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Low Testosterone
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Intro
Medical
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What is your name ?
Are you currently using testosterone replacement therapy?
Yes
No
Who first started you on testosterone treatment?
My GP
A specific doctor
Other
When did you start using testosterone treatment?
More than a year
Less than a year
When did you last see your doctor about your testosterone treatment?
More than a year
Less than a year
Have you experienced any side effects from your treatment?
Yes
No
Please provide more details
Have you ever had any type of cancer?
Yes
No
Please provide more details
Do you have, or have you ever had any of the following:
a heart condition, including heart failure or a heart attack
high blood pressure
a liver condition
too many red blood cells
none of the above
Do you have any other health conditions?
Yes
No
Please provide more details
Do you plan on having children in the future
Yes
No
Please provide more details
What is your age ?
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