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Hormone Self-Assessment Quiz

Please enter your information below and proceed with our short self-assessment quiz which will take only a few minutes to complete. It will help determine if you might be suffering from a hormonal imbalance.

Male/Female Quiz Questions
First
Last
Gender *

I have noticed an increase in:

Energy Levels *
Short-Term Memory *
Hours I Sleep Per Night *
Muscle Tone *
Body Hair *
Sex Drive *
Sexual Encounters *
Self Confidence *
Confidence During Sexual Encounters *
Concentration *
Muscle Mass *
Attention Span *
Time Spent Doing Hobbies *
Punctuality *
Overall Strength *
Ability to follow directions *

I have noticed a decrease in:

Weight *
Body fat *
Fatigue *
Moodiness *
Foggy Thinking *
Depression *
Motivation (Professional Life) *
Motivation (Personal Life) *
My Partner's Sex Drive *
Forgetfulness *
Timeliness *
Anxiety *
Irritability *
Dry Skin *

Additional Questions:

I worry or are concerned about E.D. *
I wake up rested most mornings *
I often feel sluggish *
I feel energized after physical activity *
I have noticed issues with word retrieval *
I have more sleep disturbances than usual *

I have noticed an increase in:

Sleep Disturbances *
Thinnning Hair *
Hot Flashes *
Night Sweats *
Weight *
Percentage of Body Fat *
Joint Pain *
Fatigue *
Moodiness *
Foggy Thinking *
Depression *
My partner's sex drive *
Irritability *
Painful Intercourse *
Dry Skin *
Forgetfulness *
Timeliness *
Anxiety *
Vaginal dryness *
Napping *

I have noticed a decrease in:

Mental Clarity *
Energy levels *
Hours I Sleep Per Night *
Muscle Tone *
Self confidence *
Sex Drive *
Attention Span *
Concentration *
Time spent on hobbies *
Punctuality *
Overall Strength *
Overall Zest For Life *
Time Spent With Others *

Additional Questions:

I have been told I have issues with bone density *
I have been told I have premature ovarian insufficiency *
I wake up rested most mornings *
I no longer have time or energy for hobbies *
I have noticed issues with word retrieval *
I often feel sluggish *
I spend less time with friends and family *
I travel less than I used to *
I eat more unhealthy foods than usual *
I attend less social gatherings than usual *

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Scottsdale, Arizona
For Information: (323) 986-5100
Email: info@sottopelletherapy.com

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