Please select for EACH symptom you are currently experiencing

For symptoms that do not apply, please mark NONE.

Decline in your feeling of general well-being *

Joint and muscular discomfort (Lower back pain, joint pain)*

Excessive sweating (unexpected/sudden episodes of sweating)*

Sleep problems (Difficulty in falling asleep)*

Increased need for sleep, often feeling tired*

Irritability (Feeling aggressive, easily upset about little things)*

Nervousness (inner tension, restlessness, feeling fidgety)*

Anxiety (Inner restlessness, feeling panicky)*

Physical exhaustion (General decrease in performance)*

Decrease in muscular strength (feeling of weakness)*

Depressive mood (Feeling down, sad, on the verge of tears)*

Feeling that you have passed your peak *

Feeling burnt out, having hit rock-bottom*

Decrease in beard growth*

Decrease in ability/frequency to perform sexually*

Decrease in the number of morning erections*

Decrease in sexual desire/libido*

Do you have cold hands and feet?*

Do you have daily bowel movements?*

Do you have gas, bloating or abdominal pain after eating?*

Please select your WEEKLY Activity Level based on this criteria  Physical activity that accelerates heart rate / Breathlessness

0-1 day per week

2-3 days per week

More than 3 days per week

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