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Hormone Deficiency Questionnaire

Hormone Deficiency Test

The following questionnaire is designed to assess your hormonal health.

Think about each question in detail. Don’t take too long on each question but don’t rush it either.

Hormone Deficiency Questionnaire:

Signs & Symptoms Never Sometimes Regularly Often Constantly
My hair is thinning. 0 1 2 3 4

My cheeks sag.

 0 1 2 3 4
My gums are receding. 0 1 2 3 4
My abdomen is flabby.  I’ve got a “spare tire.” 0 1 2 3 4
My muscles are slack. 0 1 2 3 4
My skin is thin and/or dry. 0 1 2 3 4
It’s hard to recover after physical activity. 0 1 2 3 4
I feel exhausted. 0 1 2 3 4
I don’t like the world.  I tend to isolate myself. 0 1 2 3 4
I feel continuously anxious and worried. 0 1 2 3 4

Add up your overall score: _____

Overall total is 10 or less: Satisfactory Level

Between 11 and 20: Possible growth hormone deficiency

21 or more: Possible growth hormone deficiency.


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