|
Please check
those that apply, rating it's severity.
None Mild Mod. Severe Extreme
- Easily fatigued, tired or loss of
energy ____ ____ ____ ____ ____
- Depression, low or negative
mood ____ ____ ____ ____ ____
- Irritable, angry, or general bad
tempered ____ ____ ____ ____ ____
- Anxious or
nervous ____ ____ ____
____ ____
- Loss of memory and/or
concentration ____ ____ ____ ____ ____
- Relationship problems with
partner ____ ____ ____ ____ ____
- Loss of sex drive or
libido ____ ____ ____ ____ ____
- Erection or potency
problems ____ ____ ____ ____ ____
- Dry skin on face or
hands ____ ____ ____ ____ ____
- Excessive flushing/sweating, day or
night ____ ____ ____ ____ ____
- Backache, joint pains or
stiffness ____ ____ ____ ____ ____
- Heavy drinking, past or
present ____ ____ ____ ____ ____
- Loss of
fitness ____ ____
____ ____ ____
- Feeling
over-stressed ____ ____
____ ____ ____
- Experiencing reduced muscle
mass ____ ____ ____ ____ ____
- Decrease in
strength ____ ____ ____
____ ____
- Increase in central/upper body
fat ____ ____ ____ ____ ____
- The age you
feel 30__ 40__ 50__
60__ 70+_
- Have you had: Adult
mumps
____
- Have you had: Testicular
trauma
____
- Have you had: Orchitis (infection of the
testicles) ____
- Have you had: Prostate operation or
inflammation ____
- Have you had: Persistent urinary
infections ____
- Have you had:
Vasectomy
____
- Are you:
Obese
____
- Have you had: Cardiovascular
Disease ____
- Have you had: Elevated lipid
levels
____
- Have you had: Sugar metabolism problems
(insulin resistance or diabetes) ____
TOTAL CHECKS IN EACH
COLUMN ____ ____ ____ ____ ____
Multiply checks by: x0
x1 x2 x3 x4
TOTAL
SCORES ____ + ____ + ____ + ____ +____
GRAND TOTAL
ANDROPAUSE SCORE = ______
RESULTS OF
ANDROPAUSE QUESTIONNAIRE:
Score Interpretation of score:
0 - 9……...…..Unlikely to have Andropause
10-19………...….Possible Andropause
20-29…….…....Probable Andropause
30-39….……....Definite Andropause
40+…….......Advanced Andropause
If you have scored
10 and above, you owe it to yourself and everyone else around you to
investigate and correct any hormonal imbalances detected.
CALL TO MAKE AN APPOINTMENT!
It doesn't have to be like
this.
Please copy the above test and bring it to your appointment. |
