Understanding The Impact Of Testosterone Replacement Therapy

Thank you for choosing to participate in this anonymous survey.  It will take approximately 10 minutes and  
your insight and experience will be incredibly valuable as we uncover the impact that testosterone  is having on relationships and families nationwide. We are looking for both the testosterone users and the family members of the testosterone users participation. The information we gain from the survey will be published anonymously in a book titled, Testosterone, The New Drug Addiction. We are grateful you've chosen to participate. 

* 1. What is your gender?

* 2. What is your age?

* 3. What state do you currently live in?

* 4. For women only:  Are you post menopausal? 

* 5. Would you consider yourself a healthy eater?

* 6. How often do you exercise?

* 7. Are you using or have used testosterone replacement therapy?

* 8. In what form are you or were receiving testosterone?

* 9. Why did you choose testosterone replacement therapy?

* 10. Did your prescriber check your testosterone levels and give you the results? 

* 11. If so, what were your total testosterone levels before using testosterone?

* 12. What was your free testosterone level before using testosterone?

* 13. Have you had your testosterone levels checked again after starting therapy?

* 14. How long have you been receiving testosterone replacement therapy?

* 15. Describe your physical changes, emotional changes, cognitive and mental state, libido changes and anything else you can think of...

* 16. If you're using testosterone or have used testosterone what side effects did you experience?

* 17. While on testosterone did you experience any of the following:

* 18. If you are the spouse of a testosterone user would you please describe your spouses behavior before and after using testosterone?

* 19. Since using a testosterone product have you participated in any of the following: 

* 20. Do you consume alcoholic beverages?

* 21. When you do consume alcohol how much do you consume?

* 22. If you answered yes to consuming alcohol how often?

* 23. Do you use marijuana?

* 24. Do you use any other illicit drugs like cocaine, heroin, methamphetamine or ecstasy?

* 25. If we were to start a chapter of Testosterone and Steroid Addicts Anonymous in your area would that interest you?

* 26. Do you suffer from depression? 

* 27. Do you suffer from anxiety? 

* 28. What is your current relationship status?

* 29. Describe your relationship?

* 30. Are you afraid to stop using testosterone?

* 31. Have you tried to stop using testosterone but when you did you started to experience:

* 32. What prescription medications do you use?

* 33. What over the counter medications do you use?

* 34. Have you had an eating disorder?

* 35. Have you used steroids? 

* 36. If there were treatment options available to help you to stop using testosterone would you be interested in knowing what they are?

* 37. If there was DNA testing that could tell you what kind of diet is best for you would that interest you?

* 38. We are looking for people who would be willing to share their testosterone replacement therapy experiences and stories that will be published in an upcoming book. Would you like to share your story? All stories will be entirely anonymous unless you specify otherwise. 

* 39. Would you like to add anything else?

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