Hormone Imbalance Forms Men Symptom Checklist for MEN Use each of the following checklists to determine sign & symptoms of hormone imbalance and help you choose the appropriate profile Category 1: Basic Hormone Imbalance Mark which of the following factors/symptoms are present and/or persist over time. Burned out feelingHot flashesWeight gain waistDecreased libidoDecreased erectionsNight sweats IrritableErectile dysfunctionProstate problemsDecreased mental sharpnessApathy InsomniaIncreased urinary urgeInfertility problemsOily skin Decreased urine flowDecreased staminaSleep disturbanceDecreased muscle mass Category 2: Adrenal Hormone Imbalance Mark which of the following factors/symptoms are present and/or persist over time. Aches and painsSleep disturbancesChronic health problemsStress DepressionLack of motivationProstate ProblemsEvening fatigue Morning fatigueAnxietyWeight gain waistDecreased erectionsAllergies Bone lossLow blood sugarAutoimmune diseaseFibromyalgiaSusceptibility to infections Category 3: Thyroid Hormone Imbalance Mark which of the following factors/symptoms are present and/or persist over time. Low libidoFoggy thinkingConstipationElevated cholesterol DepressionInfertilityFatigueDry Skin Feeling ColdHeadachesLack of motivationHeart palpitations Decreased erectionsSleep disturbancesInability to lose weightBrittle nails Category 4: Cardiometabolic Risk Mark which of the following factors/symptoms are present and/or persist over time. History of smokingHigh blood sugarHigh blood pressureLow physical activity Weight gainSugar CravingsFatigueElevated triglycerides Heart disease or family history of heart diseaseDiabetes or family history of diabetesWaist size greater than 40 inches If you checked symptoms in all four categories, the suggested test profiles are: MINIMUM: Male Blood Profile II (Blood Spot) PREFERRED: Comprehensive Male Profile I or II(Saliva/Blood Spot) and CardioMetabolic Profile (Blood Spot) If you checked symptoms ONLY in Category 1, the suggested test profiles are: MINIMUM: Male Blood Profile I (Blood Spot) or Female/Male Saliva Profile I (Saliva) PREFERRED: Comprehensive Male Profile I or II(Saliva/Blood Spot) If you checked symptoms ONLY in Category 2, the suggested test profiles are: MINIMUM: Adrenal Stress Profile (Saliva) PREFERRED: Comprehensive Male Profile I or II(Saliva/Blood Spot) If you checked symptoms ONLY in Category 3, the suggested test profiles are: MINIMUM: Essential Thyroid Profile (Blood Spot) PREFERRED: Comprehensive Male Profile I or II(Saliva/Blood Spot) OR Female/Male Saliva Profile III plus Comprehensive Thyroid Profile(Blood Spot/Dried Urine) If you checked symptoms ONLY in Category 4, the suggested test profiles are: MINIMUM: CardioMetabolic Profile (Blood Spot) PREFERRED: CardioMetabolic Profile (Blood Spot) plus Female/Male Saliva Profile III(Saliva)
