Male Questionnaire
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Do you have Diabetes?
  • Don't know
  • No, it has been ruled out within the past 6 months
  • Yes*
* more questions will be asked later


Do you suffer from Hypoglycemia (abnormally low blood glucose level)?
  • Never had it / don't know
  • Probably had it/minor episode(s) now resolved
  • Major episode(s) now resolved
  • Current minor problem
  • Current significant problem


  • Never had it / don't know
  • Probably had it/minor episode(s) now resolved
  • Major episode(s) now resolved
  • Current minor problem
  • Current significant problem


  • Never had it / not sure / don't know
  • Probably had it/minor episode(s) now resolved
  • Major episode(s) now resolved
  • Current minor problem, confirmed
  • Current significant problem, confirmed


Do you have a swelling at the front of your neck?
  • Don't know
  • Definitely not
  • Possibly - I'm not sure
  • Yes, minor
  • Yes, major / pronounced


Have you suffered from Adrenal Insufficiency?
  • Uncertain / don't know
  • No, lab tests have confirmed normal function
  • It is a suspected problem
  • Yes, a lab test has confirmed it
  • I have confirmed Addison's Disease


Have you had any swollen, tender or painful lymph nodes within the past year? They appear as small, smooth lumps under the skin. If in doubt, the link above has more information.
  • Don't know
  • No
  • Yes*
* more questions will be asked later



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


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


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


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


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


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


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


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


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


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)


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


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


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


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


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


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


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


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


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


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



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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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.


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


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


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!


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


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


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


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


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


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)


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


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