Which of the following low testosterone symptoms apply to you at this time? Please, mark the appropriate box for each
symptom. For symptoms that do not apply, please mark “none”.
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Symptoms: |
none |
mild |
moderate |
severe |
extremely severe |
| 1. |
Decline in your feeling of general well-being (general state of health, subjective feeling) |
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| 2. |
Joint pain and muscular ache (lower back pain, joint pain, pain in a limb, general back ache) |
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| 3. |
Excessive sweating (unexpected/sudden episodes of sweating, hot flushes independent of strain) |
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| 4. |
Sleep problems (difficulty in falling asleep, difficulty in sleeping through, waking up early and feeling tired, poor sleep, sleeplessness) |
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| 5. |
Increased need for sleep, often feeling tired |
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Irritability (feeling aggressive, easily upset about little things, moody) |
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Nervousness (inner tension, restlessness, feeling fidgety) |
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Anxiety (feeling panicky) |
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Physical exhaustion / lacking vitality (general decrease in performance, reduced activity, lacking interest in leisure activities, feeling of getting less done, of achieving less, of having to force oneself to undertake activities) |
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| 10. |
Decrease in muscular strength (feeling of weakness) |
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| 11. |
Depressive mood (feeling down, sad, on the verge of tears, lack of drive, mood swings, feeling nothing is of any use) |
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| 12. |
Feeling that you have passed your peak |
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| 13. |
Feeling burnt out, having hit rock-bottom |
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| 14. |
Decrease in beard growth |
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| 15. |
Decrease in ability/frequency to perform sexually |
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| 16. |
Decrease in the number of morning erections |
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| 17. |
Decrease in sexual desire/libido (lacking pleasure in sex, lacking desire for sexual intercourse) |
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If you have any other major symptoms,
please describe them here: |
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