Questionnaires
Hormone Imbalance Questionnaire
Gender selection:
Test Results:
Inflamation (warning score >12)
Sagging, thinning skin or wrinkling
Spider veins or varicose veins
Cellulite
Eczema, skin rashes, hives or acne
PMS
Fibrocystic breast disease
Menopause
Andropause
Heart desease
Prostate enlargement
Fatugue
High cholesterol or blood pressure
Poor tolerance to exercise
Lack of excercise
Heart palpitations
Loss of muscle tone in arms and legs; dificulty building or maintaining muscle
Aches and pains
Arthritis, bursitis, tendonitis or joint stiffnes
Water retention in hands or feet
Gout
Alzheimer's disease
Parkinson's disease
Depression
Night eating syndrome (walking at night to binge eat)
Fibromyalgia
Increased pain or poor pain tolerance
Headaches or migraines
High alchohol consumption
Bronchitis; allergies (food or environmental); hives or astma have worsened or developed
Autoimmune disease
Fat gain around "love handles" or abdomen
Loss of bone density or osteoporosis
Generalized overweight, weight gain, obesity
Fatty liver (diagnosed by doctor)
Diabetes (type 2)
Sleep disruptions or deprivations
Irritable bowel or inflamatory bowel disease
Frequent gas and bloating
Constipaton, diahrea or nausea
Excess Insulin (warning score >10)
Age spots and wrinkling
Sagging skin
Cellulite
Skin tags
Acanthosis nigricans (light brown and black patches or markings on neck or under arm)
Abnormal hair growth on face and chin
Vision changes or cataracts
Infertility or irregular menses
Shrinking or sagging breasts
Menopause
Andropause or erectile dysfunction
Heart disease
Fatigue
High cholesterol, high triglycerides or high blood pressure
Lack of excercise
Burning feet at night (expecially while in bed)
Water retention in the face (puffiness)
Gout
Poor memory, concentration or Alzheimer's disease
Loss of libido
Fat gain arround love handles and/or abdomen
Fat over the triceps
Generalized overweight, weight gain, obesity
Hypoglycemia; craving for sweets, carbohydrates or constant hunger or increased appetite
Fatigue after eating (expecially carbohydrates)
Fatty liver (diagnosed by doctor)
Diabetes type 2
Sleep disruption or deprivation
Low Dopamine (warning score >4)
Fatigue, especially in the morning
Poor tolerance for excersize
Lack of exercise
Restless leg syndrome
Poor memory
Parkinson's disease
Depression
Loss of libido
Feeling a strong need for stimulation or excitement (foods, gambling, partying, sex, etc.)
Addictive eating or binge eating
Genearlized overweight, weight gain, obesity
Craving for sweets, carbohydritates, junk food or fast food
Low Serotonin (warning score >8)
PMS characterized by hypoglycemia, sugar cravings and/or depression
Fatigue
Feeling wired at hight
Lack of sweating
Poor memory
Loss of libido
Depression, anxiety, irritability, seasonal affective disorder
Loss of motivation or competitive edge
Low self-esteem
Inability to make decisions
Obsessive compulsive disorder
Bulimia or binge eating
Fibromialgia
Increased pain or poor pain tolerance
Headaches or migranes
High alchohol consumption
Generalized overweight, weight gain, obesity
Craving for sweets or carbohydrates
Constant hunger or increased appetite
Failure to sleep in pitch black
Inability to sleep in no matter how late going to bed
Less that 7.5 hours of sleep per night
Irritable bowel
Constipation
Nausea
Use of corticosteroids
Low GABA (warning score >3)
PMS characterised by breast tenderness, water retention, bloating, anxiety, sleep disruptions or headaches
Feeling wired at night
Aches and pains or increased muscle tension
Irritability, tension or anxiety
Difficulty falling asleep or staying asleep
Less than 7.5 hours of sleep per night
Irritable bowel
Frequent gas and bloating
Excess Cortisol (warning score >10)
Wrinkling, thinning skin or skin has lost its fullness
Acne
Hair loss
PMS
Infertility or absent menses (unrelated to menopause)
Feeling wired at night
High cholesterol or blood pressure
Lack of exercise
Heart palpitations
Loss of miscle tone in arms and legs
Cold hands or feet
Water retention in face/puffiness
Poor memory or concentration
Loss of libido
Depression, anxiety, irritability or seasonal affective disorder
Low self esteem
High alchohol consumption
Frequent colds and flus
Hives, bronchitis, allergies (food or environmental)astma, auto-immune disease
Fat gain around "love handles" or abdomen
A "buffalo hump" or fat on back of neck/upper back
Difficulty building or maintaining muscle
Loss of bone density or osteoporosis
Cravings for sweets or carbs, hypoglycemia or constant hunger
Diffuculty falling asleep in pitch black
Difficulty staying asleep (especially waking between 2 - 4am)
Less than 7.5 hours of sleep per night
Irritable bowel or frequent gas and bloating
Use of corticosteroids
Low DHEA (warning score >7)
Dry skin
Heart disease
Erectile disfunction
Andropause
Fatigue
Feeling wired at night
Poor tolerance for exercise
Lack of exercise
Loss of muscle tone in arms and legs
Poor memory or concentration
Irritability or easily agitated
Loss of libido
Depression
Loss of motivation or competitive edge
Autoimmune disease
Fat gain around "love handles"
Fat gain over triceps
Fat gain around abdomen
Difficulty building or maintaining muscle
Difficlty staying asleep (especially waking between 2 - 4am)
Use of corticosteroids
