Hormone Deficiency Test
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ESTROGEN |
||||||||
SIGNS & SYMPTOMS |
NEVER |
SOMETIMES |
REGULARLY |
OFTEN |
CONSTANTLY |
|||
1 |
I am losing hair on top of my head. |
0 |
1 |
2 |
3 |
4 |
||
2 |
I'm getting thin, vertical wrinkles above my lips. |
0 |
1 |
2 |
3 |
4 |
||
3 |
My breasts are droopy. |
0 |
1 |
2 |
3 |
4 |
||
4 |
My face is too hairy. |
0 |
1 |
2 |
3 |
4 |
||
5 |
My eyes are dry and easily irritated. |
0 |
1 |
2 |
3 |
4 |
||
6 |
I have hot flashes. |
0 |
1 |
2 |
3 |
4 |
||
7 |
I feel tired constantly. |
0 |
1 |
2 |
3 |
4 |
||
8 |
I am depressed. |
0 |
1 |
2 |
3 |
4 |
||
9 |
My menstrual flow is light. (0=moderate/1-3=low/4=none |
0 |
1 |
2 |
3 |
4 |
||
10 |
Women with periods: My cycles are irregular, too short (<27 days), |
0 |
1 |
2 |
3 |
4 |
||
or too long (>31 days). |
||||||||
11 |
Women without periods: I do not feel like making love anymore. |
0 |
1 |
2 |
3 |
4 |
||
Add up your
Overal Score________: |
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PROGESTERONE |
||||||||
SIGNS & SYMPTOMS |
NEVER |
SOMETIMES |
REGULARLY |
OFTEN |
CONSTANTLY |
|||
1 |
My breasts are large. |
0 |
1 |
2 |
3 |
4 |
||
2 |
My close friends complained I'm nervous and agitated. |
0 |
1 |
2 |
3 |
4 |
||
3 |
I feel anxious. |
0 |
1 |
2 |
3 |
4 |
||
4 |
I sleep lightly and restlessly. |
0 |
1 |
2 |
3 |
4 |
||
The following questions are for women who have not yet reached menopause, and menopausal women who are taking hormone replacement therapy (estrogen or estrogen and progesterone) |
||||||||
5 |
My breasts are swollen and tender or painful before my period |
0 |
1 |
2 |
3 |
4 |
||
6 |
And my lower belly is swollen |
0 |
1 |
2 |
3 |
4 |
||
7 |
And I'm irritable and aggressive |
0 |
1 |
2 |
3 |
4 |
||
8 |
And I lose my self-control. |
0 |
1 |
2 |
3 |
4 |
||
9 |
I have heavy periods |
0 |
1 |
2 |
3 |
4 |
||
10 |
And they are continuously painful. |
0 |
1 |
2 |
3 |
4 |
||
* |
Add up your Overal Score________: Post-meopausal women not treated with hormone replacement therapy (estrogen or estrogen and progesterone): 4 or less: Satisfactory level. Between 5 and 8: Possible progesterone deficiency. 9 or more: Probable progesterone deficiency. Menstrual women and menopausal women taking hormone replacement therapy (estrogen or estrogen and progesterone): 10 or less: Satisfactory level. Between 11 and 20: Possible progesterone deficiency. 21 and more: Probable progesterone deficiency. |
|||||||
TESTOSTERONE | ||||||||
SIGNS & SYMPTOMS |
NEVER |
SOMETIMES |
REGULARLY |
OFTEN |
CONSTANTLY |
|||
(MEN AND WOMEN) |
||||||||
1 |
My face has become slack and more wrinkled. |
0 |
1 |
2 |
3 |
4 |
||
2 |
I've lost muscle tone. |
0 |
1 |
2 |
3 |
4 |
||
3 |
