Hormone Deficiency Test

ESTROGEN

 

SIGNS & SYMPTOMS

NEVER

SOMETIMES

REGULARLY

OFTEN

CONSTANTLY

   

1

I am losing hair on top of my head.

0

1

2

3

4

   

2

I'm getting thin, vertical wrinkles above my lips.

0

1

2

3

4

   

3

My breasts are droopy.

0

1

2

3

4

   

4

My face is too hairy.

0

1

2

3

4

   

5

My eyes are dry and easily irritated.

0

1

2

3

4

   

6

I have hot flashes.

0

1

2

3

4

   

7

I feel tired constantly.

0

1

2

3

4

   

8

I am depressed.

0

1

2

3

4

   

9

My menstrual flow is light. (0=moderate/1-3=low/4=none

0

1

2

3

4

   

10

Women with periods: My cycles are irregular, too short (<27 days),

0

1

2

3

4

   
 

or too long (>31 days).

             

11

Women without periods: I do not feel like making love anymore.

0

1

2

3

4

   

 

Add up your Overal Score________:
Overall total of 10 or less is satisfactory level.
Between 11-20: Possible Estrogen deficiency.
21 or more: Probable Estrogen deficiency.

             
 

 

             

PROGESTERONE

 

SIGNS & SYMPTOMS

NEVER

SOMETIMES

REGULARLY

OFTEN

CONSTANTLY

   

1

My breasts are large.

0

1

2

3

4

   

2

My close friends complained I'm nervous and agitated.

0

1

2

3

4

   

3

I feel anxious.

0

1

2

3

4

   

4

I sleep lightly and restlessly.

0

1

2

3

4

   
 

The following questions are for women who have not yet reached menopause, and menopausal women who are taking hormone replacement therapy (estrogen or estrogen and progesterone)

             

5

My breasts are swollen and tender or painful before my period…

0

1

2

3

4

   

6

And my lower belly is swollen

0

1

2

3

4

   

7

And I'm irritable and aggressive…

0

1

2

3

4

   

8

And I lose my self-control.

0

1

2

3

4

   

9

I have heavy periods…

0

1

2

3

4

   

10

And they are continuously painful.

0

1

2

3

4

   
                 

*

Add up your Overal Score________: Post-meopausal women not treated with hormone replacement therapy (estrogen or estrogen and progesterone): 4 or less: Satisfactory level. Between 5 and 8: Possible progesterone deficiency. 9 or more: Probable progesterone deficiency.

Menstrual women and menopausal women taking hormone replacement therapy (estrogen or estrogen and progesterone): 10 or less: Satisfactory level. Between 11 and 20: Possible progesterone deficiency. 21 and more: Probable progesterone deficiency.

             
                 
TESTOSTERONE                
 

SIGNS & SYMPTOMS

NEVER

SOMETIMES

REGULARLY

OFTEN

CONSTANTLY

   
 

(MEN AND WOMEN)

             

1

My face has become slack and more wrinkled.

0

1

2

3

4

   

2

I've lost muscle tone.

0

1

2

3

4

   

3

My belly tends to get fat.

0

1

2

3

4

   

4

I am constantly tired.

0

1

2

3

4

   

5

I feel like making love less often than I used to.

0

1

2

3

4

   
 

(MEN ONLY)

             

6

My breasts are getting fatty.

0

1

2

3

4

   

7

I feel less self-confident and more hesitant.

0

1

2

3

4

   

8

My sexual performance is poorer than it used to be.

0

1

2

3

4

   

9

I have hot flashes and sweats.

0

1

2

3

4

   

10

I tire easily with physical activity.

0

1

2

3

4

   
                 
                 
 

Add up your Overal Score________:
For women : 5 or less: Satisfactory level. Between 6 and 10: Possible testosterone deficiency. 
11 or more: Probable testosterone deficiency.

Score for Men: 10 or less: Satisfactory level. Between 11 and 20: Possible testosterone deficiency.
21 or more: Probable testosterone deficiency.

             
 

 

             
GROWTH HORMONE                
 

SIGNS & SYMPTOMS

NEVER

SOMETIMES

REGULARLY

OFTEN

CONSTANTLY

   

1

My hair is thinning.

0

1

2

3

4

   

2

My cheeks sag.

0

1

2

3

4

   

3

My gum are receding.

0

1

2

3

4

   

4

My abdomen is flabby./I've got a "spare tire".

0

1

2

3

4

   

5

My muscles are slack.

