Men

Women

Thyroid

YES

NO

YES

NO

Dry/Coarse Skin

 

 

 

 

Cold extremities or intolerance to cold

 

 

 

 

Hair loss

 

 

 

 

Fatigue or decreased energy

 

 

 

 

Decreased sexual energy 

 

 

 

 

Constipation

 

 

 

 

Easy bruising

 

 

 

 

Muscle cramps

 

 

 

 

Irregular periods

 

 

 

 

Weight gain

 

 

 

 

 

Men

Women

Testosterone

YES

NO

YES

NO

Decreased sense of well-being

 

 

 

 

Decreased libido (sex drive)

 

 

 

 

Fatigue/low energy (chronic fatigue)

 

 

 

 

Decreased firmness of erection or trouble maintaining an erection

 

 

 

 

Decreased frequency of erection

 

 

 

 

Decreased sensitivity of sex organs

 

 

 

 

Decreased intensity of orgasm

 

 

 

 

Loss of muscle strength/muscle mass

 

 

 

 

Increased fat around the waist

 

 

 

 

Decreased mental sharpness/indecisive

 

 

 

 

Decreased concentration

 

 

 

 

Heart palpitations

 

 

 

 

Excess day/night sweats

 

 

 

 

Decreased facial/body hair growth

 

 

 

 

 

Women

Estrogen

YES

NO

Headaches during menstrual flow

 

 

Loss of scalp hair

 

 

Loss of sexual desire

 

 

Shrunken or drooping breasts

 

 

Depressed or negative attitude

 

 

Heart racing or pounding around ovulation or at time your period starts

 

 

Anxiety

 

 

Insomnia

 

 

Loss of memory/forgetfulness

 

 

Irritable

 

 

Decreased energy

 

 

Hot Flashes

 

 

Night Sweats

 

 

Vaginal Dryness

 

 

 

Women

Progesterone

YES

NO

Bloating/Fluid retention

 

 

 

 

Heavy menstrual periods

 

 

 

 

Headaches prior to menstrual period

 

 

 

 

Breast lumps

 

 

 

 

Low fertility/difficulty getting pregnant

 

 

 

 

History of spontaneous abortions

 

 

 

 

HORMONE DEFICIENCY?

The following can indicate hormone deficiencies. Please print this page out and check all that apply. Discuss any areas of concern you have with your doctor.