Male Questionnaire
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SYMPTOMS: SKIN: CONDITIONS

Q597

Did you experience Adolescent Acne?

No / not applicable / don't know
Yes, moderately / briefly
Yes, severely / prolonged

Q598

Have you had Adult Acne?

Never had it / not applicable / don't know
Probably had it/minor episode(s) now resolved
Major episode(s) now resolved
Current minor problem
Current major problem

Q599

Do you have Telangiectasia (persistent red or blue veins on your face, upper chest or neck)?

Don't know
No
Mild (a few veins)
Moderate
Severe (many veins)

Q600

Have you had Eczema? This includes many kinds of red, blistering, oozing, scaly, brownish, thickened and itching skin conditions, and may be known as Dermatitis.

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

Q601

Have you had Psoriasis? It is characterized by frequent episodes of redness and itching, and thick, dry, silvery scales in discrete patches on the skin. It is most common on the scalp, trunk, elbows, knees, skin folds and fingernails.

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

Q602

Do you have Rosacea? This is a facial rash usually composed of prominent redness and sometimes also pimple-like bumps that do not become whiteheads or blackheads.

Don't know
No, definitely not
Mild
Moderate
Severe

Q603

Do you have dandruff (Seborrheic Dermatitis)?

No / don't know
Some
Significant
Severe

Q604

Actinic Keratoses. Small, raised, flaky skin lesions usually found on the forehead in older people.

Never had them / don't know
Probably have a few
Current minor problem
Current minor problem, have had many removed
Current major problem

Q605

Do you have any Seborrheic Keratoses? They have a waxy, stuck-on look, like brown candle wax dropped on the skin. Color ranges from light tan to dark brown or black. They may be smooth, or rough and crumbly; size varies from tiny spots to inches long.

None / don't know
I believe I have a few
I have some (5-10)
I have many (11-30)
I have very many (over 30)

Q606

How many normal (common) moles do you have? Normal moles have a uniform light tan/brown color and are almost perfectly round.

Don't know
10 or fewer
Between 10 and 50
Between 50 and 100
More than 100

Q607

Do you have moles that bleed, are enlarging, are painful, or are tender?

Don't know
No
A few / minor problem
Several / definitely an issue

Q608

Do you have any dark moles with a rough/irregular shape and varied color? These are different from normal moles.

No / only normal moles / don't know
Yes, under 5 irregular dark moles
Yes, about 5 to 20 irregular dark moles
Yes, more than 20 irregular dark moles

Q609

Have you had any polyps? These are small growths on a mucous membrane, usually inside the nose, colon, or uterus.

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

Q610

Do you have any tender points (very sensitive to touch) in these areas? Sides of: front of neck, rear base of neck, rear base of skull, or breastbone; shoulder blades; elbows; knees; tops of buttocks, outside rear upper legs under buttocks.

No / not very sensitive to touch / don't know
Not now, but I had them in the past
Yes, 1-5 tender points
Yes, 6-10 tender points
Yes, 11 or more tender points

Q611

Do you tend to get rashes?

It is not a problem for me / don't know
Generally not, but I do have a rash now
Occasional (several times a year) moderate rash
Frequent moderate rash / occasional severe
Frequent (several times a month) severe rash

Q612

Do you have Vitiligo (patches of depigmented/lighter skin)?

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

Q613

Do you have warts anywhere on your body other than in the genital area? (Genital warts are covered elsewhere.)

No / don't know
Probably/minor episode(s) now resolved
Major episode(s) now resolved
Yes, one or two
Yes, more than two

Q614

Whether you are male or female, do you have any unusual problems with your nipples, such as itching or discharge? (Discharge is normal in pregnant or lactating women.)

No / don't know
Yes, only because I am pregnant or lactating
Yes, something is not normal*

* more questions will be asked later

SYMPTOMS: HAIR

Q615

Do you have less hair or a bald patch on the front/side area of your lower leg(s)?

No / don't know
Yes

Q616

Have you had a recent change in body hair quantity?

Much recent loss
Some recent loss
No / don't know
Some recent gain
Much recent gain

Q617

Do you have an urge or habit of pulling or plucking hairs from your body beyond the removal of selected hairs for cosmetic reasons?

