Low T Assessment V2 - Thrive Men's Clinic

1. How satisfied are you with your physical ability?

My ability to exercise and play sports has deteriorated

I look, feel and exercise like a modern day Spartacus

My ability to exercise and play sports has NOT deteriorated

2. Has there been a recent deterioration in (choose all that apply):

Your work performance

Your overall “enjoyment of life”

3. Describe your libido (sex drive).

I almost never think about or initiate sex

My sex drive has decreased. It's not like it used to be

My libido is as good as ever

4. Describe your energy level.

I often feel fatigued and unmotivated

I don’t have as much energy I used to have

I am full of energy most of the time

5. Did you notice a decrease in strength or endurance?

Yes

No

6. Your erections are:

Less strong now

As good and satisfying as ever

I suffer from erectile dysfunction

7. Have you noticed that you (choose all that apply):

Lost height

Fall asleep after dinner

Feel more sad or grumpy than usual

8. Have you ever been diagnosed with prostate cancer?

Yes

No

Email Address

First Name

Last Name

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