Wellness Assessment
-
Male
-
Female
Decline in your feeling of general well-being (general state of health, subjective feeling).
-
1None
-
2Mild
-
3Moderate
-
4Severe
-
5Extremely Severe
Joint pain and muscular ache (lower back pain, joint pain, pain in a limb, general back ache).
-
1None
-
2Mild
-
3Moderate
-
4Severe
-
5Extremely Severe
Excessive sweating (unexpected/sudden episodes of sweating, hot flushes independent of strain).
-
1None
-
2Mild
-
3Moderate
-
4Severe
-
5Extremely Severe
Sleep problems (difficulty in falling asleep, difficulty in sleeping through, waking up early and feeling tired, poor sleep, sleeplessness).
-
1None
-
2Mild
-
3Moderate
-
4Severe
-
5Extremely Severe
Increased need for sleep, often feeling tired.
-
1None
-
2Mild
-
3Moderate
-
4Severe
-
5Extremely Severe
Irritability (feeling aggressive, easily upset about little things, moody).
-
1None
-
2Mild
-
3Moderate
-
4Severe
-
5Extremely Severe
Nervousness (inner tension, restlessness, feeling fidgety).
-
1None
-
2Mild
-
3Moderate
-
4Severe
-
5Extremely Severe
Anxiety (feeling panicky).
-
1None
-
2Mild
-
3Moderate
-
4Severe
-
5Extremely Severe
Physical exhaustion / lacking vitality (general decrease in performance, reduced activity, lacking interest in leisure activities, feeling of getting less done, of achieving less, of having to force oneself to undertake activities).
-
1None
-
2Mild
-
3Moderate
-
4Severe
-
5Extremely Severe
Decrease in muscular strength (feeling of weakness).
-
1None
-
2Mild
-
3Moderate
-
4Severe
-
5Extremely Severe
Depressive mood (feeling down, sad, on the verge of tears, lack of drive, mood swings, feeling nothing is of any use).
-
1None
-
2Mild
-
3Moderate
-
4Severe
-
5Extremely Severe
Feeling that you have passed your peak.
-
1None
-
2Mild
-
3Moderate
-
4Severe
-
5Extremely Severe
Feeling burnt out, having hit rock-bottom.
-
1None
-
2Mild
-
3Moderate
-
4Severe
-
5Extremely Severe
Decrease in beard growth.
-
1None
-
2Mild
-
3Moderate
-
4Severe
-
5Extremely Severe
Decrease in ability/frequency to perform sexually.
-
1None
-
2Mild
-
3Moderate
-
4Severe
-
5Extremely Severe
Decrease in the number of morning erections.
-
1None
-
2Mild
-
3Moderate
-
4Severe
-
5Extremely Severe
Decrease in sexual desire/libido (lacking pleasure in sex, lacking desire for sexual intercourse).
-
1None
-
2Mild
-
3Moderate
-
4Severe
-
5Extremely Severe
Heart beating quickly and strongly.
-
1None
-
2Mild
-
3Moderate
-
4Severe
feeling tense or nervous.
-
1None
-
2Mild
-
3Moderate
-
4Severe
difficulty in sleeping.
-
1None
-
2Mild
-
3Moderate
-
4Severe
excitable.
-
1None
-
2Mild
-
3Moderate
-
4Severe
attacks of panic.
-
1None
-
2Mild
-
3Moderate
-
4Severe
difficulty in concentrating.
-
1None
-
2Mild
-
3Moderate
-
4Severe
feeling tired or lacking.
-
1None
-
2Mild
-
3Moderate
-
4Severe
loss of interest in most things.
-
1None
-
2Mild
-
3Moderate
-
4Severe
feeling unhappy or depressed.
-
1None
-
2Mild
-
3Moderate
-
4Severe
crying spells.
-
1None
-
2Mild
-
3Moderate
-
4Severe
irritability.
-
1None
-
2Mild
-
3Moderate
-
4Severe
feeling dizzy or faint.
-
1None
-
2Mild
-
3Moderate
-
4Severe
pressure or tightness in head or body.
-
1None
-
2Mild
-
3Moderate
-
4Severe
parts of body feeling numb or tingling.
-
1None
-
2Mild
-
3Moderate
-
4Severe
headaches.
-
1None
-
2Mild
-
3Moderate
-
4Severe
muscle or joint pains.
-
1None
-
2Mild
-
3Moderate
-
4Severe
loss of feeling in hands or feet.
-
1None
-
2Mild
-
3Moderate
-
4Severe
breathing difficulties.
-
1None
-
2Mild
-
3Moderate
-
4Severe
hot flashes.
-
1None
-
2Mild
-
3Moderate
-
4Severe
sweating at night.
-
1None
-
2Mild
-
3Moderate
-
4Severe
loss of interest in sex.
-
1None
-
2Mild
-
3Moderate
-
4Severe
vaginal dryness.
-
1None
-
2Mild
-
3Moderate
-
4Severe
anxiety.
-
1None
-
2Mild
-
3Moderate
-
4Severe
mood swings.
-
1None
-
2Mild
-
3Moderate
-
4Severe
weight gain.
-
1None
-
2Mild
-
3Moderate
-
4Severe
apathy.
-
1None
-
2Mild
-
3Moderate
-
4Severe
thinning nails.
-
1None
-
2Mild
-
3Moderate
-
4Severe
thinning skin.
-
1None
-
2Mild
-
3Moderate
-
4Severe
dry skin.
-
1None
-
2Mild
-
3Moderate
-
4Severe
breast tenderness.
-
1None
-
2Mild
-
3Moderate
-
4Severe
1 of 17