• Rate Yourself on a Scale of 1 to 10 (10 being highest)

    The qualities listed below peak when we are in our 20s, which would rate a 10 on a scale of 1-10. In comparison, how would you rate these qualities NOW?
  • Male Symptoms Form

    The following symptoms form will help determine whether a referral to a Medical Doctor specializing in hormones is recommended. Please check all that apply.
  • Suffering from Medical Issues?

  • Family History

  • Any Information for the Doctor?

    Please provide any further information that you would like for the doctor to take into consideration while reviewing your assessment form.
  • This field is for validation purposes and should be left unchanged.