Men’s Health Survey

1. How much do you experience fatigue?

 
 
 
 

2. Do you deal with anxiety?

 
 
 
 

3. Have you seen increased abdominal or other weight gain in your body?

 
 
 
 

4. Have you noticed decreased urinary flow (smaller amounts and/or interrupted flow)?

 
 
 
 

5. Do you get night sweats or hot flashes?

 
 
 
 

6. Do you have problems concentrating?

 
 
 
 

7. Have you noticed a decrease of muscle tone in your body?

 
 
 
 

8. Do you experience bouts of depression?

 
 
 
 

9. Do you or have you experienced decreased erectile function?

 
 
 
 

10. Do you or have you had high blood pressure readings recently?

 
 
 
 

11. Have you noticed decreased strength in your body recently?

 
 
 
 

12. How much do you deal with a lowered libido (or sex drive)?

 
 
 
 

13. How much have you dealt with hair loss?

 
 
 
 

14. Do you ever feel irritable?