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Hormone questionnaire

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After attending many lectures I have amassed some symptom profiles to be a

guideline to fine tune which hormone tests would be beneficial to order to get

the actual picture of what is going on inside.

 

Just because you have many of these symptoms does not mean you automatically

need to supplement with the hormone listed. It is only a guide to weed out

unnecessary tests and help save you some money.

Many of the hormone imbalances can have similar symptoms. Also when one goes

out of whack normally other hormone levels are then affected which then

produce symptoms that correcting the original imbalance would correct without

taking

more hormones.

 

I use this in my practice as a guideline for needed tests

the square boxes got changed into? marks

 

Hormone Balance Questionnaire

Thyroid Deficiency

? Cold Body Temp ? Cold Hands & Feet ? Tired

? Hair Loss ? Hair Dry/Brittle ? Brittle Nails ? Thinning Skin

? Bone Loss ? Aches/Pains ? Weight Gain ? Can't Lose Weight

 

? Low Libido ? Infertility ? Thick Tongue ? Face Swollen puffy

eyes

? Heart Palpitations ? Low Blood Pressure ? Slow Pulse ? Slowed

Reflexes

? Slow Ankle Reflex ? Constipation ? Sleep Disturbed ? Decreased

Sweating

? Memory Lapses ? Forgetful ? Mood Changes ? Difficult

Concentration

? High Cholesterol ? Sad/Depressed ? Decreased Muscle Mass

 

Thyroid Excess

? Insomnia ? Difficult Falling Asleep ? Unusual Swelling ? Always Feeling Hot

 

? Bulging Eyes ? Erratic Behavior ? Irritable ? Nervous ? Panic Attacks

? Decreased Concentration ? Short Attention Span ? Rapid Heart Rate ? Goiter

? Finger Tremors

 

Estrogen Deficiency

? Memory Lapses ? Night Sweats ? Incontinence ? Heart Palpitations ?

Tearful/Depressed ? Vaginal Dryness ? Bone Loss ? Foggy Thinking ? Hot

Flashes

? Sleep Disturbances

 

Estrogen Excess

? Mood Swings ? Tender Breasts ? Water Retention ? Nervous ? Irritable ?

Anxious ? Uterine Fibroids ? Fibrocystic Breasts ? Weight Gain in Hips ?

Bleeding

Changes ? Headaches

 

Progesterone Deficiency

? Night Sweats ? Hot Flashes ? Vaginal Dryness ? Foggy Thinking ? Tearful ?

Depressed ? Sleep Disturbances ? Heart Palpitations ? Bone Loss ? Memory

Lapses

 

Progesterone Excess

? Mild Depression ? Candida Infection ? Breast Swelling/Tenderness ?

Sleepiness

 

 

Androgens DHEA & Testosterone Deficiency

? Low Libido ? Vaginal Dryness ? Foggy Thinking ? Fatigue ? Aches Pains

? Memory Lapses ? Incontinence ? Depressed ? Sleep Disturbances

 

Androgen Excess

? Excessive Facial/Body Hair ? Loss of Scalp Hair ? Increased Acne ? Oily

Skin

 

Cortisol Deficiency

? Fatigue ? Heart Palpitations ? Aches/Pains ? Stress ? Arthritis ? Cold Body

Temp

? Sugar Cravings ? Allergies ? Chemical Sensitivities

 

Cortisol Excess

? Sleep Disturbances ? Bone Loss ? Thinning Skin ? Fatigue ? Weight Gain In

Waist

? Loss of Muscle Mass

 

Please note how many symptoms are in several categories.

 

Male Hormone Questionnaire Screens for excess deficiency signs for all

hormones

 

Using Symptoms to Determine Which Hormones to Test (For Men Only)

 

<FONT COLOR= " #000000 " BACK= " #ffffff " style= " BACKGROUND-COLOR: #fffffEach

hormone category is divided into hormone deficiency and hormone excess

symptoms, as each has a different subset of symptoms. On a piece of paper,

score the symptoms that apply to you as 0 (none), 1 (mild), 2 (moderate), or 3 

(severe). If you score higher than 10 in any hormone excess or deficiency

category it is probably worthwhile to do a Saliva Test for that hormone.

 

Prostate Survey:  A screen for benign prostate hypertrophy (BHP)

 Catch Prostate Problems Early!

 Do you suffer from any of the following?

* Increasingly frequent urges to urinate, especially at night?

* Lessening urinary volume and stream of flow?

* Generally greater difficulty and discomfort voiding?

