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Male Hormone Self-Assessment Test

Check any of the following statements that apply to you.

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Do You...
Have a history of antibiotic use
Continuously use prescription medication
Take synthetic hormones in topical cream, patch or orally
Have prostate problems
Experience difficulty sleeping
Experience mood swings
Experience low libido
Drink more than one glass of alcohol weekly
Drink caffeine daily
Experience Exhaustion
Experience low sperm count
Experience penile erectile dysfunction
Experience infertility
Experience frequent urination

Male Reproductive
Do You Have...
Prostate trouble
Urination difficult or dribbling
Night urination frequent
Pain on inside of legs or heels

Feeling of incomplete bowel evacuation

Leg nervousness at night
Tire easily/avoid activity
Reduced sex drive


Migrating aches and pains
Frequent or urgent need to urinate
Delayed, weak or interrupted urinary stream
Pain or burning upon urination
Urge to urinate several times a night
Rose colored (bloody) urine
Difficulty urinating
A sense of bladder fullness
Ejaculation causes pain
Blood in the semen
Lack of sex drive
Pain or fatigue in the legs or back
Dripping after urination
Increased straining with small amounts of urine passed
Current prostate enlargement or elevated PSA (prostate) test

Male Genital Health

Do You Have...
Itchy patches around inner thigh or groin
Itching at night
Painful testicles
Difficulty attaining and or maintaining an erection
Low sexual drive
Premature Ejaculation
Low energy level or stamina
Inflammation on the head of the penis
Genital and/or rectal rash or irritation
Distorted nail growth
Loss of pubic or armpit hair
Low sperm count, low sperm motility
Unexplained weight gain

Testicles appear smaller

Development of breasts or nipple tenderness
Feeling of heaviness or hardness in testicles
Sparse beard or slow hair growth

Decreased body hair

Fine wrinkling in corner of mouth and/or eyes
Current or recurrent epididimiti