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Golden Steel Plate

Hormone Clinic

Call Us: (913) 261-9668

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Email: parker@daileyaesthetics.com

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Hormone Replacement
- Males Hormone Assessment Form
- Females Hormone Assessment Form
Men's Sexual Health
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Males Hormone Assessment Form

TestosteroneMental- Select all that apply...

Decreased Mental Sharpness and Stamina

Depression

Anxiety

Poor Memory

Forgetfulness

Mood swings

Irritability

Lack of Focus

Lack of Motivation and Drive

Testosterone Physcial- Select all that apply...

Fatigue - Lack of Energy

Back/Body - Joint Pains

Loss of Muscle Mass

Weight Gain Around Torso

Decreased Exercise Toleranc

Change in Sleep Habits

Testosterone Sexual- Select all that apply...

Reliant on/or Ineffective Results from ED Medications

Decreased Sexual Desire

Loss of Spontaneous and Morning Erections

Decreased Erection Strength

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