For Men

Use each of the following checklists to determine your patients’ symptoms of hormone imbalance and to help you choose the appropriate hormone test profile.

Category 1:  Basic Hormone Imbalance

Mark which of the following symptoms are troublesome and/or persist over time.

 Burned out feeling	 Night sweats	 Insomnia	 Decreased urine flow
 Hot flashes	 Irritable	 Increased urinary urge	 Decreased stamina
 Weight gain waist	 Erectile dysfunction	 Infertility problems	 Sleep disturbances
 Decreased libido	 Prostrate problems	 Oily Skin	 Decreased muscle mass
 Decreased erections	 Decreased mental sharpness	 Sleep disturbances

Number selected: ____

Category 2:  Adrenal Hormone Imbalance 

Mark which of the following symptoms are troublesome and/or persist over time.

 Aches and pains	 Elevated triglycerides	 Morning fatigue	 Susceptibility to infections
 Sleep disturbances	 Depression	 Anxiety	 Bone loss
 Infertility	 Lack of motivation	 Allergic conditions	 Blood sugar imbalance
 Lack of motivation	 Prostrate problems	 Weight gain waist	 Autoimmune illness
 Chronic illness	 Evening fatigue	 Decreased erections	 Fibromyalgia
 Stress

Number selected: ____

Category 3: Thyroid Hormone Imbalance

Mark which of the following symptoms are troublesome and/or persist over time.

 Low libido	 Depression	 Cold body temperature	 Decreased erections
 Foggy thinking	 Infertility	 Headaches	 Sleep disturbances
 Constipation	 Fatigue	 Lack of motivation	 Inability to lose weight
 Elevated cholesterol

Number selected: ____

If your patient checked symptoms in MORE THAN ONE Category, this is an indication of hormone imbalance.
Good:  Male Hormone Profile I or II (blood spot)     Best:  Comprehensive Profile (Combination Kit)

If your patient checked symptoms ONLY in Category 1, this is an indication of hormone imbalance.
Good:  Male Hormone Profile I (blood spot)     Best:  Comprehensive Profile (Combination Kit)

If your patient checked symptoms ONLY in Category 2, this is an indication of hormone imbalance.
Good:  Male Hormone Profile II     Best:  Comprehensive Profile (Combination Kit)
 
If your patient checked symptoms ONLY in Category 3, this is an indication of hormone imbalance.
Good:  Complete Thyroid Profile (Blood Spot)     Best:  Comprehensive Profile (Combination Kit)