, 2 Occupational and Environmental Medicine, and 3 Clinical Chemistry, Faculty of Health Sciences, University Hospital, Linko ¨ping, Sweden. Funding/support: The Lions Foundation, the Swedish Medical Research Council (grant no K2000-72X-12651-04B), and the Medical Research Council of Southeast Sweden. Financial disclosure: None reported. Address correspondence to: Anna-Clara Spetz, MD, PhD, Department of Molecular and Clinical Medicine, Division of Obstetrics and Gynecology, Faculty of Health Sciences, University Hospital, S-581 85 Linko ¨ping, Sweden. E-mail: Anna-Clara.Spetz@LiO.se Menopause, Vol. 14, No. 6, 2007 999