Have you ever taken hormone therapy before?

Have you ever had an abnormal prostate exam before?

Have you ever had an elevated PSA level before?

Do you have any symptoms listed here that could indicate Androgen Deficiency?

Do you have any symptoms listed here that could indicate Adrenal Insufficiency or Excess?

Do you have any symptoms listed here that could indicate Thyroid Excess?

Do you have any symptoms listed here that could indicate Thyroid Deficiency?

What medical problems do you have?

Please indicate if you have had any of these medical conditions

Medication Allergies

Family History

Tobacco Use

Illicit Drug Use

Alcohol Use

13 + 12 =