Men’s Bioidentical Hormone Replacement

Health Assessment For Men (Male Symptom Questionnaire)

Take this brief health assessment to explore whether your symptoms may be related to hormone imbalance and if hormone replacement therapy might be a good fit for you. You deserve to feel like yourself again—this is a simple, yet meaningful first step toward restoring balance and well-being.

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Symptoms

Which of the following symptoms apply to you currently (in the last 2 weeks)? Please mark the appropriate box for each symptom. For symptoms that do not currently apply or no longer apply mark "never".
Sweating (night sweats or excessive sweating)
Sleep problems (difficulty falling asleep, sleeping through the night or waking up too early)
Increased need for sleep or falls asleep easily after a meal
Depressive mood (feeling down, sad, lack of drive)
Irritability (mood swings, feeling aggressive, angers easily)
Anxiety (inner resltessness, feeling panicky, feeling nervous, inner tension)
Physical exhaustion (general decrease in muscle strength or endurance, decrease in work performance, fatigue, lack of energy, stamina or motivation)
Sexual problems (change in sexual desire or in sexual performance)
Bladder problems (difficulty in urinating, increased need to urinate)
Erectile changes (less strong erections, loss of morning erections)
Joint and muscular symptoms (joint pain or swelling, muscle weakness, poor recovery after excercise)
Difficulties with memory
Problems with thinking, concetrating or reasoning
Difficulty learning new things
Trouble thinking of the right word to describe persons, places or things when speaking
Increase in frequency or intensity of headaches/migraines
Rapid hair loss or thinning
Feel cold all the time or have cold hands or feet
Weight gain, increased belly fat or difficulty losing weight despite diet and excercise
Infrequent or absent ejaculations

Severity Score Breakdown

Mild: 1-20 | Moderate: 21-40 | Severe: 41-60 | Very Severe: 61-80