Don't know
No
Yes, from time to time
Yes, I habitually pull hairs out
Yes, I habitually pull hairs out and eat them

Q618

Do you have less pubic or underarm hair growth than previously?

I can't tell / don't know
No, quantity is at least as much as before
Yes, the quantity has decreased somewhat
Yes, the quantity has decreased substantially

Q619

Is your head (scalp) hair generally thinning/falling out? Do not include male pattern baldness.

Normal loss / not applicable / don't know
Moderate loss
Much loss

Q620

Do you have male pattern hair loss? Male pattern hair loss is a common condition in which men - and sometimes women - experience a receding hairline and/or balding on the top of the head.

No / don't know
Mildly / frontal loss only
Moderately / partial loss on top only
Moderately / complete loss on top only
Severely / nearly or totally bald

Q621

If you suffer from male pattern hair loss (balding), at approximately what age did it start progressing significantly?

Not applicable / don't know
25 or under
26 to 35
36 to 45
Over 45

Q622

How dry or oily is your hair?

Generally dry
Recently more dry
Average / not applicable / don't know
Recently more oily
Generally oily

Q623

Apart from graying, what color tone is or was the hair on your head?

Very light
Light
Average / not applicable / don't know
Dark
Very dark

Q624

If you have gray hair, choose the answer that best describes the graying process in your case. Hair graying is both genetic and age-related.

I have no hair / no gray hair / don't know
It retained its natural color longer than expected
It has grayed normally for my age and race
Somewhat prematurely (over half gray before 45)
Very prematurely (over half gray before 35)

Q625

How dense (thick) is the hair on your head in areas that are not affected by any type of hair loss?

I'm bald / my whole head is affected by hair loss
Very sparse/thin
Somewhat sparse/thin
About average / don't know
Dense/abundant/thick

Q626

Without hair treatments, how strong and healthy are the hairs on your head? Brittle hair is dull, rough, lifeless, frizzy, has split ends and breaks easily. Healthy, strong hair appears moist and shiny.

Very dry/brittle, break easily
Somewhat dry/brittle/dull
Healthy / strong / I don't have hair / don't know

Q627

Approximately how fast does your head (scalp) hair grow? Hair normally grows about 1/2 inch (1.25cm) per month or 6 inches (15cm) per year.

Very slowly (under 3 inches or 8cm per year)
Slowly (3-6 inches or 8-15cm per year)
Average / not applicable / I have no idea
Quickly (6-12 inches or 15-30cm per year)
Very quickly (over 12 inches or 30cm per year)

SYMPTOMS: NAILS

Q628

Approximately how fast do your fingernails grow? Normal growth is about 1/12th to 1/8th of an inch (2-3mm) per month.

Very slowly
A little slower than average
Average / I have no idea
A little quicker than average
Very quickly

Q629

Do you bite your nails?

No / don't know
Sometimes a little, but my nails look quite normal
Moderately - they are bitten back to the nail bed
Severely - my nails are deformed or mostly gone

Q630

Do you experience inflamed/red cuticles (the skin around the edge of your nails)?

No / don't know
Slightly - Occasionally / one or two nails
Significantly - Regularly / a few nails
Severely - Usually or always / several nails

Q631

Do you suffer from hangnails/agnails (torn skin around the fingernails or toenails)? If there is a physical cause such as biting, picking, cutting or regular exposure to water/soaps/chemicals then select that response.

No / don't know
Yes, from a known physical cause
Occasionally - A few times a year
Regularly - A few times a month
Frequently - I usually/always have them

Q632

Aside from injury, are your fingernails or toenails at all unusual? For example, white spots/areas, pale, unusual color, weak/brittle, lines/ridges/grooves, widened, or curved up/downwards? Healthy nails are smooth and strong with a uniform pink nail bed.

Not applicable / don't know
No, my nails are normal and healthy
Yes/probably I have some nail abnormalities*

* more questions will be asked later

LIFESTYLE / EXERCISE

Q633

How many hours do you work each week? Include any tasks which you would prefer not to do, for example housework, studying, childcare.

