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Male Health Assessment

Please click the appropriate circle to rate the following symptoms that apply to you within the past 2-4 weeks. Once completed, submit form and someone in our office will respond to let you know if you might be a good candidate for BioTe pellets!
Sweating (night sweats or excessive sweating).
Sleep problems (falling or just staying asleep).
Increased need for sleep or falls asleep easily after a meal.
Depressive mood (feeling down, sad, lack of motivation).
Irritability (mood swings, feeling aggressive, angers easily).
Anxiety (inner restlessness or tension, feeling nervous or panicky).
Physical exhaustion (decrease in muscle strength or endurance, decrease in work performance, fatigue, lack of energy or stamina).
Sexual problems (decrease in sexual desire, or sexual performance).
Bladder problems (difficulty urinating, increased need to urinate).
Erectile changes (weaker erections, loss of morning erections).
Joint and muscular symptoms (joint pain or swelling, muscle weakness, poor recovery after exercise).
Difficulties with memory.
Problems with thinking, concentrating, or reasoning.
Difficulty learning new things.
Trouble thinking of the right word to describe persons, places, or things when speaking.
Increase in frequency or intensity of headaches or migraines.
Rapid hair loss or thinning.
Feel cold all the time or have cold hands or feet.
Weight gain, increased belly fat, or difficulty losing weight despite diet and exercise.
Infrequent or absent ejaculations.

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