Male Checklist Date Name Phone Number Email Address Declined In Well Being Declined In Well Being Never Mild Moderate Severe Fatigue Fatigue Never Mild Moderate Severe Joint Pain/Muscle Ache Joint Pain/Muscle Ache Never Mild Moderate Severe Excessive Sweating Excessive Sweating Never Mild Moderate Severe Increased Need For Sleep Increased Need For Sleep Never Mild Moderate Severe Sleep Problems Sleep Problems Never Mild Moderate Severe Irritability Irritability Never Mild Moderate Severe Nervousness Nervousness Never Mild Moderate Severe Anxiety Anxiety Never Mild Moderate Severe Depressed Mood Depressed Mood Never Mild Moderate Severe Exhaustion/Lacking Vitality Exhaustion/Lacking Vitality Never Mild Moderate Severe Declining Mental Ability/Focus/Concentration Declining Mental Ability/Focus/Concentration Never Mild Moderate Severe Feeling Like You Have Passed Your Peak Feeling Like You Have Passed Your Peak Never Mild Moderate Severe Feeling Burned Out/Hit Rock Bottom Feeling Burned Out/Hit Rock Bottom Never Mild Moderate Severe Decreased Muscle Strength Decreased Muscle Strength Never Mild Moderate Severe Weight Gain/Belly Fat/Inability to lose Weight Weight Gain/Belly Fat/Inability to lose Weight Never Mild Moderate Severe Breast Development Breast Development Never Mild Moderate Severe Shrinking Testicles Shrinking Testicles Never Mild Moderate Severe Rapid Hair Loss Rapid Hair Loss Never Mild Moderate Severe Decreased Beard Growth Decreased Beard Growth Never Mild Moderate Severe New Migraine Headaches New Migraine Headaches Never Mild Moderate Severe Decreased Sexual Desire/Libido Decreased Sexual Desire/Libido Never Mild Moderate Severe Decreased Morning Erections Decreased Morning Erections Never Mild Moderate Severe Decreased Ability To Preform Sexually Decreased Ability To Preform Sexually Never Mild Moderate Severe Infrequent Or Absent Ejaculations Infrequent Or Absent Ejaculations Never Mild Moderate Severe No Results From E.D. Medications No Results From E.D. Medications Never Mild Moderate Severe 2 + 14 = Submit