1. Do you have a decrease in sex drive? YesNo
2. Do you have a lack of energy? YesNo
3. Do you have a decrease in strength and/or endurance? YesNo
4. Have you lost height? YesNo
5. Have you noticed a decreased enjoyment of life/hobbies that you once enjoyed? YesNo
6. Are you sad and/or moody? YesNo
7. Are your erections less strong/inability to have an erection? YesNo
8. Has it been more difficult to maintain your erection throughout intercourse? YesNo
9. Are you accumulating more body fat, especially in the midsection? YesNo
10. Has your work performance deteriorated recently? YesNo
11. Is your hair thinning or falling out? YesNo
12. Have you noticed a decrease in semen production or change in size of your testes? YesNo
13. Are you experiencing hot flashes? YesNo
I am interested in booking an appointment with you.
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