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HORMONE, THYROID & ADRENALS FOR MEN

Do you have or experience any of the following?

Does Not Apply

Fatigue?

Difficulty losing weight?

Difficulty thinking?

Depressed moods?

Less than one bowel movement per day?

Fluid retention?

Restless sleep or difficulty sleeping?

Afternoon fatigue?

Recurrent infections?

Thinning of your eyebrows or eyelashes?

Hoarse voice?

Body temperature below 98.6?

Decreased assertiveness?

Decline in self-confidence?

Difficulty making decisions?

Loss of muscle mass, strength and/or tone?

Decreased libido?

Chronic emotional or physical stress?

Feeling as though you might pass out when you rise quickly?

Elevated cholesterol?

Cold hands and feet?

Poor short term memory?

Hair loss?

Dry skin?

Recurrent headaches or migraine headaches?

Tired upon waking, even after a full night’s sleep?

Tingling or numbness in your hands and feet?

Muscle aches & joint pain?

Puffy, pasty or pale skin?

Low blood pressure?

Lack of drive or initiative?

Frequently irritable?

Difficulty setting goals?

Decreased stamina and endurance?

Increased body fat around your waist?

Decline in sexual ability?

Low pulse rate (less than 70 beats per minute with no exercise)?

(Check all that apply)

HORMONE, THYROID & ADRENALS FOR WOMEN

Do you have or experience any of the following?

Does Not Apply

Fatigue?

Difficulty thinking?

Less than one bowel movement per day?

Restless sleep or difficulty sleeping?

Problems with infertility or miscarriage?

Puffy, pasty or pale skin?

Premenstrual mood swings, fluid retention or weight gain?

Decreased libido?

Chronic emotion or physical stress?

Elevated cholesterol?

Poor short term memory?

Dry skin?

Tired upon waking, even after a full night's sleep?

Recurrent infections?

Hoarse voice?

Migraine headaches?

Low pulse rate (less than 70 beats per minute with no exercise)?

Difficulty losing weight?

Depressed moods?

Fluid retention?

Afternoon fatigue?

Muscle aches and joint pain?

Low blood pressure?

Irregular menstrual cycles?

Hot flashes or night sweats?

Feeling as though you might pass out when you rise quickly?

Cold hands and feet?

Hair loss?

Recurrent headaches or migraine headaches?

Tingling or numbness in your hands and feet?

Thinning of your eyebrows or eyelashes?

Body temperature below 98.6?

Uterine fibroids, fibocystic breast disease or endometriosis?

Ceased periods?

(Check all that apply)

DO YOU HAVE CANDIDA OR YEAST OVERGROWTH?

Do you have or experience any of the following?

Does Not Apply

Fatigue?

Abdominal bloating, cramping or gas?

Depressed moods?

Fungal infections under your toenails or fingernails?

Feeling lethargic?

Indigestion or heartburn?

Difficulty concentrating?

Rectal itching?

Muscle aches and/or joint pain?

Recurrent yeast infections?

Athlete's foot?

Recurrent respiratory infections?

Use of antibiotics multiple times in your life?

Cravings for sugar and bread products?

Skin rashes or hives?

Allergy symptoms?

Abnormal bodily reactions to wine, beer or alcoholic beverages, such as flushing, headache, sinus congestion or itchy skin?

(Check all that apply)

DO YOU SUFFER FROM ALLERGIES?

Do you have or experience any of the following?

Does Not Apply

Fatigue?

Eyes that itch, water, get red or swell?

Indigestion, bloating, diarrhea or constipation?

Reactions when coming into contact with dust?

Recurrent yeast infections, jock itch, athlete's foot or fungus under your toenails?

Frequent colds?

Recurrent ear infections?

Symptoms that worsen during a particular seasons, such as spring or fall?

Symptoms that worsen around animals?

Symptoms after drinking or eating certain foods?

Crease across the bridge of your nose?

Sneezing, post nasal drainage or itching of the nose?

Asthma, wheezing, tightness in the chest or chronic cough?

Symptoms that change when going indoors or outdoors?

Relatives with allergies?

Dark circles under your eyes?

Frequent headaches?

Sinus infections at least once per year?

Skin problems, such as eczema, skin rashes, itching or hives?

Awakening in the middle of the night with congestion?

Mood swings or feeling depressed for no reason?

Feeling stimulated, hyperactive or fatigued after meals?

(Check all that apply)

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Houston doctors specializing in holistic medicine including bioidentical hormones, hypothyroidism, adrenal fatigue, menopause, perimenopause, low testosterone, allergies, candida, detoxification and nutritional deficiencies.

20214 Braidwood Dr., Houston, TX 77450 | 281.698.8698

© Braidwood Management, Inc. All Rights Reserved. The information on this website is provided for educational purposes only, and does not constitute any medical advice. By using this website you fully waive all legal claims based on any information contained herein, and fully agree to this disclaimer.

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