Phase seven of eight

77%

Medical Questionnaire 7 – Hormones

Age and Weight

Are you younger than 50 years? *

Yes

No

Do you have a normal weight (BMI less than 28)? *

Yes

No

Health Status

Do you find yourself often tired in the afternoon? *

Yes

No

Do you feel listless and unmotivated? *

Yes

No

Do you suffer from menopausal symptoms? *

Yes

No

Do you have extreme wrinkling in your skin? *

Yes

No

Do you feel down to the point of neglecting your appearance? *

Yes

No

Have you lost interest in sex? *

Yes

No

Do you suffer from impotence or erection problems? *

Yes

No

Do you suffer from premature ejaculations? *

Yes

No

Do you need to urinate frequently (e.g. at night)? *

Yes

No

Stress and Psyche

Are there often tensions in your relationship? *

Yes

No

Is your work strenous? *

Yes

No

Do you often have problems with colleagues? *

Yes

No

Do you often blame yourself for things? *

Yes

No

Do you suffer from high anxiety? *

Yes

No

Do you suffer from depressive moods? *

Yes

No

Do you often find yourself irritable? *

Yes

No

Stimulants

Do you smoke? *

Yes

No

Do you more than two alcoholic drinks daily? *

Yes

No