I don't/can't work / don't know
Under 35
35 to 47
48 to 60
Over 60

Q634

Approximately how much moderately strenuous AEROBIC exercise do you manage to get each week? Examples would include a brisk walk, running, bicycling or swimming.

Don't know
Less than 2 hours total each week
2-5 hours total each week
5-7 hours total per week
Over 7 hours total per week

Q635

Approximately how much moderately strenuous NON-AEROBIC exercise do you manage to get each week? Also known as anaerobic exercise, examples include weight training, circuit training or other load-bearing exercises.

Don't know
Less than 2 hours total per week
2-5 hours total per week
5-7 hours total per week
Over 7 hours total per week

Q636

Aside from specific exercise sessions, for approximately how many hours each week are you strenuously active? This includes activities/jobs that involve lifting/carrying heavy objects, digging, running etc.

Don't know
None
1 to 5
6 to 10
More than 10

Q637

If you are not getting as much exercise as you should (at least 4-5 hours of aerobic exercise per week), what is the reason for this? Work-related activity involving raised heart rate and sweating qualifies as exercise.

Not applicable (I do exercise enough) / don't know
I just don't feel like it
I don't have the time
Physical problems prevent me
Disease or illness prevents me

Q638

When you exercise (run, walk fast, cycle, etc.), do you get a 'side stitch'?

I don't exercise / don't know
No, never
Rarely
Regularly, but under half the time
Most of the time

Q639

How long does it take you to recover from moderate physical exertion? Moderate exertion is defined as any activity that causes an increase in pulse / breathing / sweating for at least 10 minutes.

Don't know
Under an hour
Several hours
Most of the day
24 hours or more

Q640

Excessive exercise. Would friends say that you exercise compulsively, or that you train too much?

No / don't know
Some do
Yes, definitely

Q641

Do you practice any form of calming/stretching exercise, for example Yoga, Tai Chi, or Pilates?

Never / don't know
Once per month or less
Once per week or less
A few times per week
At least daily

Q642

Computer use: On average, approximately how much time do you spend in front of a computer?

Don't know
None / under 1 hour a week
1-20 hours a week (under 3 hours a day)
21-60 hours a week (3-9 hours a day)
Over 60 hours a week (over 9 hours a day)

Q643

Television: On average, approximately how much time do you spend in front of the TV?

Don't know
None / I watch under 1 hour a week
1-10 hours a week (about an hour a day)
11-30 hours a week (1-4 hours a day)
Over 30 hours a week (over 4 hours a day)

DIET

These questions give us a rough idea of your diet. Don't worry if you can't get these answers exactly right – simply answer to the best of your ability.

Q644

Roughly how often do you consume refined sugar? Include sugar-containing snacks (cookies, candy...), desserts (cakes, puddings...), or other servings of at least one tablespoon of sugar (for example in cereal, coffee...) Do not include soft drinks here.

Never / rarely / don't know
About once per week
About 2-3 times per week
Roughly daily or almost daily
More than once per day

Q645

Do you make a point of avoiding the artificial sweeteners Aspartame and Neotame? They are commonly found in low-calorie drinks and foods.

No / don't know
Sometimes
I generally try to avoid them
I try very hard to avoid them
I absolutely avoid them

Q646

Approximately how often do you consume tofu, soy milk, soybean curd or other soy-based products?

Never / don't know
Once per month or less
Once per week or less
A few times per week
At least daily

Q647

How often do you consume dairy (cheese/cream/milk-based) products?

Never / don't know
Once per week or less
2-6 times per week
Some every day
A lot / more than once daily

Q648

Approximately how much calcium-fortified food do you consume? Common examples are orange juice, breakfast cereals, soy milk, milk and other dairy products. (Do not include calcium supplements/tablets here.)

Don't know / I don't keep track
None / rarely
A little / under one cup (250ml) per day
1-3 cups (250-750ml) per day
A lot / at least three cups (750ml) each day

Q649

Estimate how often you consume iodine-containing foods. The most common dietary sources of iodine are seaweeds and iodized salt.

