Validity of the AMS questionnaire for screening hypogonadism in men with type 2 diabetes: A cross-sectional study

Background. Hypogonadism is common among men with type 2 diabetes mellitus (T2DM), but diagnosis can be confounded by overlapping symptoms from diabetic complications. The Aging Males' Symptoms (AMS) questionnaire is widely used for screening, yet its validity in this specific population remains unclear. Objective. To evaluate the relationship between AMS scores and serum testosterone levels in men with T2DM, assess diagnostic accuracy at various AMS cut-offs, and examine the influence of diabetic comorbidities on AMS scores. Methods. We conducted a cross-sectional study in 158 men with T2DM. Participants completed the AMS questionnaire and underwent morning testosterone measurement. Comorbidities such as neuropathy, nephropathy, and obstructive sleep apnea were assessed. AMS diagnostic performance was evaluated using different cut-off values (≥27, 30, 35, 40). Results. AMS total score showed a modest inverse correlation with testosterone (ρ = -0.16, P=0.047), primarily driven by the physical subscale. Neuropathy and nephropathy were associated with higher sexual subscale scores. An AMS ≥27 cut-off had high sensitivity (91%) but poor specificity (21%) for testosterone <12 nmol/L. Conclusion. AMS scores correlate weakly with testosterone levels in men with T2DM. Diabetic complications can elevate AMS scores independently, suggesting the need for caution and possibly higher cut-offs when using AMS for hypogonadism screening in this population.