0

1

2

3

4

   

6

My skin is thin and/or dry.

0

1

2

3

4

   

7

It's hard to recover after physical activity.

0

1

2

3

4

   

8

I feel exhausted.

0

1

2

3

4

   

9

I don't like the world. I tend to isolate myself.

0

1

2

3

4

   

10

I feel continuously anxious and worried.

0

1

2

3

4

   
 

Add up your Overal Score________:
Overall total is 10 or less is satisfactory level. Between 11-20: Possible Growth Hormone deficiency.
21 or more: Probable Growth Hormone deficiency.

             
 

 

             
                 
DHEA                
 

SIGNS & SYMPTOMS

NEVER

SOMETIMES

REGULARLY

OFTEN

CONSTANTLY

   

1

My hair is dry.

0

1

2

3

4

   

2

My skin and eyes are dry.

0

1

2

3

4

   

3

My muscles are flabby.

0

1

2

3

4

   

4

My belly is getting fat.

0

1

2

3

4

   

5

I don't have much hair under my arm.

0

1

2

3

4

   

6

I don't have much hair in the pubic area (0=plenty of hair;

0

1

2

3

4

   
 

4=hairless

             

7

I don’t have much fatty tissue in the pubic area (flat "mound of

0

1

2

3

4

   
 

Venus" in women). 0=padded/4= flat

             

8

My body doesn't have much of a special scent during sexual

0

1

2

3

4

   
 

arousal.

             

9

I can't tolerate noise.

0

1

2

3

4

   

10

My libido is low.

0

1

2

3

4

   
                 
 

Add up your Overal Score________:
Overall total is 10 or less is satisfactory level. Between 11-20: Possible DHEA deficiency.
21 or more: Probable DHEA deficiency.

             
 

 

             
                 
THYROID                
 

SIGNS & SYMPTOMS

NEVER

SOMETIMES

REGULARLY

OFTEN

CONSTANTLY

   

1

I'm sensitive to cold.

0

1

2

3

4

   

2

My hands and feet are always cold.

0

1

2

3

4

   

3

In the morning my face is puffy and my eyelids are swollen.

0

1

2

3

4

   

4

I put on weight easily.

0

1

2

3

4

   

5

I have dry skin.

0

1

2

3

4

   

6

I have trouble getting up in the morning.

0

1

2

3

4

   

7

I feel more tired at rest than when I am active.

0

1

2

3

4

   

8

I am constipated.

0

1

2

3

4

   

9

My joints are stiff in the morning.

0

1

2

3

4

   

10

I feel like I'm living in slow motion.

0

1

2

3

4

   
                 
 

Add up your Overal Score________:
Overall total is 10 or less is satisfactory level. Between 11-20: Possible Thyroid Hormone deficiency.
21 or more: Probable Thyroid Hormone deficiency.

             
 

 

             
                 
PREGNENOLONE                
 

SIGNS & SYMPTOMS

NEVER

SOMETIMES

REGULARLY

OFTEN

CONSTANTLY

   

1

I have memory loss.

0

1

2

3

4

   

2

My joints hurt (fingers, wrists, elbows, feet, ankles, knees).

0

1

2

3

4

   

3

I'm feeling drained and I have a hard time handling stress.

0

1

2

3

4

   

4

I don’t see colors as brightly as before.

0

1

2

3

4

   

5

I have lost interest in art; I don't aprreciate art as much anymore.

0

1

2

3

4

   

6

I don't have much hair under my arms or in the pubic area.

0

1

2

3

4

   
 

(0= plenty of hair/ 4= hairless)

             

7

My muscles are flabby.

0

1

2

3

4

   

8

I have abundant, light -colored urine during the day.

0

1

2

3

4

   

9

I have low blood pressure.

0

1

2

3

4

   

10

I crave salty food.

0

1

2

3

4

   
                 
 

Add up your Overal Score________:
Overall total is 10 or less is satisfactory level. Between 11-20: Possible Pregnenolone deficiency.
21 or more: Probable Pregnenolone deficiency.

             
 

 

             
                 
MELATONIN                
 

SIGNS & SYMPTOMS

NEVER

SOMETIMES

REGULARLY

OFTEN

CONSTANTLY

   

1

I look older than I am.

0

1

2

3

4

   

2

I have trouble falling asleep in at night.

0

1

2

3

4

   

3

I wake up during the night…

0

1

2

3

4

   

4

And I can't get back to sleep.

0

1

2

3

4

   

5

My mind is busy with anxious thoughts while I'm trying to fall asleep.

