AMS Questionnaire

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Full Name*

Nombre

Apellido

Birth Date*

Are you currently taking any testosterone treatment?*

Yes No

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If you are taking an injectable testosterone, which one are you taking?

Testosterone Enanthate Testosterone Cypionate Sustanon Nebido Other

If you are taking an injectable testosterone, when was your last injection?

If you are taking a testosterone cream, which one are you taking?

Testosterone Gel 1% Testosterone Gel 1.62% Other

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Informational text

Decline in your feeling of general well-being (general state of health, subjective feeling)

Not likely

1 2 3 4 5 6 7 8 9 10

Very likely

Joint pain and muscular ache (lower back pain, joint pain, pain in a limb, general back ache)

Not likely

1 2 3 4 5 6 7 8 9 10

Very likely

Excessive sweating (unexpected/sudden episodes of sweating, hot flushes independent of exertion)

Not likely

1 2 3 4 5 6 7 8 9 10

Very likely

Sleep problems (difficulty falling asleep, difficulty sleeping through the night, waking up tired, poor sleep, insomnia)

Not likely

1 2 3 4 5 6 7 8 9 10

Very likely

Increased need for sleep or often feeling tired

Not likely

1 2 3 4 5 6 7 8 9 10

Very likely

Irritability (feeling aggressive, easily upset about little things, moody)

None Mild Moderate Severe Extremely severe

Irritability (feeling aggressive, easily upset about little things, moody)

Not likely

1 2 3 4 5 6 7 8 9 10

Very likely

Nervousness (inner tension, restlessness, feeling fidgety)

Not likely

1 2 3 4 5 6 7 8 9 10

Very likely

Anxiety (feeling panicky)

Not likely

1 2 3 4 5 6 7 8 9 10

Very likely

Physical exhaustion/lack of vitality (general decrease in performance, reduced activity, lack of interest in leisure activities, feeling of achieving less, of having to force oneself to undertake activities)

Not likely

1 2 3 4 5 6 7 8 9 10

Very likely

Decrease in muscular strength (feeling of weakness)

Not likely

1 2 3 4 5 6 7 8 9 10

Very likely

Depressive mood (feeling down, sad, on the verge of tears, lack of drive, mood swings, feeling nothing is of any use)

Not likely

1 2 3 4 5 6 7 8 9 10

Very likely

Feeling that you have passed your peak

Not likely

1 2 3 4 5 6 7 8 9 10

Very likely

Feeling burnt out, having hit rock bottom

Not likely

1 2 3 4 5 6 7 8 9 10

Very likely

Decrease in beard growth

Not likely

1 2 3 4 5 6 7 8 9 10

Very likely

Decrease in ability/frequency to perform sexually

Not likely

1 2 3 4 5 6 7 8 9 10

Very likely

Decrease in the number of morning erections

Not likely

1 2 3 4 5 6 7 8 9 10

Very likely

Decrease in sexual desire/libido (lacking pleasure in sex, lacking desire for sexual intercourse)

Not likely

1 2 3 4 5 6 7 8 9 10

Very likely

Increased need for sleep or often feeling tired

Not likely

1 2 3 4 5 6 7 8 9 10

Very likely

Informational text

What was your score?

Informational text

AMS Questionnaire

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