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Men's Hormone Imbalance Quiz

This questionnaire can help us understand which symptoms you are experiencing and also acts as  starting point for us when determining the best approach for our patients.


We will review results at your appointment and talk through what the best way to address your symptoms. Following a simple blood test, we then determine the best treatment plan.

Abstract Background
On a scale of 1-5 from never to severe how does each symptom affect you?

Depressed mood

I often feel depressed

Memory Loss

Memory Loss

Unexplained weight gain

Mental Confusion

Decreased sex drive/libido

Libido Level

Sleep problems

Sleep Problems

Mood changes/irritability

Mood Changes/Irritability

Low Motivation/Drive

I Feel Tense

Thanks for submitting!

What's Next?

After we receive your quiz results, we will contact you to schedule your appointment.

Doctor's Desk
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