Stay Young & Sexy

 
  FREE Hormone Assessment
 
 
 
 
  Sample Chapter: Chapter 1
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FREE Hormone Self Assessment

Instructions: Please enter the appropriate response number to each statement in the columns below. Use the values in the rating scale below. Once you have answered all of the questions, scroll to the bottom of the page and click the "Calculate" button. Your score and assesment will be tabulated and displayed.

Rating Scale
0 Never / rarely
1 Occasionally / Slightly
2 Moderate in intensity or frequency
3 Intense / severe or frequent

Past Now Questions
Do you have water retention/bloating/weight gain?
Do you have increased facial hair?
Do you experience breast tenderness/swelling?
Are you experiencing pain: Headache/migraine?
Are you experiencing pain: low back/muscle ache/joint ache?
Do you suffer from fatigue/lack of energy?
Have you noticed a decrease in concentration/alertness?
Have you experienced memory loss?
Do you suffer form PMS?
Are you more irritable/angry?
Are you experiencing anxiety?
Are you feeling depressed?
Do you have mood swings?
Do you have an increase in acne or oily skin?
Do you have an increase in dry hair/skin?
Does your skin itch?
Do you suffer from urinary incontinence?
Do you have frequent urinary tract infections?
Have you experienced increased vaginal dryness/pain/itching?
Have you noticed a decrease in libido/sex drive?
Is it more difficult to reach orgasm?
Do you experience painful intercourse?
Do you experience hot flashes/night sweats?
Are your sleep patterns disturbed?
What do you think is your personal risk of osteoporosis?
What do you think is your personal risk factors for heart disease?



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