Symptoms Profile

Date of last prostate exam (male):

Date of last PSA test (male):

Symptoms List( please check if applicable)

Mood Swings

Fatigue

Irritability

Depression

Memory Loss

Cloudy Mind

Decreased Sex Drive

Absent Sex Drive

Decreased Energy Level

Decreased Strength/Endurance

Loss of Height

Weight Gain Despite Exercise/Diet

Inability to Lose Weight Despite Exercise/Diet

Painful Joints

Headaches

Difficulty Maintaining Erection

Difficulty Achieving Orgasm

Others

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