How many hours per week do you work?
Do you play any sports? Yes
No
Which ones?
VI. H
ORMONAL
D
EFICIENCY
S
CREENING
Check any of the following that apply:
_
Loss of sense of well-being
_
Reduced muscle mass, strength, or endurance
_
Reduced energy and vitality
_
Increased waist size and fat in abdomen, thighs, and buttocks
_
Reduced exercise ability
_
Increased anxiety levels
_
Increased appearance of aging and wrinkles
_
Problems sleeping or change in sleep patterns
_
Decline in sexual action or function or libido
_
Skin aging and wrinkles
_
Depression and social isolation
_
Loss of libido
_
Reduced cardiovascular function
_
Osteoporosis
_
Worry, fears, panic attacks
_
Fatigue
_
Menstrual changes
_
Weakened immune system
_
Decreased memory and concentration
_
Night sweats, hot flashes
_
Memory problems
_
Easy bruising, slow healing
