Date of Degree


Document Type

Doctoral Project

Degree Name

Doctor of Nursing Practice (DNP)




Julio Lujano-Gutierrez


Heather Miles


Testosterone replacement therapy (TRT) has been shown to improve the symptoms of metabolic syndrome by reducing Hemoglobin A1C, belly fat, cholesterol, and blood pressure (Cunningham, 2015). The ultimate goal for testosterone-deficient patients is to have an improved quality of life by starting TRT. This quality improvement project was conducted at a small primary care clinic in South Texas. The project was started by screening 84 male patients ≥ 40 years of age using the Androgen Deficiency in Aging Males (ADAM) questionnaire. The ADAM questionnaire was considered positive for anyone who answered “yes” to 3 or more questions or “yes” to questions 1 or 7 (Morley et al., 2000). Out of the 84 patients screened by the ADAM questionnaire, 57 screened positive for low testosterone. Only 23 of those 57 patients agreed a confirmatory testosterone blood test; 20 of those 23 had low testosterone blood levels. Any patient who had an abnormally low testosterone level was given the option to start TRT. Eleven of the 20 patients included in the project accepted TRT. After 6 to 8 weeks of testosterone replacement therapy, patients were given the ADAM questionnaire again to assess if improved scores had occurred. After starting TRT, only 1 of the 11 participants had an unchanged ADAM score although it was noted his testosterone levels were still subtherapeutic. Ten of the 11 participants who received TRT had improved ADAM scores at the end of the project window. The ADAM questionnaire has a sensitivity of 88-97%, so poor ADAM scores were highly linked to low total testosterone levels (Morley et al., 2000; Lunenfield et al., 2015).