Hormone Troubleshooting Survey
Hormone Troubleshooting SurveyDo you have aches, pains and inflammation?
Not Applicable / Don't Know
Mild
Moderate
Strong
Are you aging rapidly?
Not Applicable / Don't Know
Mild
Moderate
Strong
Do you have allergies?
Not Applicable / Don't Know
Mild
Moderate
Strong
Are you anxious?
Not Applicable / Don't Know
Mild
Moderate
Strong
Do you have bleeding changes?
Not Applicable / Don't Know
Mild
Moderate
Strong
Do you have bloating?
Not Applicable / Don't Know
Mild
Moderate
Strong
Do you have high blood pressure?
Not Applicable / Don't Know
Mild
Moderate
Strong
Do you have low blood pressure?
Not Applicable / Don't Know
Mild
Moderate
Strong
Do you have low blood sugar?
Not Applicable / Don't Know
Mild
Moderate
Strong
Do you have bone loss?
Not Applicable / Don't Know
Mild
Moderate
Strong
Do you have tender breasts?
Not Applicable / Don't Know
Mild
Moderate
Strong
Do you have chemical sensitivities?
Not Applicable / Don't Know
Mild
Moderate
Strong
Do you have high cholesterol?
Not Applicable / Don't Know
Mild
Moderate
Strong
Do you have cold body temperature?
Not Applicable / Don't Know
Mild
Moderate
Strong
Do you have constipation?
Not Applicable / Don't Know
Mild
Moderate
Strong
Do you cry easily?
Not Applicable / Don't Know
Mild
Moderate
Strong
Do you have depression?
Not Applicable / Don't Know
Mild
Moderate
Strong
Do you have discomfort or pain in legs?
Not Applicable / Don't Know
Mild
Moderate
Strong
Do you have dizziness?
Not Applicable / Don't Know
Mild
Moderate
Strong
Do you have drowsiness?
Not Applicable / Don't Know
Mild
Moderate
Strong
Do you have endometriosis?
Not Applicable / Don't Know
Mild
Moderate
Strong
Do you have fatigue in the evening?
Not Applicable / Don't Know
Mild
Moderate
Strong
Do you have fatigue in the morning?
Not Applicable / Don't Know
Mild
Moderate
Strong
Do you have fear or are fearful?
Not Applicable / Don't Know
Mild
Moderate
Strong
Do you feel tense?
Not Applicable / Don't Know
Mild
Moderate
Strong
Do you have fibromyalgia?
Not Applicable / Don't Know
Mild
Moderate
Strong
Are you forgetful?
Not Applicable / Don't Know
Mild
Moderate
Strong
Do you have goiter?
Not Applicable / Don't Know
Mild
Moderate
Strong
Do you have dry hair or brittle hair?
Not Applicable / Don't Know
Mild
Moderate
Strong
Do you have increased body hair?
Not Applicable / Don't Know
Mild
Moderate
Strong
Do you have increased facial hair?
Not Applicable / Don't Know
Mild
Moderate
Strong
Do you have hair loss (scalp)?
Not Applicable / Don't Know
Mild
Moderate
Strong
Do you have headaches?
Not Applicable / Don't Know
Mild
Moderate
Strong
Do you have hearing loss?
Not Applicable / Don't Know
Mild
Moderate
Strong
Do you have heart palpitations?
Not Applicable / Don't Know
Mild
Moderate
Strong
Do you have a fast heart rate?
Not Applicable / Don't Know
Mild
Moderate
Strong
Do you have a slow heart rate?
Not Applicable / Don't Know
Mild
Moderate
Strong
Do you have hoarseness?
Not Applicable / Don't Know
Mild
Moderate
Strong
Do you have hot flashes?
Not Applicable / Don't Know
Mild
Moderate
Strong
Do you have hypothyroid?
Not Applicable / Don't Know
Mild
Moderate
Strong
Do you have incontinence?
Not Applicable / Don't Know
Mild
Moderate
Strong
Do you have infertility issues?
Not Applicable / Don't Know
Mild
Moderate
Strong
Do you have insomnia?
Not Applicable / Don't Know
Mild
Moderate
Strong
Do you have decreased libido (sex drive)?
Not Applicable / Don't Know
Mild
Moderate
Strong
Do you have irritability?
Not Applicable / Don't Know
Mild
Moderate
Strong
Do you have mood swings?
Not Applicable / Don't Know
Mild
Moderate
Strong
Do you have decrease muscle mass?
Not Applicable / Don't Know
Mild
Moderate
Strong
Do you easily break nails?
Not Applicable / Don't Know
Mild
Moderate
Strong
Are you nervous?
Not Applicable / Don't Know
Mild
Moderate
Strong
Do you have brittle nails?
Not Applicable / Don't Know
Mild
Moderate
Strong
Do you have night sweats?
Not Applicable / Don't Know
Mild
Moderate
Strong
Do you have numbness in your hands or feet?
Not Applicable / Don't Know
Mild
Moderate
Strong
Do you have panic attacks?
Not Applicable / Don't Know
Mild
Moderate
Strong
Do you have puffy/swelling eyes/face?
Not Applicable / Don't Know
Mild
Moderate
Strong
Do you have a sense of physical instability?
Not Applicable / Don't Know
Mild
Moderate
Strong
Do you have thinning skin?
Not Applicable / Don't Know
Mild
Moderate
Strong
Do you have disturbed sleep?
Not Applicable / Don't Know
Mild
Moderate
Strong
Do you have a spinning sensation?
Not Applicable / Don't Know
Mild
Moderate
Strong
Do you have decreased stamina?
Not Applicable / Don't Know
Mild
Moderate
Strong
Do you have sugar cravings?
Not Applicable / Don't Know
Mild
Moderate
Strong
Do you have diminished sweating?
Not Applicable / Don't Know
Mild
Moderate
Strong
Do you have foggy thinking?
Not Applicable / Don't Know
Mild
Moderate
Strong
Do you have high triglycerides?
Not Applicable / Don't Know
Mild
Moderate
Strong
Do you have an increased urge to urinate?
Not Applicable / Don't Know
Mild
Moderate
Strong
Do you have uterine fibroids?
Not Applicable / Don't Know
Mild
Moderate
Strong
Do you have fibrocystic breasts?
Not Applicable / Don't Know
Mild
Moderate
Strong
Do you have vaginal dryness?
Not Applicable / Don't Know
Mild
Moderate
Strong
Do you wake up groggy and on edge?
Not Applicable / Don't Know
Mild
Moderate
Strong
Do you have water retention?
Not Applicable / Don't Know
Mild
Moderate
Strong
Do you have weight gain in your hips?
Not Applicable / Don't Know
Mild
Moderate
Strong
Do you have weight gain around your waist?
Not Applicable / Don't Know
Mild
Moderate
Strong
Do you have significant weight gain of 30 pounds or more?
Not Applicable / Don't Know
Mild
Moderate
Strong
Do you have a deepening voice?
Not Applicable / Don't Know
Mild
Moderate
Strong
Do you worry?
Not Applicable / Don't Know
Mild
Moderate
Strong
Do you have acne?
Not Applicable / Don't Know
Mild
Moderate
Strong
Do you have excessive blood clotting?
Not Applicable / Don't Know
Mild
Moderate
Strong
Do you have an increased appetite?
Not Applicable / Don't Know
Mild
Moderate
Strong
Have you stopped feeling like yourself?
Not Applicable / Don't Know
Mild
Moderate
Strong
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