Female Hormone Deficiency Self-Assessment

Please use the Female Hormone Deficiency Assessment Questionnaire below by checking one box for each symptom then click on "submit" to discover the action steps that may be right for you. Once you have completed the questionnaire you can print the results page and hand it to your doctor, or nurse.

If any of these symptoms apply to you, you may want to consult with one of our health care providers. The results of this self assessment quiz are not to be considered as medical advice or diagnoses.

Symptoms None Mild Moderate Severe
Water Retention/bloating/weight gain
Increased facial hair
Breast tenderness/swelling
Pain: Headache/migraine/low back/muscle ache/joint ache
Vaginal dryness/pain/itching
Fatigue/lack of energy
Decreased concentration/alertness/memory loss
Urinary Incontinence
Mood Swings
Acne or oily skin
Lack of libido/sex drive
Hot flashes/night sweats
Sleep disturbance
Personal risk factors for heart disease
Personal risk factors for osteoporosis

Contact Dr. L.A. Torres Jr.
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Dr. L.A. Torres Jr. M.D.
4601 Old Shepard Pl.
Building One, Suite 101
Plano, Texas 75093

Phone: 214-919-2350
Fax: 214-919-2361
Dr. L.A. Torres Jr. M.D.