Male Questionnaire
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SYMPTOMS: SKIN: CONDITIONS

Q596

Did you experience Adolescent Acne?
  • No / not applicable / don't know
  • Yes, moderately / briefly
  • Yes, severely / prolonged

Q597

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

Q598

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)

Q599

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

Q600

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

Q601

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

Q602

Do you have dandruff (Seborrheic Dermatitis)?
  • No / don't know
  • Some
  • Significant
  • Severe

Q603

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

Q604

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)

Q605

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

Q606

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

Q607

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

Q608

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

Q609

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

Q610

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

Q611

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

Q612

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

Q613

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

Q614

Do you have less hair or a bald patch on the front/side area of your lower leg(s)?
  • No / don't know
  • Yes

Q615

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

Q616

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

Q617

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

Q618

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

Q619

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

Q620

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

Q621

How dry or oily is your hair?
  • Generally dry
  • Recently more dry
  • Average / not applicable / don't know
  • Recently more oily
  • Generally oily

Q622

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

Q623

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)

Q624

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

Q625

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

Q626

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

Q627

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

Q628

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

Q629

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

Q630

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

Q631

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

Q632

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

Q633

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

Q634

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

Q635

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

Q636

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

Q637

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

Q638

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

Q639

Excessive exercise. Would friends say that you exercise compulsively, or that you train too much?
  • No / don't know
  • Some do
  • Yes, definitely

Q640

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

Q641

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)

Q642

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.

Q643

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

Q644

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

Q645

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

Q646

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

Q647

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

Q648

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

Q649

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

Q650

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

Q651

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

Q652

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

Q653

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

Q654

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

Q655

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

Q656

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

Q657

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

Q658

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

Q659

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

Q660

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

Q661

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

Q662

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

Q663

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

Q664

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

Q665

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