Men's Health Survey:

Male Female


Male Hormone Survey

Symptom Group #1

Check which of these symptoms are troublesome and persist over
time. Two or more symptoms are an indication of the need to test
both Estradiol and Progesterone.

Symptom Group #2

Check which of these symptoms are troublesome and persist over
time. Two or more symptoms are an indication that Testosterone
and DHEAS testing is recommended.

Symptom Group #3

Check which of these symptoms are troublesome and persist over
time. Two or more symptoms are an indication that testing Cortisol
for adrenal imbalance is recommended.

Type any additional information that you
would like the Doctor to know: