Let’s start with your symptoms.

Fatigue

Mood changes (such as irritability, anxiety, nervousness, depression)

Decreased Mental Ability (such as Memory Loss, Confusion, Loss of Focus)

Excessive Sweating

Hot Flashes / Night Sweats

Weight Gain (Bloating, Excessive Belly Fat, Inability to Lose Weight)

Decreased Sex Drive (No Morning Erections, Vaginal Dryness)

Sleep Problems (Trouble Falling or Staying Asleep)

Decreased Muscle Strength

Cold Hands & Feet / Always Cold

Hair Loss / Breakage

Joint Pain / Muscle Aches

Dry, Wrinkled Skin

What about family history?

Please select which, if any, of the following conditions are in your family medical history.

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First Name Last Name

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