Male Questionnaire
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SYMPTOMS: METABOLIC

Q395

Are you hyperactive? In other words, do you always feel the need to be active?
  • Don't know
  • No
  • Somewhat
  • Yes, very

Q396

How would you rate your physical stamina (ability to undertake prolonged exercise)?
  • I have poor endurance
  • I'm about average / don't know
  • I have strong endurance

Q397

How warm or cold do your hands and feet tend to be? Consider when you shake hands with other people: do their hands usually feel warm (meaning your hands are colder) or cold (your hands are warmer)?
  • Usually or always cold
  • Colder than average
  • Average / don't know
  • Warmer than average
  • Usually or always warm

Q398

How often do you feel cold for no apparent reason? This question refers to your whole body, not just hands and feet.
  • Don't know / hands and feet only
  • Never / less than once a year
  • Occasionally - several times a year
  • Regularly - several times a month
  • Often/always

Q399

Do you experience inappropriate/excessive sweating during the day? Only include sweating that is not explained by a hot/humid climate, physical exertion, or dressing too warmly.
  • It is explained by my environment / don't know
  • Never / rarely / less than once a year
  • Yes, I sweat excessively several times a year
  • Yes, regular/frequent unexplained sweating
  • Yes, regular/frequent unexplained heavy sweating

Q400

Do your feet tend to have a strong odor and/or sweat a lot?
  • No / not particularly / don't know
  • Slight sweating, no significant odor
  • Slight sweating, significant odor
  • Significant sweating, no significant odor
  • Significant sweating and odor

Q401

Do you suffer from edema (swelling/puffiness caused by fluid retention) anywhere on your body? Do not include swelling that is red or painful to the touch: this is due to infection or injury and is covered elsewhere.
  • Don't know
  • No
  • Yes / probably*
* more questions will be asked later

Q402

Compared to other people, how quickly do you tend to recover from a cold or flu? Normally symptoms are at their worst in the first 2-3 days, then start improving during days 3-5, with full recovery taking 7-14 days.
  • Don't know
  • Quickly - full recovery usually within 1 to 5 days
  • I'm about average
  • Colds/flus often hit me harder than other people
  • Recovery usually/always takes over 2 weeks

Q403

In an average year, about how often do you get a cold or flu?
  • Rarely / once or twice / don't know
  • 2-3 times
  • More than 3 times

Q404

Do you currently have a fever? If you do, try to rate your average temperature.
  • Don't know
  • No
  • Mild fever, 99-100°F (37.2-37.8°C)
  • Moderate fever, 100.1-103°F (37.8-39.4°C)
  • High fever, usually over 103°F (39.4°C)

Q405

How often do you get unexplained fevers?
  • Never / rarely / don't know
  • Occasionally - one or two per year
  • Frequently - several/many per year

Q406

If you suffer from unexplained recurring fever, how would you rate its average severity?
  • Not applicable / don't know
  • Very mild, almost nothing
  • Mild - I can function normally with it
  • High - I can function but I would rather be in bed
  • Very high - I'm bedridden

Q407

Do you sometimes experience 'chills' (sensations of cold accompanied by shivering) that can not be explained by your environment?
  • Don't know
  • No
  • Occasionally
  • Often - more than once a month
  • I am experiencing chills due to a current illness

Q408

Have you experienced any unusual headaches within the past month?
  • They are ongoing / don't know
  • No
  • Yes, one/some that have now resolved
  • Yes, I am having mild to moderate headaches
  • Yes, I am having severe headaches

Q409

Are headaches an ongoing / long-term problem for you?
  • Don't know
  • No, headaches are not a problem for me
  • My headaches started less than a month ago
  • In the past only, not any more
  • Yes, I have been having headaches for over a month*
* more questions will be asked later

Q410

Do you feel shaky, headachy, tired, faint or nauseated when meals are delayed?
  • No / don't know
  • Occasionally / moderately
  • Often / severely

Q411

Do you experience inner trembling?
  • No / don't know
  • Occasional / moderate
  • Often / severe

Q412

Have you suffered from Pancreatitis?
  • Never had it / don't know
  • Probably had it/minor episode(s) now resolved
  • Major episode(s) now resolved
  • Current minor problem
  • Current major problem

Q413

What is your approximate percentage body fat?
  • Don't know
  • 6-13% / very low
  • 14-17% / low
  • 18-25% / average
  • Over 25% / high, obese

Q414

Do you have any problems with your weight? This includes being under/overweight, difficulty maintaining weight, a history of serious weight gains and losses, recent unexplained weight changes, etc.
  • Don't know
  • No
  • Yes*
* more questions will be asked later

SYMPTOMS: URINARY

Q415

Have you suffered from kidney stones?
  • Never had one / don't know
  • Probably had one/minor episode(s) now resolved
  • Major episode(s) now resolved
  • Current minor problem
  • Current major problem

Q416

Do you have any degree of Chronic Renal Insufficiency or Kidney Failure?
  • Don't know
  • No, definitely not (confirmed)
  • Chronic Renal Insufficiency
  • Chronic Renal Failure - not on dialysis yet
  • End-Stage Renal Disease - on dialysis

Q417

Do you dribble significantly after voiding urine (peeing)?
  • No / don't know
  • Yes

