Hormone Health Questionnaire
The HHQ is a symptoms-based survey that looks at particular symptoms of hormonal dysfunction, and may be able to identify potential hormonal imbalances that may be preventing you from achieving your health and fitness goals.
What is your gender?
*
Male
Female
1. Do you crave sweets?
*
Never
Sometimes
Frequently
2. Do you experience frequent thirst?
*
Never
Sometimes
Frequently
3. Do you get irritable or shaky between meals?
*
Never
Sometimes
Frequently
4. Do you have fatigue that is relieved by eating?
*
Never
Sometimes
Frequently
5. Do you "need" coffee/caffiene in the morning or afternoon?
*
Never
Sometimes
Frequently
6. Do you have a hard time getting going in the morning?
*
Never
Sometimes
Frequently
7. Do you have difficulty falling asleep at night?
*
Never
Sometimes
Frequently
8. Do you crave salt?
*
Never
Sometimes
Frequently
9. Do you get lightheaded when standing up quickly?
*
Never
Sometimes
Frequently
10. Do you have difficulty staying asleep?
*
Never
Sometimes
Frequently
11. Do you tend to be cold in your hands and feet?
*
Never
Sometimes
Frequently
12. Do you find that you have difficulty losing weight?
*
Never
Sometimes
Frequently
13. Do you experience low energy or feel tired all the time?
*
Never
Sometimes
Frequently
14. Do you feel like your brain is "foggy" or can't function correctly?
*
Never
Sometimes
Frequently
15. Have you noticed your hair is thinning?
*
Never
Sometimes
Frequently
16. Have you experienced a decreased libido?
*
Never
Sometimes
Frequently
17. Do you feel your energy or strength is diminished?
*
Never
Sometimes
Frequently
18. Do you feel less enjoyment for life?
*
Never
Sometimes
Frequently
19. Have you experienced a decrease in morning erections?
*
Never
Sometimes
Frequently
20. Have you experienced a decrease in strength of erections?
*
Never
Sometimes
Frequently
16. Do you have an irregular mentraul cycle?
*
Never
Sometimes
Frequently
17. Do you have acne or unwanted facial hair growth?
*
Never
Sometimes
Frequently
18. Do you experience pain, cramping, or breast tenderness during your mentraul cycle?
*
Never
Sometimes
Frequently
19. Do you experience hot flashes?
*
Never
Sometimes
Frequently
20. Do you experience mood swings, depression, or night sweats?
*
Never
Sometimes
Frequently
Full Name
*
First Name
Last Name
E-mail
*
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