Men's Health Screening For Blood Draw
Name
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First Name
Last Name
Date
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Month
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Day
Year
Date
Phone Number
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Please enter a valid phone number.
Format: (000) 000-0000.
Email
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example@example.com
Date of Birth
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Month
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Day
Year
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Please upload a copy of picture of the back of your insurance card:
*
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Do you often feel fatigued during the day?
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Please Select
Yes
No
Persistent fatigue, even after getting a good night's sleep, is a symptom of low Testosterone.
Do you get irritated more than usual?
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Please Select
Yes
No
Testosterone influences a person's mood, and low levels of the hormone can result in mood changes, including irritability, depression, or lack of focus.
Are you less interested in sex?
*
Please Select
Yes
No
A declining sex drive is normal for men as they age. However, someone with low Testosterone will likely experience a more drastic drop in their desire to have sex.
Is your hair thinning?
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Please Select
Yes
No
Balding is a natural part of aging for many men, and it's also influenced by genetics. Men with low T may experience hair loss on their head, body and face.
Do you have difficulty achieving or maintaining an erection?
*
Please Select
Yes
No
Erectile dysfunction (ED) is a common issue with numerous causes. Having low testosterone can make it more difficult to get an erection.
Have you gained weight?
*
Please Select
Yes
No
Weight gain is a normal part of andropause—the male equivalent of menopause—and doesn't necessarily mean you have low T. But an increase in body fat, especially in the breasts and belly, can be a symptom of low testosterone.
If you answered "yes" to 3 or more questions, then low testosterone may be a concern. Request a consultation at MAT’S to learn about your options.
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