My belly tends to get fat. |
0 |
1 |
2 |
3 |
4 |
||
4 |
I am constantly tired. |
0 |
1 |
2 |
3 |
4 |
||
5 |
I feel like making love less often than I used to. |
0 |
1 |
2 |
3 |
4 |
||
(MEN ONLY) |
||||||||
6 |
My breasts are getting fatty. |
0 |
1 |
2 |
3 |
4 |
||
7 |
I feel less self-confident and more hesitant. |
0 |
1 |
2 |
3 |
4 |
||
8 |
My sexual performance is poorer than it used to be. |
0 |
1 |
2 |
3 |
4 |
||
9 |
I have hot flashes and sweats. |
0 |
1 |
2 |
3 |
4 |
||
10 |
I tire easily with physical activity. |
0 |
1 |
2 |
3 |
4 |
||
Add up your
Overal Score________: Score for Men: 10 or less: Satisfactory
level. Between 11 and 20: Possible testosterone deficiency. |
||||||||
GROWTH HORMONE | ||||||||
SIGNS & SYMPTOMS |
NEVER |
SOMETIMES |
REGULARLY |
OFTEN |
CONSTANTLY |
|||
1 |
My hair is thinning. |
0 |
1 |
2 |
3 |
4 |
||
2 |
My cheeks sag. |
0 |
1 |
2 |
3 |
4 |
||
3 |
My gum are receding. |
0 |
1 |
2 |
3 |
4 |
||
4 |
My abdomen is flabby./I've got a "spare tire". |
0 |
1 |
2 |
3 |
4 |
||
5 |
My muscles are slack. |
0 |
1 |
2 |
3 |
4 |
||
6 |
My skin is thin and/or dry. |
0 |
1 |
2 |
3 |
4 |
||
7 |
It's hard to recover after physical activity. |
0 |
1 |
2 |
3 |
4 |
||
8 |
I feel exhausted. |
0 |
1 |
2 |
3 |
4 |
||
9 |
I don't like the world. I tend to isolate myself. |
0 |
1 |
2 |
3 |
4 |
||
10 |
I feel continuously anxious and worried. |
0 |
1 |
2 |
3 |
4 |
||
Add up your
Overal Score________: |
||||||||
DHEA | ||||||||
SIGNS & SYMPTOMS |
NEVER |
SOMETIMES |
REGULARLY |
OFTEN |
CONSTANTLY |
|||
1 |
My hair is dry. |
0 |
1 |
2 |
3 |
4 |
||
2 |
My skin and eyes are dry. |
0 |
1 |
2 |
3 |
4 |
||
3 |
My muscles are flabby. |
0 |
1 |
2 |
3 |
4 |
||
4 |
My belly is getting fat. |
0 |
1 |
2 |
3 |
4 |
||
5 |
I don't have much hair under my arm. |
0 |
1 |
2 |
3 |
4 |
||
6 |
I don't have much hair in the pubic area (0=plenty of hair; |
0 |
1 |
2 |
3 |
4 |
||
4=hairless |
||||||||
7 |
I dont have much fatty tissue in the pubic area (flat "mound of |
0 |
1 |
2 |
3 |
4 |
||
Venus" in women). 0=padded/4= flat |
||||||||
8 |
My body doesn't have much of a special scent during sexual |
0 |
1 |
2 |
3 |
4 |
||
arousal. |
||||||||
9 |
I can't tolerate noise. |
0 |
1 |
2 |
3 |
4 |
||
10 |
My libido is low. |
0 |
1 |
2 |
3 |
4 |
||
Add up your
Overal Score________: |
||||||||
THYROID | ||||||||
SIGNS & SYMPTOMS |
NEVER |
SOMETIMES |
REGULARLY |
OFTEN |
CONSTANTLY |
|||
1 |
I'm sensitive to cold. |
0 |
1 |
2 |
3 |
4 |
||
2 |
My hands and feet are always cold. |
0 |
1 |
2 |
3 |
4 |
||
3 |
In the morning my face is puffy and my eyelids are swollen. |
0 |
1 |
2 |
3 |
4 |
||
4 |
I put on weight easily. |
0 |
1 |
2 |
3 |
4 |
||
5 |
I have dry skin. |
0 |
1 |
2 |
3 |
4 |
||
6 |
I have trouble getting up in the morning. |
