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Symptoms: (select all that apply) Anxiety Change in mood Constipation Declining memory and mental ability Decreased Libido Decreased sense of well being Depression Difficulty sleeping or insomnia Diminished strength Discomfort during intercourse due to dryness Dislike of intercourse ED Exercise tolerance Fatigue and lack of energy Heavy bleeding Hot Flashes/night sweats Infertility Irregular periods Joint aches and arthritic symptoms Lack of motivation Missed periods Muscle loss/shrinkage PMS Tender breasts Trouble reaching orgasm Underactive sex drive Urinary leaking or urgency Use of oral contraceptives Weight gain/weight loss
What are your goals: (select all that apply) Athletic Performance Overall Health Decreased Stress Low Energy Weight Loss Sexual Performance Increased Energy
Have you done hormone therapy before? Yes No
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