Don't know
Never / rarely / I don't make a point of it
A few times per week
Daily or almost daily

Q650

How often do you consume processed meats? Examples include hot dogs, sausages, bacon, jerky, smoked ham, pepperoni, salami, lunch meat, sandwich meats, or red meat in canned/frozen products.

Never / don't know
Once per week or less
2-3 times per week
4-7 times per week
A lot / more than once daily

Q651

How often do you consume fast food?

Never / don't know
Once per week or less
2-3 times per week
4-7 times per week
A lot / more than once daily

Q652

Aside from fast food, how often do you consume deep-fried foods?

Never / don't know
Once per week or less
2-3 times per week
4-7 times per week
A lot / more than once daily

Q653

Aside from fast food, roughly how often do you eat grilled or barbecued red meat or chicken?

Don't know
Never / no more than once per year
Once per month or less
2-4 times per month
More than 4 times per month

Q654

On average, how many DAILY servings of fruits and vegetables do you eat? A serving is about the size of a tennis ball, or half a cup (125ml) for most fruits and vegetables. Include everything except potatoes and grains such as rice.

Don't know
None / under two
About 2 to 3
About 4 to 5
More than 5 servings per day

Q655

Roughly how many WEEKLY servings of LEGUMES (peas, beans, lentils, peanuts, soy etc.) do you eat? A serving is about the size of a tennis ball, or half a cup (125ml).

Don't know
None / under two
About 2 to 3
About 4 to 5
More than 5 servings per week

Q656

Approximately how much dark leafy green vegetable or broccoli do you eat? Examples include spinach, kale, collard greens. A serving is about the size of a tennis ball, or half a cup (125ml).

Don't know
None / less than one serving per week
Less than one serving per day
1-3 servings per day
3 or more servings per day

Q657

Hydrogenated oils / fats. How often, on average, do you consume them, not distinguishing good oil from bad? They are often found in margarines, cakes, biscuits, french fries, chips, and sweets for example.

Never
On rare occasions / I try very hard to avoid them
A few times per week
About once a day
More than once daily (average diet) / don't know

Q658

Roughly how much unheated flax or hemp oil, non-hydrogenated canola oil or fish oil you consume per week? A 'unit' can be: 1 tbsp flax oil, 3 tbsp flax seed, 3 tbsp hemp oil, 1/3 cup hemp seeds, 1/2 cup walnuts, 4 tbsp canola oil OR 1gm fish oil.

None / rarely / don't know
One unit per week
2-3 units per week
4-10 units per week
More than 10 units per week

Q659

How many tablespoons of safflower, sunflower, corn or cottonseed oil do you consume per week? NOTE: "All-purpose vegetable oil" is commonly a mixture of corn and cottonseed oil - look at the label.

None / rarely
1-3 per week
4-7 per week / don't know
8-14 per week
Definitely more than 14 per week

Q660

How many servings of fish do you eat on average per month? A serving is about the size of a tennis ball, or half a cup (125ml).

None / rarely / don't know
One
Two
Three to four
Five or more

Q661

Do you eat refined white flour products, for example French, Italian or other white bread, pizza, bagels, pasta etc.?

Don't know
Never
No more than 3 times per week
4-7 times per week
A lot / more than once daily

Q662

Salt consumption. How much added salt (salt that is not already in the food) and salty foods/snacks do you eat on average?

None
Very little, I try to avoid it
Average / don't know
Above average
A lot - I usually add salt and enjoy salted foods

Q663

Being honest with yourself, do you feel that the amount of calories you are consuming is...?

Definitely not enough calories
Probably not enough
About right / don't know
Probably too many
Definitely too many calories

Q664

How would you rate your overall fat / oil consumption from food and supplements?

Extremely low
Moderately low
Average / don't know
Moderately high
Very high

Q665

How high would you rate your overall consumption of eggs and egg-containing foods? Eggs are an ingredient of many foods such as mayonnaise, most cakes, many desserts, breads, other flour-based products.

None - I carefully avoid eggs and egg products
Lower than average - I usually avoid eggs
About average / don't know
High - I enjoy eggs most/every day

Q666

How often do you consume garlic?

Never / don't know
Once per month or less
Once per week or less
A few times per week
At least daily