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Testosterone Symptom Questionnaire

9-item Likert-scale adaptation (screening & tracking only – not a stand-alone diagnostic tool)

Welcome to the Testosterone Symptom Questionnaire.

This brief survey is designed to help you understand how your testosterone levels may be impacting your daily life. Please enter today’s date and answer each question as accurately and honestly as possible.

Your responses help our team at BlissElla Physiologic Arts understand how you’re feeling, monitor changes over time, and guide personalized discussions about optimizing your hormones, lifestyle, and overall well-being. After completing the questionnaire and reviewing your score, please download your report and share it with us so we can review your results together and continue working toward optimizing your health.

Next steps:
After calculating your score, please download the PDF report and share it with the BlissElla team so we can review your results together.

Scoring: Each item is rated 1–5. Higher scores generally reflect fewer symptoms / better functioning. Use alongside clinical evaluation and serum testosterone testing.

Results

# Question Score (1–5)

This tool is for symptom tracking and shared decision-making. It does not replace formal diagnosis, physical examination, or laboratory assessment.

Attribution:
These questionnaire items were informed by the work of:
Mohamed O, Freundlich RE, Dakik HK, et al. The quantitative ADAM questionnaire: a new tool in quantifying the severity of hypogonadism. Int J Impot Res. 2010;22(1):20-24.
BlissElla Physiologic Arts, PLLC
Concierge metabolic, hormonal, and lifestyle optimization.