Hormone Replacement Therapy

BioTE Health Assessment for Men

Male Symptom Questionnaire

Step 1 of 4

  • Date Format: MM slash DD slash YYYY
  • Date Format: MM slash DD slash YYYY
  • Symptoms

  • Which of the following symptoms apply to you currently (in the last 2 weeks)? Please mark the appropriate box for each symptom. For symptoms that do not currently apply or no longer apply, mark "never".
  • (night sweats or excessive sweating):
  • (difficulty falling asleep, sleeping through the night or waking up too early):
  • (feeling down, sad, on the verge of tears, lack of drive):
  • (mood swings, feeling aggressive, angers easily):