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Welcome to the Vital Life!
Take the Self test below.
This is designed to help you (and me) determine some of the areas of concern about your hormone levels. This test applies to men and women, though the estrogen and progesterone questions are for women (even though men have these hormones also).
Check the score at each line, then total the score at the bottom of each hormone. You may find it easier to print out the page. That way you can share this information with your doctor.
0 = never
1 = sometimes
2 = regularly
3 = often
4 = constantly
Growth Hormone
1 My hair is thinning _____
2 My cheeks sag _____
3 My gums are receding _____
4 My abdomen is flabby / I've got a "spare tire" _____
5 My muscles are slack _____
6 My skin is thick and/or dry _____
7 It's hard to recover after physical activity _____
8 I feel exhausted _____
9 I don't feel like the world, I tend to isolate myself _____
10 I feel continuously anxious and worried _____
Add up your overall score: _____
10 or less = satisfactory level
11-20 = possible growth hormone deficiency
21 or more = probably growth hormone deficiency
DHEA
1 My hair is dry _____
2 My skin and eyes are dry _____
3 My muscles are flabby _____
4 My belly is getting fat _____
5 I don't have much hair under my arm _____
6 I don't have much hair in my pubic area _____
(1=plenty of hair / 4=hairless
7 I don't have much fatty tissue in the pubic area _____
(0=padded / 4=flat)
8 My body doesn't have much of a special scent during
sex _____
9 I can't tolerate noise_____
10 My libido is low_____
Add up your overall score: _____
10 or less = satisfactory level
11-20 = possible DHEA deficiency
21 or more = probably DHEA deficiency
Cortisol
1 My face looks thinner _____
2 My friends call me skinny _____
3 I have eczema, psoriasis, or other rashes _____
4 My heart beats quickly _____
5 My blood pressure is low _____
6 I crave salt or sugar _____
7 I have digestive problems _____
8 I have allergies _____
9 I am stressed out _____
10 I am easily confused _____
Add up your overall score: _____
10 or less = satisfactory level
11-20 = possible cortisol deficiency
21 or more = probably cortisol deficiency
Testosterone
1 My face has gotten slack and more wrinkled _____
2 I've lost muscle tone _____
3 My belly tends to get fat _____
4 I'm constantly tired _____
5 I feel like making love less often than I used to _____
The rest of the questions are for men only
6 My breasts are getting fatty _____
7 I feel less self-confident and more hesitant _____
8 My sexual performance is poorer than it used to be _____
9 I have hot flashes and sweats _____
10 I tire easily with physical activity _____
For women: (questions 1-5)
Add up your overall score: _____
5 or less = satisfactory level
6-10 = possible testosterone deficiency
11 or more = probably testosterone deficiency
For men: (questions 1-10)
Add up your overall score: _____
10 or less = satisfactory level
11-20 = possible testosterone deficiency
21 or more = probably testosterone deficiency
Pregnenolone
1 I have memory loss _____
2 My joints hurt (fingers, elbows, ankles, knees) _____
3 I'm feeling a bit drained and it is hard to handle stress _____
4 I don't see colors as brightly as before _____
5 I have lost interest/appreciation for art _____
6 I don't have much hair under my arms or in my pubic
area ____ (0 = plenty of hair, 4 = hairless)
7 I feel more tired at rest than when I'm active _____
8 I have abundant light colored urine during the day _____
9 I have low blood pressure _____
10 I crave salty foods _____
Add up your overall score: _____
10 or less - satisfactory level
11-20 = possible pregnenolone deficiency
21 or more = probable pregnenolone deficiency
Melatonin
1 I look older than I am _____
2 I have trouble falling asleep at night _____
3 I wake up during the night _____
4 And I can't get back to sleep _____
5 I have anxious thoughts while trying to get to sleep _____
6 My feet are too hot at night _____
7 When I get up, I don't feel rested _____
8 I go to bed late and wake up late _____
9 I can't tolerate jet lag _____
10 I smoke, drink, use prescription sleep aids _____
Add up your overall score _____
10 or less = satisfactory level
11-20 = possible melatonin deficiency
21 or more = probable melatonin deficiency
Thyroid
1 I'm sensitive to cold _____
2 My hands and feet are always cold _____
3 In the morning, my face is puffy and my eyelids are
swollen ___
4 I put on weight easily _____
5 I have dry skin _____
6 I have trouble getting up in the morning _____
7 I feel more tired at rest than when I'm active _____
8 I am constipated _____
9 My joints are stiff in the morning _____
10 I feel like I'm living in slow motion _____
Add up your overall score _____
10 or less = satisfactory level
11-20 = possible thyroid hormone deficiency
21 or more = probable thyroid hormone deficiency
Progesterone (for women only)
1 My breasts are large _____
2 My close friends complain I'm nervous and agitated _____
3 I feel anxious _____
4 I sleep lightly and restlessly _____
The following questions are for women who have not reached menopause, and menopausal women who are taking hormone replacement therapy.
