• Androgen deficiency in aging male (ADAM) is functional hypogonadism and is a diagnosis of exclusion.
• Sexual symptoms (erectile dysfunction and reduced sexual thoughts) are significant symptoms for the diagnosis.
• Diagnosis is based on the demonstration of low levels of total testosterone done at least twice along with symptoms.
• Other hormonal panel aids in the exclusion of other causes.
• Free testosterone has limited role in the diagnosis.
• Testosterone therapy is not approved by US FDA for ADAM and is considered as off-label use only.
• Prostate and breast carcinoma are absolute contraindications for testosterone therapy and beware of the risks involved with therapy.
• Anabolic steroids and other compounds have limited benefit.

Testosterone offers moderate benefit on sexual symptoms and modest benefit on body composition, bone density and cognition. Individualized testosterone therapy is recommended by guidelines from the Endocrine and Geriatric societies.