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  • AMS Questionnaire

    Pre-Consultation Questionnaire
  • Are you currently taking any testosterone treatment?*

  • Testosterone Treatment

  • If you are taking an injectable testosterone, which one are you taking?
  • If you are taking a Testosterone Cream, which one are you taking?

  • AMS Questionnaire

  • This is a standardised international questionnairre called the Ageing Male Sympton Questionnaire.  It is used to determine the if you might have symptoms due to decreasing Testosterone levels.  Please indicate which of these symptoms apply to you AT THIS TIME:

  • Decline in your feeling of general well-being (general state of health, subjective feeling)
  • Joint Pain and Muscular Ache (lower back pain, joint pain, pain in a limb, general back ache)
  • Excessive Sweating (unexpected/sudden episodes of sweating, hot flushes independant of strain)
  • Sleep problems (Difficulty in falling as;eep, difficulty in sleeping through, waking up and feeling tired, poor sleep, sleeplessness)
  • Increased need for sleep or often feeling tired
  • Irritability (feeling aggressive, easily upset about little things, moody)
  • Nervousness (inner tension, restlessness, feeling fidgety)
  • Anxiety (feeling panicky)
  • Physical exhaustion/lacking vitality (general decrease in performance, reduced activity, lacking interest in leasure activities, feeling of getting less done, of achieving less, of having to force oneself to undertake activities)
  • Decrease in muscular strength (feeling of weakness)
  • Depressive mood (feeling down, sad, on the verge of tears, lack of drive, mood swings, feeling nothing is of any use)
  • Feeling that you have passed your peak
  • Feeling burnt out, having hit rock bottom
  • Decrease in beard growth
  • Decrease in ability/frequency to perform sexually
  • Decrease in the number of morning erections
  • Decrease in sexual desire/libido (lacking pleasure in sex, lacking desire for sexual intercourse)
  • Please go back to these seventeen questions and add up your score for all of them.
  • Please indicate your score here:*
  • Should be Empty: