Men's Hormone Test
Take this test to help us assess how bioidentical hormone replacement might benefit you.
Last Name
First Name
Phone
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Email
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Do you feel depressed?
Do you feel depressed?
Yes
No
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Have you noticed a loss of self-confidence?
Have you noticed a loss of self-confidence?
Yes
No
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Do you have less interest in sex?
Do you have less interest in sex?
Yes
No
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Do you have joint pain?
Do you have joint pain?
Yes
No
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Have you noticed fewer morning erections or do you have trouble getting an erection?
Have you noticed fewer morning erections or do you have trouble getting an erection?
Yes
No
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Do you find yourself having difficulty concentrating or focusing?
Do you find yourself having difficulty concentrating or focusing?
Yes
No
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Have you noticed a loss of muscle mass, strength, or endurance?
Have you noticed a loss of muscle mass, strength, or endurance?
Yes
No
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Do you feel less energetic than when you were 30?
Do you feel less energetic than when you were 30?
Yes
No
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Do you feel irritable, angry, or impatient without control of emotions?
Do you feel irritable, angry, or impatient without control of emotions?
Yes
No
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Do you have high blood pressure or cholesterol?
Do you have high blood pressure or cholesterol?
Yes
No
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How did you hear about us?
How did you hear about us?
TV
Online Search
Friend
Dr. Referred
Social Media
Online Ad
Other
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