Excess Estrogen (warning score >6)
Spider veins
Varicose veins
Cellulite
Heavy menstrual bleeding
PMS charaterised by breast tenderness, water retention, bloating, swelling and/or weight gain
Fibrocystic breast disease
Prostate enlargment
Erectile disfunction
Breast growth
Loss of morning erection
Irritability, mood swings, anxiety
Headaches or migranes
High alchohol consumption (>4drink per week for women, >7 drinks per week for men)
Autoimmune disease
Fat gain around "love handles" or abdomen (men)
Fat gain at hips (women)
Current use of hormone replacement therapy or birth control pills
Low Estrogen (warning score >8)
Dry or sagging skin
Thinning skin or skin has lost its fullness
Hair loss
Dry eyes or cataracts
PMS characterised by depression, hypoglycemia, sugar/sweets cravings
Infertility or absent menses (not related to menopause)
Painful intercourse and/or vaginal dryness
Shrinking or sagging breasts
Urinary incontience (stress or otherwise)
Menopause
Fatigue
Hot flashes
High cholesterol or blood pressure
Poor memory or concentration
Irritability
Loss of libido
Depression or mood swings
Headaches or migranes
Fat gain around "love handles" or abdomen (menopausal women)
Loss of bone density or osteporosis
Cravings for sweets or carbohydrates
Difficulty falling or stying asleep
Low Progesterone (warning score >6)
Dry skin or sin that has lost its fullness
Spider or varicose veins
Hair loss
Short menstrual cycle(<28 days)
PMS characterised by breast tenderness, anxiety, sleep disruptions, headaches, menstrual spotting, water retention, bloating amd/or weight gain
Infertility or absent menses (not related to menopause)
Fybrocyctic breast disease
Menopause (women), andropause (men)
Prostate enlargment
Hot flashes
Lack of sweating
Feeling cold and/or cold hands/feet
Heart palpitations
Water retention
Irritability and/or anxiety
Loss of libido
Headaches or migranes
Autoimmune disease, hives, astma, allergies
Loss of bone density or osteporosis
Difficulty falling or staying asleep
Excess Progesterone (warning score >4)
Acne
PMS characteised by depression
Infertility
Water retention
Depression
Headaches or migranes
Frequent colds and flus
Weight gain or difficulty loosing weight
Current use of hormone replacement therapy or birth control pills
Low Testosterone (warning score >8)
Dry skin
Thinning skin or skin has lost its fullness
Painful intercoarse
Heart disease men)
Erectile disfunction
Andropause
Loss or morning erection
Fatigue
Poor tolerance for exercise
Lack of exercise
Heart palpitations
Loss of muscle tone in arms and legs
Poor memory or concentration
Loss of libido
Depression or anxiety
Loss of motivation or competitive edge
Low self-esteem
Difficulty making decisions
Headaches or migranes (men)
Gaing fat around abdomen or "love handles"
Difficulty building or maintaining muscle
Loss of bone density or osteoporosis
Sleep apnea (men)
Use of corticosteroids
Excess Testosterone (warning score >5)
Acne
Acanthosis nigricans (women)
Hair loss
Abnormal hair growth on face (women)
Infertility
Shrinking or sagging breasts
Prostate enlargement
Irritability, aggression, easily agitated
Headaches or migranes (women)
Fat gain at abdomen(women)
Generalized overweight/weight gain/obesity (women)
Cravings for sweets or carbohydrates (women)
Constant hunger or increased apetite (women)
Fatty liver (women)
Low Thyroid (warning score >8)
Dry skin and/or hair
Acne
Hair loss
Brittle hair and/or nails
PMS, infertility, long menstrual cycle (>30 days) or irregular periods
Fibrocystic breast disease
Abnormal lactation
Fatigue
Lack of sweating, feeling cold, cold hands/feet
High cholesterol
Poor tolerance for exercise
Heart palpitations
Outer edge of eyebrows thinning
Aches and pains
Water retention/puffines in hands or feet
Poor memory
Loss of libido
Depression
Loss of motivation or competitive edge
Iron deficiency anemia
Hives
Generalized overweight, weight gain, obesity
Constipation
Use of corticosteroids
Currrent use of synthetic hormone replacement therapy or birth control pills
Low Acetylcholine (warning score >3)
Fatigue
Poortolerance for exercise
Loss of muscle tone in arms and legs or poor muscle function/strenght
Poor memory or concentration, decrease in memory or recall
Alzheimer's disease
Difficulty building or maintaing muscle
Difficulty falling asleep or staying asleep, disturbed sleep pattern
Irritable bowel
Constipation
Low Melatonin (warning score >4)
Andropause (men), menopause (women)
Fatigue
Night eating syndrome
High alchohol consumption
Frequent colds and flus
Cravings for sweets or carbohydrates, increased appetite
Difficulty falling asleep (especially waking between 2 - 4am)
Sleep apnea
Less than 7.5 hours of sleep per night
Use of corticosteroids
Low Growth Hormone (warning score >6)
Dry skin
Thinning skin or skin has lost its fullness
Sagging skin
Menopause (women), Andropause (men)
Fatigue
Poor tolerance for exercise
Lack of exercise
Loss of muscle tone in arms and legs
High alchohol consumption
Fat gain around "love handles" or abdomen
Difficulty building or maintaing muscle
Loss of bone density or osteoporosis
Generalized overweight, weight gain, obesity
Failing to sleep in total darkness
Difficulty falling asleep (especially waking between 2 - 4am)
Sleep apnea
Use of corticosteroids