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Women’s Questionnaire
Men’s Questionnaire
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Men Form Questionnaire
Do you have a decrease in libido (Sex drive) ?
Yes
No
Do you have a lack of energy?
Yes
No
Do you have a decrease in strength and/or endurance ?
Yes
No
Have you lost height?
Yes
No
Have you noticed a decrease “enjoyment of life”?
Yes
No
Are you sad and/or grumpy?
Yes
No
Are your erections less strong?
Yes
No
Have you noticed a recent deterioration in your ability to play sports?
Yes
No
Are you falling asleep after dinner?
Yes
No
Has there been a recent deterioration in your work performance?
Yes
No
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