* And, accompanying the above symptoms:

      Backache?

      Loss of libido?

      Feeling sexually impotent?

These are some of the common signs of prostate disorders. In men under 40,

these are usually related to prostatitis. In men over 50, usually benign

prostatic hypertrophy (BHP), but may well be prostatic cancer.

The recommended saliva tests is the DHEA Challenge Test,

 

If you are experiencing these symptoms, see your doctor. Prostatitis is an

inflammation of the prostate of non-specific origin. BHP will cause a positive

digital rectal exam (DRE), but the blood test called a PSA (for prostate

specific antigen) will be normal. High PSAs indicate prostate cancer. All men

over

50 should have regular prostate and rectal exams.

 

Estrogens (Estrone):

 

Estrogen Deficiency

Hot flashes __

Night sweats __

Foggy thinking __

Depressed__

Apathy__

Bone loss    __        

Total Points:____

 

Total Points > 8 suggests estrogen deficiency. Consider estradiol and

progesterone saliva test.

 

 

Estrogen Excess

 prostate disorders__

 Urinary problems  __

 High triglycerides __

 Nervous__

 Irritable __

 Anxious __

 Weight gain in hips__

 Gynecomastia__ 

 Headaches __

Total points: __

 

Total Points > 8 suggests estradiol excess. Consider a two hormone  (estrone

and testosterone) saliva tests  Stop all androgens (DHEA, Androstenes and

testosterone enhancers)

 

 

Progesterone

 

Progesterone Deficiency 

 Decreased libido __

 Prostate growths__

 Urinary difficulties __

 Sleep disturbances__

 Bone loss __

Total Score: ___

 

If your Total Score is greater than 5, consider a two hormone test

(testosterone/progesterone)

 

Androgens (DHEA and Testosterone)

 

Androgen Excess

More Anxious

Loss of scalp hair __

Increased acne __

Oily skin __

Increased aggression_

More Irritable__

Total Score__

 

If  Total = to or > 10 then excess androgens are indicated. DHEA, androstenes

should be avoided

 

Androgen Deficiency

Low libido __

Decreased erections__

Lessened mental sharpness __

Fatigue __

Aches/pains__

Memory lapses__

Urinary problems __

Depressed/burned out __

Sleep disturbances__

Bone loss __

Decreased muscle mass__

Thinning skin __

Total Score:__

 

If Total Score > 10 then DHEA, testosterone and perhaps progesterone and

estrogen should be tested via saliva testing. This is called a DCT or DHEA

Challenge test.

 

Cortisol:

 

Cortisol Deficiency

Sugar craving __

Allergies/chemical sensitivities __

Decreased concentration_

Stress __

Cold body temperature  (BMR)__

Heart palpitations __

Increased Aches/pains __

Worsening Arthritis

Total Score:__

 

If Total score is > 10, then adrenal exhaustion is suggested. An ASI or

Adrenal Stress Index salivary test would be highly recommended.

 

Cortisol Excess

Chronically Irritable, forgetful, and/or fatigued __

Sleep disturbances and /or depression __

Low libido, anxious, " wired but tired " __

Weight gain in waist, loss of muscle, __

Elevated triglycerides (>200)__

Thinning skin and/or bone loss  __

Total Score: __

 

If Total score > 8 then adrenal hyperactivity is indicated. An ASI or Adrenal

Stress Index saliva test would be highly recommended.

 

Tests for Women

 

Most women would do well to at least measure estradiol and progesteroneThe

DCT is the preferred recommended test, however. Taking a DHEA and testosterone

saliva measurement along with progesterone and estrogen is known as a DHEA

Challenge Test or DCT.

 

Women who still menstruate should test on the 19 th to 22 nd day of their

cycle.

If a female develops facial hair, acne, unusually strong sex drive, testing

DHEA and testosterone is indicated, as these are likely too high, often a sign

of dysglycemias, Syndrome X, or polycystic ovaries. DHEA and testosterone

precursors are to be avoided.

 

In peri- and post-menopausal women, if sex drive is too low, especially once

progesterone is optimized, low to low normal testosterone should be checked

for along w/ DHEA, a precursor to testosterone.

 

 Hope this helps someone.

 

Sunny

 

 

 

 

 

 

 

 

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Thanks for an excellent guideline to which tests may be needed. I'm

bookmarking it.

 

There are doctors who don't have this information spelled out this

logically and exactly.

 

A number of the symptoms listed also point to various Kidney

imbalance problems.

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