Male Hormone Quiz

1

Name

First Name

Last Name

2

How did you hear about us?

3

Date

4

If you are trying to lose weight, how much weight would you like to lose?

5

Age

6

How often do you feel fatigued, even after a full night's sleep?

Never

Occasionally

Frequently

Almost Always

7

Do you experience a noticeable lack of energy during the day?

Never

Occasionally

Frequently

Almost Always

8

How would you rate your overall motivation and drive?

Excellent

Good

Fair

Poor

9

Have you noticed a decrease in muscle mass or strength over the past year?

No

Slightly

Significantly

10

Do you struggle with maintaining or losing weight, particularly aroud your midsection?

No

Slightly

Significantly

11

How would you describe your physical stamina and endurance compared to a few years ago?

Better

About the same

Worse

12

Have you experienced changes in mood, such as increased irritability or feelings or sadness?

Never

Occasionally

Frequently

13

Do you find it harder to concentrate or stay focused on tasks?

Never

Occasionally

Frequently

14

How would you rate your overall mental clarity and sharpness?

Excellent

Good

Fair

Poor

15

Have you experienced a decrease in sex drive or libido?

No

Slightly

Significantly

16

Do you have difficulty maintaining or achieving erections?

Never

Occasionally

Frequently

17

How often do you feel stressed or overwhelmed?

Rarely

Occasionally

Frequently

18

Do you get at least 7-8 hours of quality sleep most nights?

Yes, always

Sometimes

Rarely

19

How would you describe your current diet and exercise habits?

Healthy and Consistent

Average with room for improvement

Poor and inconsistent