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Men’s Signature
Hormone Assessment
Men’s Signature Hormone Assessment
1.
Have you experienced a recent unexplained loss of sex drive?
Yes
Not Sure
No
2.
How often do you experience loss of morning erection?
Often
Sometimes
Never
3.
Have you recently experienced any concentration changes?
Yes
Not Sure
No
4.
Have you recently experienced unexplained irritability, grumpiness or depression?
Yes
Not Sure
No
5.
Do you experience decreased erections and have difficulty keeping it up?
Yes
Not Sure
No
6.
Have you recently experienced weight gain?
Yes
Not Sure
No
7.
How often do you feel ‘burned out’?
Often
Sometimes
Never
8.
Have you recently noticed shrinkage in your testicles or penis?
Yes
Not Sure
No
9.
Have you recently noticed poor exercise tolerance?
Yes
Not Sure
No
10.
Have you experienced any hot flashes or night sweats?
Yes
Not Sure
No
Your Full Name
To what email address may we send your results?
Enter your phone # if you would like us to call you to discuss your results.
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