Hormone Therapy Survey for Men - Do You Have Any of the Following Symptoms:

First Name(Required.)
Last Name(Required.)
Phone Number(Required.)
Physical exhaustion (fatigue, lack of energy, stamina, exhaustion.(Required.)
Sleep Problems (difficulty falling asleep or sleeping through the night)(Required.)
Irritability (mood swings, feeling aggressive, angers easily)(Required.)
Anxiety (feeling overwhelmed, feeling panicky, or feeling nervous)(Required.)
Decline in drive or interest (loss of "zest for life," feeling down or sad)(Required.)
Joint and muscular symptoms (joint pain, muscle weakness, poor recovery after exercise)(Required.)
Difficulties with memory (concentration, finding the right word, or retaining information)(Required.)
Sexual Desire or Performance (reduced or diminished)(Required.)
Sexual problems (change in desire, activity, orgasm, and/or satisfaction)(Required.)
Sweating (night sweats or increased episodes of sweating)(Required.)
Hair loss, rapid or thinning(Required.)
Feeling cold all the time, having cold hands or feet(Required.)
Headaches or migraines (increase in frequency or intensity)(Required.)
Weight (difficulty losing weight despite diet/exercise)(Required.)
Bladder problems (difficulty in urinating, increased need to urinate, incontinence)(Required.)
Thank you for taking our survey.

If you answered mild to severe to more than two of the symptoms listed on the survey you may be a potential candidate for hormone replacement therapy.

If you're interested in scheduling a Hormone Therapy consultation, please share a few upcoming dates and times that work for you, and we’ll do our best to find a convenient appointment.