Q418

Do you have a problem with urine leakage (incontinence)?
  • Don't know
  • No
  • Minor occasional problem
  • Occurs with physical stress only (cough, jumping)
  • A continual problem / use absorptive pads

Q419

Do you have internal pain or discomfort in the inguinal (groin) area?
  • Never / don't know
  • Occasional moderate discomfort
  • Frequent moderate discomfort
  • Occasional severe pain
  • Frequent severe pain

Q420

Is there an interruption of the stream while urinating?
  • No / don't know
  • Occasionally / slight
  • Often / definite

Q421

How difficult or easy is it for you to urinate? In other words, how forceful is your urine stream?
  • Very weak stream / great difficulty urinating
  • Weakened stream / some difficulty
  • Don't know
  • Average / the same as it has always been
  • Strong stream, rapid emptying

Q422

Nighttime urination. On average, about how many times do you get up to urinate during your sleeping hours?
  • Rarely / only if I drink too much / don't know
  • Once
  • Twice
  • Three times
  • Four or more times

Q423

Daytime urination. On average, how many times do you urinate during your waking hours?
  • Under 2 times
  • 2 or 3 times
  • About 4 to 5 times / don't know
  • 6 to 9 times
  • 10 or more times

Q424

Do you feel a frequent need to urinate, even when your bladder is empty?
  • Don't know
  • No, definitely not
  • Yes, sometimes
  • Yes, often

Q425

What is the usual color of your urine, ignoring supplement (B-vitamin) yellowing, medications you are taking or other obvious factors?
  • Don't know
  • Colorless
  • Light Yellow
  • Dark Yellow
  • Very dark or black

Q426

Is your urine cloudy?
  • Don't know
  • No, it is clear
  • Occasionally slightly cloudy
  • Often slightly cloudy / occasionally very cloudy
  • Often very cloudy - as if a little milk was added

Q427

Do you ever see blood in your urine?
  • No / don't know
  • Yes, once or twice recently
  • Yes, occasionally
  • Yes, regularly

Q428

When you urinate, is foam produced in the toilet? This is known as 'foamy urine'.
  • Don't know
  • No / extremely rarely
  • Occasionally foamy
  • Frequently foamy OR occasionally very foamy
  • Always very foamy

Q429

Do you suffer pain or burning while urinating?
  • No / don't know
  • Very slight, barely noticeable
  • Yes, but not too worrying
  • Yes, worrying
  • Yes, severe - excruciating

Q430

Have you had any form of unusual urethral discharge? In other words, do you have a discharge from the same opening that you pee through?
  • No / don't know
  • Minor, in the past only
  • Major, in the past only
  • Current minor problem
  • Current major problem

Q431

Does your urine usually have a strong odor?
  • No / don't know
  • Fairly strong
  • Very strong

SYMPTOMS: REPRODUCTIVE

Some of the questions below are personal in nature.  If you are unwilling to answer a question, skip it by leaving the default "don't know" response.

Q432

At what age did you become sexually active?
  • Not applicable / never active / don't know
  • Before age 15
  • 15 to 19
  • 20 to 25
  • Over 25

Q433

What is the approximate number of sexual partners that you have had during your lifetime?
  • Prefer not to say / don't know
  • One or fewer
  • 2 to 5
  • 6 to 20
  • Over 20

Q434

How strong is your sex drive (libido)? In other words, how strong is your desire for sexual activity?
  • Totally absent - I am not at all interested in sex
  • Reduced
  • About average / prefer not to say / don't know
  • Increased
  • Very strong - I can't live without it!

Q435

Roughly how often do you ejaculate?
  • Prefer not to say / don't know
  • Once per week or less / I am sexually inactive
  • About 2 times per week
  • 3-4 times per week
  • 5 or more times per week

Q436

How frequently do you experience premature ejaculation?
  • Prefer not to say / not applicable / don't know
  • Never / rarely
  • It was a problem in the past, but not now
  • Less than half the time
  • More than half the time

Q437

Do you have difficulty achieving or maintaining an erection?
  • No / never / prefer not to say / don't know
  • Very rarely I will fail to maintain full erection
  • I occasionally fail to achieve/maintain erection
  • I usually/always fail to achieve/maintain erection

Q438

Have you suffered any prostate problems such as Prostatitis, Enlarged Prostate or Prostate Cancer?
  • Don't know
  • No
  • Yes*
* more questions will be asked later

Q439

Do you have any genital sores or lesions?
  • No / don't know
  • One or two, minor
  • Numerous, minor
  • One or two, worrying
  • Numerous, worrying

Q440

Do you have any wart-like fleshy bumps in or around the anus, penis, groin, or scrotal area? They may bleed when irritated, and may occur individually or merge to form small cauliflower-like clusters.
  • Don't know
  • No
  • Yes, one or two
  • Yes, a few
  • Yes, many / cluster(s)

Q441

What is your HIV/AIDS risk/status?
  • I am not at risk and have tested negative
  • I am not at risk, but have not been tested
  • Don't know
  • I am at risk
  • I have been diagnosed with it

Q442

Other than AIDS, have you had any form of sexually-transmitted disease (STD)?
  • Don't know
  • No
  • Yes / probably*
* more questions will be asked later
Report by The Analyst™
 Click to see sample report
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