5 My breasts are swollen and tender before my period _____
6 And my belly is swollen _____
7 And I'm irritable and aggressive _____
8 And I lose my self control _____
9 I have heavy periods _____
10 and they are continuously painful _____
Add up your overall score:
Post menopausal women not treated with hormones; overall score _____
4 or less = satisfactory level
5-8 = possible progesterone deficiency
9 or more = probable progesterone deficiency
Menstruating women or menopausal women using hormones; overall score _____
10 or less = satisfactory levels
11-20 = possible progesterone deficiency
21 or more = probable progesterone deficiency
Estrogen (for women only)
1 I'm losing hair on the top of my head _____
2 I'm getting thin, vertical wrinkles above my lips _____
3 My breasts are droopy _____
4 My face is too hairy _____
5 My eyes are dry and easily irritated _____
6 I have hot flashes _____
7 I feel tired constantly _____
8 I am depressed _____
9 My menstrual flow is light (0 = moderately, 1-3 = low,
4 = none) _____
10 My periods are irregular (< 27 or > 31 days) _____
11 For women without periods; I do not feel like sex any
more _____
Add up your overall score: _____
10 or less = satisfactory level
11-20 = possible estrogen deficiency
21 or more = probable estrogen deficiency
Part II - Circle the answers to the ailments and discuss them with your physician.
Energy
Do you have a hard time getting up in the morning? yes / no
Do you always feel tired or tired in the afternoon? yes / no
Sex
Do you lack sexual desire? yes / no
Does your penis or clitoris seem less sensitive? yes / no
Are your erections not firm enough? yes /no
Have you lost your attraction toward your partner? yes / no
Do you lack vaginal lubrication? yes/ no
Sleep
Do you sleep poorly? yes / no
Do you rarely dream? yes / no
Memory
Do you suffer from memory loss? yes / no
Do you have trouble concentrating? yes / no
Skin and Hair
Do you have wrinkles along the nose, smile lines or forehead? yes / no
Do you have little wrinkles around the eyes and crows
feet? yes / no
Do you have age spots? yes / no
Do you have dry, thin skin? yes / no
Are you losing your hair or is it turning gray? yes / no
Weight Control
Is your abdomen too plump? Is it distended? yes / no
Are your breasts too large? Do they get larger before
periods? yes / no
Are your buttocks and thighs too well padded, pear
shaped? yes / no
Stress and Mood
Do you suffer from constant fatigue? yes / no
Do you have high blood pressure? yes / no
Are you anxious, nervous, or irritable? yes / no
Do small things set you off? yes / no
Are you depressed? yes / no
Joints and Bones
Do you have arthritis? yes / no
Do you have osteoarthritis? yes / no
Do you have fibromyalgia (sharp shoulder pain)? yes / no
Have you lost muscle mass, tone, and strength? yes / no
Do you have bone loss of the spine, hips, hands, wrists
or feet? yes / no
