Questionnaire

Questionnaire

“Andropause” is what some refer to as male menopause, or more commonly known as — low T. Low levels of testosterone can cause hormonal changes that come with uncomfortable symptoms, including low libido, erectile dysfunction, fatigue, muscle loss, and mood changes. Testosterone levels decrease gradually as a man ages. We have created a quiz to help you determine whether or not you think you many be suffering from Low T.

The Androgen Quiz is a low testosterone test to help men decide if they should talk to a medical professional about the symptoms they are experiencing. This quiz consists of questions concerning symptoms of androgen deficiency. If you answer, “Yes” to several of these or even just one, you may have low testosterone and should consult with a medical professional.


Male Low Testosterone Questionnaire

Have you been feeling down, depression, or moody?

  • yes
  • no
  • maybe

Do you have less energy, easily fatigued, or no stamina?

  • yes
  • no
  • maybe

Has your sex drive diminished?

  • yes
  • no
  • maybe

Have you noticed a decrease in strength or muscle mass?

  • yes
  • no
  • maybe

Have you experienced unexplained bone fracture?

  • yes
  • no
  • maybe

Do you have hot flashes or unexplained sweats?

  • yes
  • no
  • maybe

Do you have difficulty getting or keeping erections?

  • yes
  • no
  • maybe

Have you experienced hair loss or body hair loss?

  • yes
  • no
  • maybe

***IF YOU ANSWERED YES TO 3 OR MORE, YOU MAY BE SUFFERING FROM LOW TESTOSTERONE LEVELS***

Hormonal imbalance is more common than you may realize. Women of all ages struggle with this. Each individual has a unique balance of hormones, but when they are not balanced properly, symptoms arise. You may be experiencing fatigue, low libido, hot flashes, night sweats, decrease in lean muscle and an increase in fat, along with constant mood swings. Getting back into balance and feeling like yourself again can be trying and frustrating.

In order to help you understand what you may be going through, we have designed a quiz to assess hormonal imbalance in women. When your body has a hormonal imbalance you start to experience symptoms you’ve never had and quite honestly, you probably don’t want. WE CAN HELP! Start by taking our quiz and you can be on the path to happy hormonal balance again!


Female Hormone Deficiency Questionnaire

Have you experienced depressed mood?

  • yes
  • no
  • maybe

Do you experience issues with mental clarity?

  • yes
  • no
  • maybe

Have you experienced decreased sex drive / libido?

  • yes
  • no
  • maybe

Do you have problems with sleep?

  • yes
  • no
  • maybe

Have you experienced more anxiety or irritability?

  • yes
  • no
  • maybe

Have you experienced weight gain or bloating?

  • yes
  • no
  • maybe

Have you experienced night sweats or hot flashes?

  • yes
  • no
  • maybe

Have you experienced vaginal dryness or painful sex?

  • yes
  • no
  • maybe

Have you experienced joint pain?

  • yes
  • no
  • maybe

Have you experienced hair falling out?

  • yes
  • no
  • maybe

***IF YOU ANSWERED YES TO 4 OR MORE QUESTIONS, YOU MAY BE SUFFERING FROM DEPLETED HORMONE LEVELS OR HORMONAL IMBALANCES***


Rejuvime Medical does not accept any form of insurance. Many of the formulations we use in our therapies are not covered by insurance, and the cost of overall treatment is often less than when using insurance. On case by case basis, some insurance companies do reimburse for Hormone Replacement Therapy and Testosterone Replacement Therapy. It is each patient’s responsibility to contact their own insurance company to confirm reimbursement. Rejuvime Medical will not contact your insurance company, nor will we take any responsibility for any additional forms your insurance may require.

OUR PROCESS

Step 1

Meet with our "lifestyle/anti-aging" consultant to discuss our program and have labs drawn.

Step 2

Meet with a medical professional to review labs, complaints and symptoms, and have comprehensive physical performed.

Step 3

Initiate a personalized anti-aging prescription regimen customized for your specific needs.

Step 4

Monitor your progress and adjust each patient's regimen according to laboratory results and clinical symptoms.