0 |
1 |
2 |
3 |
4 |
||
7 |
I feel more tired at rest than when I am active. |
0 |
1 |
2 |
3 |
4 |
||
8 |
I am constipated. |
0 |
1 |
2 |
3 |
4 |
||
9 |
My joints are stiff in the morning. |
0 |
1 |
2 |
3 |
4 |
||
10 |
I feel like I'm living in slow motion. |
0 |
1 |
2 |
3 |
4 |
||
Add up your
Overal Score________: |
||||||||
PREGNENOLONE | ||||||||
SIGNS & SYMPTOMS |
NEVER |
SOMETIMES |
REGULARLY |
OFTEN |
CONSTANTLY |
|||
1 |
I have memory loss. |
0 |
1 |
2 |
3 |
4 |
||
2 |
My joints hurt (fingers, wrists, elbows, feet, ankles, knees). |
0 |
1 |
2 |
3 |
4 |
||
3 |
I'm feeling drained and I have a hard time handling stress. |
0 |
1 |
2 |
3 |
4 |
||
4 |
I dont see colors as brightly as before. |
0 |
1 |
2 |
3 |
4 |
||
5 |
I have lost interest in art; I don't aprreciate art as much anymore. |
0 |
1 |
2 |
3 |
4 |
||
6 |
I don't have much hair under my arms or in the pubic area. |
0 |
1 |
2 |
3 |
4 |
||
(0= plenty of hair/ 4= hairless) |
||||||||
7 |
My muscles are flabby. |
0 |
1 |
2 |
3 |
4 |
||
8 |
I have abundant, light -colored urine during the day. |
0 |
1 |
2 |
3 |
4 |
||
9 |
I have low blood pressure. |
0 |
1 |
2 |
3 |
4 |
||
10 |
I crave salty food. |
0 |
1 |
2 |
3 |
4 |
||
Add up your
Overal Score________: |
||||||||
MELATONIN | ||||||||
SIGNS & SYMPTOMS |
NEVER |
SOMETIMES |
REGULARLY |
OFTEN |
CONSTANTLY |
|||
1 |
I look older than I am. |
0 |
1 |
2 |
3 |
4 |
||
2 |
I have trouble falling asleep in at night. |
0 |
1 |
2 |
3 |
4 |
||
3 |
I wake up during the night |
0 |
1 |
2 |
3 |
4 |
||
4 |
And I can't get back to sleep. |
0 |
1 |
2 |
3 |
4 |
||
5 |
My mind is busy with anxious thoughts while I'm trying to fall asleep. |
0 |
1 |
2 |
3 |
4 |
||
6 |
My feet are too hot at night |
0 |
1 |
2 |
3 |
4 |
||
7 |
When I get up, I don't feel rested. |
0 |
1 |
2 |
3 |
4 |
||
8 |
I feel like I'm living out of sync with the world, going to bed late, and |
0 |
1 |
2 |
3 |
4 |
||
waking up late. |
||||||||
9 |
I can't tolerate jet lag. |
0 |
1 |
2 |
3 |
4 |
||
10 |
I smoke, drink, and/or use a beta-blocker or a sleep aid |
0 |
1 |
2 |
3 |
4 |
||
Add up your
Overal Score________: |
||||||||
FACE AND SKIN | ||||||||
SIGNS & SYMPTOMS |
NEVER |
SOMETIMES |
REGULARLY |
OFTEN |
CONSTANTLY |
|||
1 |
My face has fine lines at the side of the eyes. |
0 |
1 |
2 |
3 |
4 |
||
2 |
I have a thick line from my nose to my mouth. |
0 |
1 |
2 |
3 |
4 |
||
3 |
I have eczema, psoriasis, or other rashes. |
0 |
1 |
2 |
3 |
4 |
||
4 |
I have a furrow between my eye brows. |
0 |
1 |
2 |
3 |
4 |
||
5 |
I have lines on my forhead. |
0 |
1 |
2 |
3 |
4 |
||
6 |
I have rosacea (redness on the nose and cheeks). |
0 |
1 |
2 |
3 |
4 |
||
7 |
The skin is thin on the back of the hand. |
0 |
1 |
2 |
3 |
4 |
||
8 |
My skin looks thicker on my face. |
