Hormone Self-Test

Estrogen Deficiency – Women

Hot flashes or night sweats

0 – Never
1 – Occasionally
2 – Often
3 – Almost Always

Vaginal dryness or discomfort

0 – Never
1 – Occasionally
2 – Often
3 – Almost Always

Dry skin or brittle hair

0 – Never
1 – Occasionally
2 – Often
3 – Almost Always

Poor memory or brain fog

0 – Never
1 – Occasionally
2 – Often
3 – Almost Always

Mood swings or irritability

0 – Never
1 – Occasionally
2 – Often
3 – Almost Always

Low libido

0 – Never
1 – Occasionally
2 – Often
3 – Almost Always

Irregular or absent periods

0 – Never
1 – Occasionally
2 – Often
3 – Almost Always

Progesterone Deficiency – Women

Anxiety or restlessness

0 – Never
1 – Occasionally
2 – Often
3 – Almost Always

PMS symptoms

0 – Never
1 – Occasionally
2 – Often
3 – Almost Always

Insomnia or trouble sleeping

0 – Never
1 – Occasionally
2 – Often
3 – Almost Always

Spotting before periods

0 – Never
1 – Occasionally
2 – Often
3 – Almost Always

Headaches or menstrual migraines

0 – Never
1 – Occasionally
2 – Often
3 – Almost Always

Short luteal phase

0 – Never
1 – Occasionally
2 – Often
3 – Almost Always

Testosterone Deficiency – Women and Men

Low energy or fatigue

0 – Never
1 – Occasionally
2 – Often
3 – Almost Always

Decreased muscle tone

0 – Never
1 – Occasionally
2 – Often
3 – Almost Always

Low libido

0 – Never
1 – Occasionally
2 – Often
3 – Almost Always

Difficulty achieving orgasm or ED

0 – Never
1 – Occasionally
2 – Often
3 – Almost Always

Low motivation or assertiveness

0 – Never
1 – Occasionally
2 – Often
3 – Almost Always

Low mood or irritability

0 – Never
1 – Occasionally
2 – Often
3 – Almost Always

Thyroid – Women and Men

Fatigue or sluggishness

0 – Never
1 – Occasionally
2 – Often
3 – Almost Always

Cold sensitivity

0 – Never
1 – Occasionally
2 – Often
3 – Almost Always

Constipation

0 – Never
1 – Occasionally
2 – Often
3 – Almost Always

Weight gain

0 – Never
1 – Occasionally
2 – Often
3 – Almost Always

Hair thinning or eyebrow loss

0 – Never
1 – Occasionally
2 – Often
3 – Almost Always

Brain fog

0 – Never
1 – Occasionally
2 – Often
3 – Almost Always

Dry skin or brittle nails

0 – Never
1 – Occasionally
2 – Often
3 – Almost Always

Low mood

0 – Never
1 – Occasionally
2 – Often
3 – Almost Always

Growth Hormone Deficiency – Women and Men

Low stamina

0 – Never
1 – Occasionally
2 – Often
3 – Almost Always

Increased belly fat

0 – Never
1 – Occasionally
2 – Often
3 – Almost Always

Poor recovery after workouts

0 – Never
1 – Occasionally
2 – Often
3 – Almost Always

Decreased muscle mass

0 – Never
1 – Occasionally
2 – Often
3 – Almost Always

Thinning or sagging skin

0 – Never
1 – Occasionally
2 – Often
3 – Almost Always

Weak bones

0 – Never
1 – Occasionally
2 – Often
3 – Almost Always

Poor sleep quality

0 – Never
1 – Occasionally
2 – Often
3 – Almost Always

Low mood

0 – Never
1 – Occasionally
2 – Often
3 – Almost Always

Hormone Self-Test Questionnaire

Estrogen Deficiency – Women

Progesterone Deficiency – Women

Testosterone Deficiency – Women and Men

Thyroid – Women and Men

Growth Hormone Deficiency – Women and Men