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Men’s Health Evaluation Form

This Basic Questionnaire can be very useful for men to describe the kind and severity of their low testosterone symptoms.

Do you have a decrease in libido (sex drive)?YesNo

Do you have a lack of energy?YesNo

Do you have a decrease in strength or endurance?YesNo

Have you lost height?YesNo

Do you noticed a decreased "enjoyment of life"?YesNo

Are you sad or grumpy?YesNo

Are your erection less strong?YesNo

Have you noticed a recent deterioration in your ability to play sports?yesNo

Are you falling asleep after dinner?YesNo

Has there been a recent deterioration in your work performance?YesNo

If your answer is yes to number 1 to 7 or if your answer yes to more than 3 questions, you may have low testosterone.

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10440 Shaker Drive #108, Columbia, Maryland 21046, United States

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