Excessive Body Hair

Ovarian Cysts

 

Increased Acne

Hair Loss (scalp)

 

Excessive Facial Hair

Oily Skin

Irritable

 

Elevated Triglycerides

Nervous

 

Symptoms Associated with Androgen Excess DHEA/Testosterone:

HRT Self Assessment                                  Patient Name:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

---

Copyright © 2005 [Community Pharmacy]. All rights reserved.
Revised: 02/08/2005

Headaches

Hot Flashes

Night Sweats

Vaginal Dryness

Foggy Thinking

 

Sleep Disturbances

Heart Palpitation

Bone Loss

Dry Skin/Hair

 

Specific symptoms have been associated with particular hormone deficiencies and excesses. The purpose of this self assessment is not intended to be a substitute for the advice of a physician, nor is it intended to diagnose. Rather the self assessment is  intended to be a tool for the patient & physician. After completing the form, print it from your browser and offer it to your physician.

Symptoms Associated with Estrogen Deficiency:

Memory Lapses

Incontinence

Tearful

Depressed

 

Elevated Triglycerides

Fibrocystic Breasts

Uterine Fibroids

Weight Gain in Hips

 

Mood Swings (PMS)

Tender Breasts

Water Retention

Nervous

 

Bleeding Changes

Headaches

Low Libido

Heavy Periods

Symptoms Associated with Estrogen Excess:

Irritable

Anxious

Sleep Disturbances

Cold Body Temperature

 

Community Pharmacy

2500 Lillian Miller Parkway

Denton,  Texas 76210

(940) 382-1618  Fax (940) 898-1986

Email: community.pharmacy@verizon.net