Quiz for Men Name First Last PhoneBest Time to Call AM PM Email*(Required) Age MessageOn a scale of 0-3, from Never (0) to Mild (1) to Moderate (2) to Severe (3), how does this symptom effect you?DECLINE IN GENERAL WELL-BEING 0 1 2 3 JOINT PAIN/ MUSCLE ACHES 0 1 2 3 EXCESSIVE SWEATING 0 1 2 3 INCREASED NEED FOR SLEEP 0 1 2 3 IRRITABILITY 0 1 2 3 NERVOUSNESS 0 1 2 3 ANXIETY 0 1 2 3 DEPRESSED MOOD 0 1 2 3 DECLINING MENTAL ABILITY/ FOCUS/ CONCENTRATION 0 1 2 3 FEELING YOU HAVE PASSED YOUR PEAK 0 1 2 3 FEELING BURNED OUT/ HIT ROCK BOTTOM 0 1 2 3 DECREASED MUSCLE STRENGTH 0 1 2 3 SHRINKING TESTICLES 0 1 2 3 RAPID HAIR LOSS 0 1 2 3 NEW MIGRAINE HEADACHES 0 1 2 3 BREAST DEVELOPMENT 0 1 2 3 DECREASED SEX DRIVE 0 1 2 3 DECREASED MORNING ERECTIONS 0 1 2 3 DECREASED ABILITY TO PERFORM SEXUALLY 0 1 2 3 DIFFICULTY TO ACHIEVE EJACULATION 0 1 2 3 NO RESULTS FROM E.D. MEDICATIONS 0 1 2 3 Decrease Cognition 0 1 2 3 Increase Belly Fat 0 1 2 3 Weight Gain 0 1 2 3 Decreased Bone Density 0 1 2 3 Inability to get Erection 0 1 2 3 Difficulty to Sustain Erection 0 1 2 3 Lack of Motivation 0 1 2 3 Trouble with Memory 0 1 2 3 BRAIN FOG 0 1 2 3 Decrease Energy/Exhaustion 0 1 2 3
