Hormone Therapy Assessment for Women

Biote Health Assessment for Women

Which of the following symptoms apply to you currently (in the last 2 weeks)? Please mark the appropriate box for each symptom. For symptoms that do not currently apply or no longer apply, mark "never."
Name(Required)
Hot flashes
Sweating (night sweats or excessive sweating)
Sleep problems (difficulty falling asleep, sleeping through the night or waking up too early)
Depressive mood (feeling down, sad, on the very of tears, lack of drive)
Irritability (mood swings, feeling aggressive, angers easily)
Anxiety (inner restlessness, feeling panicky, feeling nervous, inner tension)
Physical exhaustion (general decrease in muscle strength or endurance, decrease in work performance, fatigue, lack of energy, stamina or motivation)
Sexual problems (change in sexual desire, in sexual activity and/or orgasm and satisfaction)
Bladder problems (difficulty in urinating, increased need to urinate, incontinence)
Vaginal symptoms (sensation of dryness or burning in vagina, difficulty with sexual intercourse)
Joint and muscular symptoms (joint pain or swelling, muscle weakness, poor recovery after exercise)
Difficulties with memory
Problems with thinking, concentrating or reasoning
Difficulty learning new things
Trouble thinking of the right word to describe persons, places or things when speaking
Increase in frequency or intensity of headaches/migraines
Hair loss, thinning or change in texture of hair
Feel cold all the time or have cold hands or feet
Weight gain or difficulty losing weight despite diet and exercise
Dry or wrinkled skin