0 |
1 |
2 |
3 |
4 |
||
9 |
I have smile lines at the side of my mouth. |
0 |
1 |
2 |
3 |
4 |
||
10 |
I have dark circles under my eyes. |
0 |
1 |
2 |
3 |
4 |
||
Add up your Overal Score________: Overall total is 10 or less is satisfactory level. Between 11-20: Possible sun damage and aging 21 or more: Probable sun damage and aging. Your doctor can prescribe anti-oxidant creams that can reduce the aging lines on the face. Anti-oxidant creams will also repair the damage from the sun. |
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PART II -- CIRCLE THE ANSWERS TO THE AILMENTS AND DISCUSS THEM WITH YOUR PHYSICIAN. | ||||||||
ENERGY |
||||||||
1 |
Do you have a hard time getting up in the morning? |
YES |
NO |
|||||
2 |
Do you always feel tired or tired in the afternoon? |
YES |
NO |
|||||
SEX |
||||||||
1 |
Do you lack sexual desire? |
YES |
NO |
|||||
2 |
Does your penis or clitoris seem less sensitive? |
YES |
NO |
|||||
3 |
Are your erections not firm enough? |
YES |
NO |
|||||
4 |
Have you lost your attraction toward your partner? |
YES |
NO |
|||||
5 |
Do you lack vaginal lubrication? |
YES |
NO |
|||||
SLEEP |
||||||||
1 |
Do you sleep poorly? |
YES |
NO |
|||||
2 |
Do you rarely dream? |
YES |
NO |
|||||
MEMORY |
||||||||
1 |
Do you suffer from short-or-long-term memory loss? |
YES |
NO |
|||||
2 |
do you have trouble concentrating? |
YES |
NO |
|||||
SKIN AND HAIR |
||||||||
1 |
Do you have wrinkles on you face along the nose, smile lines, and forehead creases? |
YES |
NO |
|||||
2 |
Do you have little wrinkles around the eyes and crows feet? |
YES |
NO |
|||||
3 |
Do you have age spots? |
YES |
NO |
|||||
4 |
Do you have dry, thin skin? |
YES |
NO |
|||||
5 |
Are you losing your hair or is it turning gray? |
YES |
NO |
|||||
WEIGHT CONTROL |
||||||||
1 |
Is your abdomen too plump? Is it distended? |
YES |
NO |
|||||
2 |
Women: Are your breasts too large? Do they get larger before your period? |
YES |
NO |
|||||
3 |
Are your buttocks and thighs too well padded? Are you pear-shaped? |
YES |
NO |
|||||
STRESS AND MOODS |
||||||||
1 |
Do you suffer from constant fatigue? |
YES |
NO |
|||||
2 |
Do you have high blood pressure? |
YES |
NO |
|||||
3 |
Are you anxious, nervous, or irritable? |
YES |
NO |
|||||
4 |
Do small things set you off? |
YES |
NO |
|||||
5 |
Are you depressed? |
YES |
NO |
|||||
JOINTS AND BONES |
||||||||
1 |
Do you have arthritis? |
YES |
NO |
|||||
2 |
Do you have osteoarthritis in the hip? |
YES |
NO |
|||||
3 |
Do you have fibromyalgia (feverish aching muscles and fatigue)? |
YES |
NO |
|||||
4 |
Have you lost muscle mass, tone, and strength? |
YES |
NO |
|||||
5 |
Do you have bone loss of the spine, hips, hands, wrists, and/or feet? |
YES |
NO |