Validation of Uzbek-Language ADAM, AMS, and IPSS Questionnaires in Men Aged 35-59 Years

Test-retest reliability of the Uzbek-language Aging Males' Symptoms (AMS) questionnaire total score will be assessed among clinically stable participants using the intraclass correlation coefficient (ICC) with a 95% confidence interval. The AMS consists of 17 items scored from 1 to 5, yielding a total score ranging from 17 to 85, with higher scores indicating greater symptom severity. Reliability will be estimated from paired total scores obtained at baseline and repeat assessment.

Test-retest reliability of the Uzbek-language International Prostate Symptom Score (IPSS) questionnaire total symptom score will be assessed among clinically stable participants using the intraclass correlation coefficient (ICC) with a 95% confidence interval. The IPSS total symptom score is calculated from seven items scored from 0 to 5, yielding a total score ranging from 0 to 35, with higher scores indicating more severe lower urinary tract symptoms. The separate quality-of-life item is not included in the total symptom score. Reliability will be estimated from paired total scores obtained at baseline and repeat assessment.

Internal consistency of the Uzbek-language Aging Males' Symptoms (AMS) questionnaire will be evaluated using Cronbach's alpha after evaluation of the dimensional structure. Internal consistency will be reported for each unidimensional scale or subscale supported by the confirmatory factor analysis. The AMS consists of 17 items scored from 1 to 5 and has a total score ranging from 17 to 85, with higher scores indicating greater symptom severity.

Internal consistency of the Uzbek-language International Prostate Symptom Score (IPSS) questionnaire will be evaluated using Cronbach's alpha after evaluation of the dimensional structure. Internal consistency will be reported for each unidimensional scale or subscale supported by the confirmatory factor analysis. The seven symptom items are scored from 0 to 5, yielding a total symptom score ranging from 0 to 35, with higher scores indicating more severe lower urinary tract symptoms. The separate quality-of-life item will not be included in the internal consistency analysis of the symptom scale.

Measurement error of the Uzbek-language Aging Males' Symptoms (AMS) questionnaire will be evaluated among clinically stable participants using the standard error of measurement (SEM) and smallest detectable change at the 95% confidence level (SDC95), based on paired baseline and retest total scores. The AMS consists of 17 items scored from 1 to 5, yielding a total score ranging from 17 to 85, with higher scores indicating greater symptom severity. SEM and SDC95 will be expressed in AMS total-score points.

Measurement error of the Uzbek-language International Prostate Symptom Score (IPSS) questionnaire will be evaluated among clinically stable participants using the standard error of measurement (SEM) and smallest detectable change at the 95% confidence level (SDC95), based on paired baseline and retest total symptom scores. The seven symptom items yield a total score ranging from 0 to 35, with higher scores indicating more severe lower urinary tract symptoms. The separate quality-of-life item is not included in the total symptom score. SEM and SDC95 will be expressed in IPSS total-score points.

Construct validity of the Uzbek-language Androgen Deficiency in Aging Males (ADAM), Aging Males' Symptoms (AMS), and International Prostate Symptom Score (IPSS) questionnaires will be evaluated by testing prespecified hypotheses concerning the direction and magnitude of associations with relevant external measures and/or differences between clinically defined groups. ADAM will be analyzed using its binary positive or negative screening classification; AMS will be analyzed using its total score and prespecified domain scores where applicable; and IPSS will be analyzed using its seven-item total symptom score. Observed associations or group differences will be compared with the prespecified hypotheses. Diagnostic performance of ADAM against biochemically low testosterone will be evaluated separately.

The diagnostic performance of the Uzbek-language Androgen Deficiency in Aging Males (ADAM) questionnaire for identifying biochemically low serum total testosterone will be evaluated using sensitivity and specificity with 95% confidence intervals. ADAM consists of 10 yes/no items and is classified as positive when the participant answers yes to item 1 or item 7, or to any three of the remaining items. Biochemically low serum total testosterone will be defined as a baseline serum total testosterone concentration <12.0 nmol/L (approximately <346 ng/dL), measured in a fasting morning venous blood sample using the study laboratory's validated assay. This biochemical classification will be used as the reference standard for calculating sensitivity and specificity and does not, by itself, constitute a clinical diagnosis of hypogonadism.

Floor and ceiling effects of the Uzbek-language Aging Males' Symptoms (AMS) questionnaire total score will be evaluated at baseline. The AMS total score ranges from 17 to 85, with higher scores indicating greater symptom severity. Floor and ceiling effects will be summarized as the percentage of participants obtaining the minimum possible total score of 17 and the maximum possible total score of 85, respectively.

Floor and ceiling effects of the Uzbek-language International Prostate Symptom Score (IPSS) total symptom score will be evaluated at baseline. The seven-item IPSS total symptom score ranges from 0 to 35, with higher scores indicating more severe lower urinary tract symptoms. Floor and ceiling effects will be summarized as the percentage of participants obtaining the minimum possible total score of 0 and the maximum possible total score of 35, respectively. The separate quality-of-life item is not included in this analysis.