Header image  

Network for Optimal Aging and Wellness
Located in Watkinsville,Georgia

Phone: 706.769.0720

 
line decor
  
line decor
 
 
 
 
 
 
Andropause Questionnaire

Andropause Questionnaire Please check those that apply, rating it's severity.

   
None
Mild
Mod.
Severe

Extreme
  Easily fatigued, tired or loss of energy
.
.
.
.
.
  Depression, low or negative mood
.
.
.
.
.
  Irritable, angry, or general bad tempered
.
.
.
.
.
  Anxious or nervous
.
.
.
.
.
  Loss of memory and/or concentration
.
.
.
.
.
  Relationship problems with partner
.
.
.
.
.
  Loss of sex drive or libido
.
.
.
.
.
  Erection or potency problems
.
.
.
.
.
  Dry skin on face or hands
.
.
.
.
.
  Excessive flushing/sweating, day or night
.
.
.
.
.
  Backache, joint pains or stiffness
.
.
.
.
.
  Heavy drinking, past or present
.
.
.
.
.
  Loss of fitness
.
.
.
.
.
  Feeling over-stressed
.
.
.
.
.
  Experiencing reduced muscle mass
.
.
.
.
.
  Decrease in strength
.
.
.
.
.
  Increase in central/upper body fat
.
.
.
.
.
  The age you feel
30
40
50
60
70+
   
NO
YES
 
Have you had: Adult mumps
.
.
 
Have you had: Testicular trauma
.
.
 
Have you had: Orchitis (infection of the testicles)
.
.
 
Have you had: Prostate operation or inflammation
.
.
 
Have you had: Persistent urinary infections
.
.
 
Have you had: Vasectomy
.
.
 
Have you had: Cardiovascular Disease
.
.
 
Have you had: Elevated lipid levels
.
.
 
Have you had: Sugar metabolism problems (insulin resistance or diabetes)
.
.
 
Are you: Obese
.
.
 
TOTAL CHECKS IN EACH COLUMN
.
.
.
.
.
 
--Multiply checks by:
x0
x1
x2
x3
x4
 
TOTAL SCORES
+
+
+
+
+
 
GRAND TOTAL
ANDROPAUSE SCORE = __________________

RESULTS OF ANDROPAUSE QUESTIONNAIRE: Interpretation of score:
0 - 9 ---.Unlikely to have Andropause
10-19---.Possible Andropause
20-29----Probable Andropause
30-39----Definite Andropause
40+----.Advanced Andropause
If you have scored 10 and above, you owe it to yourself and everyone else around you to investigate and correct any hormonal imbalances detected.
CALL TO MAKE AN APPOINTMENT! It doesn't have to be like this.
Please copy the above test and bring it to your appointment.
 
-------------------------------------------------------------------------

All rights reserved. / Property of www.noaw.com  /  Reprints with permission only. 
NEWS and NOAW are not responsible for the content of external internet sites.
Privacy Policy  / Disclaimer
Revised last: 5/2010