1. Do you have a decrease in libido (sex drive)?

Yes

No

2. Do you have a lack of energy

Yes

No

3. Do you have a decrease in strength and/or endurance?

Yes

No

4. Have you lost height?

Yes

No

5. Have you noticed a decreased "enjoyment of life"?

Yes

No

6. Are you sad and/or grumpy?

Yes

No

7. Are your erections less strong?

Yes

No

8. Have you noticed a recent deterioration in your ability to play sports?

Yes

No

9. Are you falling asleep after dinner?

Yes

No

10. Has there been a recent deterioration in your work performance?

Yes

No

Results And Recommendations Will Be Prepared For You Following The Completion Of Your Self-Assessment

First Name *

Last Name *

Phone *

Email *

I AM OVER 30 YEARS OLD. Please be advised that our office does not accept patients under 30 years of age for TRT/HRT Services.