0

1

2

3

4

   

6

My feet are too hot at night

0

1

2

3

4

   

7

When I get up, I don't feel rested.

0

1

2

3

4

   

8

I feel like I'm living out of sync with the world, going to bed late, and

0

1

2

3

4

   
 

waking up late.

             

9

I can't tolerate jet lag.

0

1

2

3

4

   

10

I smoke, drink, and/or use a beta-blocker or a sleep aid

0

1

2

3

4

   
 

Add up your Overal Score________:
Overall total is 10 or less is satisfactory level. Between 11-20: Possible Melatonin deficiency.
21 or more: Probable Melatonin deficiency.

             
 

 

             
                 
FACE AND SKIN                
 

SIGNS & SYMPTOMS

NEVER

SOMETIMES

REGULARLY

OFTEN

CONSTANTLY

   

1

My face has fine lines at the side of the eyes.

0

1

2

3

4

   

2

I have a thick line from my nose to my mouth.

0

1

2

3

4

   

3

I have eczema, psoriasis, or other rashes.

0

1

2

3

4

   

4

I have a furrow between my eye brows.

0

1

2

3

4

   

5

I have lines on my forhead.

0

1

2

3

4

   

6

I have rosacea (redness on the nose and cheeks).

0

1

2

3

4

   

7

The skin is thin on the back of the hand.

0

1

2

3

4

   

8

My skin looks thicker on my face.

0

1

2

3

4

   

9

I have smile lines at the side of my mouth.

0

1

2

3

4

   

10

I have dark circles under my eyes.

0

1

2

3

4

   
                 
 

Add up your Overal Score________: Overall total is 10 or less is satisfactory level. Between 11-20: Possible sun damage and aging 21 or more: Probable sun damage and aging.  Your doctor can prescribe anti-oxidant creams that can reduce the aging lines on the face. Anti-oxidant creams will also repair the damage from the sun.

             
 

 

             
 

 

             
PART II -- CIRCLE THE ANSWERS TO THE AILMENTS AND DISCUSS THEM WITH YOUR PHYSICIAN.                
 

ENERGY

             

1

Do you have a hard time getting up in the morning?

   

YES

NO

     

2

Do you always feel tired or tired in the afternoon?

   

YES

NO

     
 

SEX

             

1

Do you lack sexual desire?

   

YES

NO

     

2

Does your penis or clitoris seem less sensitive?

   

YES

NO

     

3

Are your erections not firm enough?

   

YES

NO

     

4

Have you lost your attraction toward your partner?

   

YES

NO

     

5

Do you lack vaginal lubrication?

   

YES

NO

     
 

SLEEP

             

1

Do you sleep poorly?

   

YES

NO

     

2

Do you rarely dream?

   

YES

NO

     
 

MEMORY

             

1

Do you suffer from short-or-long-term memory loss?

   

YES

NO

     

2

do you have trouble concentrating?

   

YES

NO

     
 

SKIN AND HAIR

             

1

Do you have wrinkles on you face along the nose, smile lines, and forehead creases?

   

YES

NO

     

2

Do you have little wrinkles around the eyes and crows feet?

   

YES

NO

     

3

Do you have age spots?

   

YES

NO

     

4

Do you have dry, thin skin?

   

YES

NO

     

5

Are you losing your hair or is it turning gray?

   

YES

NO

     
 

WEIGHT CONTROL

             

1

Is your abdomen too plump? Is it distended?

   

YES

NO

     

2

Women: Are your breasts too large? Do they get larger before your period?

   

YES

NO

     

3

Are your buttocks and thighs too well padded? Are you pear-shaped?

   

YES

NO

     
 

STRESS AND MOODS

             

1

Do you suffer from constant fatigue?

   

YES

NO

     

2

Do you have high blood pressure?

   

YES

NO

     

3

Are you anxious, nervous, or irritable?

   

YES

NO

     

4

Do small things set you off?

   

YES

NO

     

5

Are you depressed?

   

YES

NO

     
 

JOINTS AND BONES

             

1

Do you have arthritis?

   

YES

NO

     

2

Do you have osteoarthritis in the hip?

   

YES

NO

     

3

Do you have fibromyalgia (feverish aching muscles and fatigue)?

   

YES

NO

     

4

Have you lost muscle mass, tone, and strength?

   

YES

NO

     

5

Do you have bone loss of the spine, hips, hands, wrists, and/or feet?

   

YES

NO

     
Source: theantiagingdoctor.com