Hormone Balance Self-Assessment
Hormone Balance Self-Assessment
How to Score Each Symptom:
0
= Never / No symptom
1
= Occasionally / Mild
2
= Frequently / Moderate
3
= Always / Severe
Select your gender:
Female
Male
🧠 Section A: Thyroid Function (0–3)
Feeling cold often
0
1
2
3
Dry skin, brittle nails, hair thinning
0
1
2
3
Fatigue after sleep
0
1
2
3
Brain fog or slow thinking
0
1
2
3
Weight gain despite eating well
0
1
2
3
Constipation
0
1
2
3
⚡ Section B: Adrenal Health / HPA Axis (0–3)
Difficulty falling/staying asleep
0
1
2
3
Tired but wired at night
0
1
2
3
Need caffeine/sugar to start day
0
1
2
3
Craving salty foods
0
1
2
3
Feel overwhelmed/anxious easily
0
1
2
3
Blood sugar crashes
0
1
2
3
🍬 Section C: Insulin & Blood Sugar (0–3)
Fatigue after meals
0
1
2
3
Frequent urination/thirst
0
1
2
3
Hard to lose belly fat
0
1
2
3
Energy dips between meals
0
1
2
3
Sugar or carb cravings
0
1
2
3
Acne or dark neck patches
0
1
2
3
🌱 Section E: Gut-Hormone Axis & Detox (0–3)
Bloating or irregular stools
0
1
2
3
Skin issues (acne, eczema)
0
1
2
3
Reactions to alcohol/caffeine
0
1
2
3
History of antibiotics/pill use
0
1
2
3
Brain fog after meals
0
1
2
3
Poor tolerance to detox/supplements
0
1
2
3
♀ Section D: Sex Hormones – Female (0–3)
PMS, breast tenderness, heavy periods
0
1
2
3
Irregular cycles
0
1
2
3
Mood swings or irritability
0
1
2
3
Low libido or vaginal dryness
0
1
2
3
Menopausal symptoms
0
1
2
3
♂ Section D: Sex Hormones – Male (0–3)
Low libido or erectile issues
0
1
2
3
Low muscle mass/strength
0
1
2
3
Low motivation or mood
0
1
2
3
Belly fat / breast tissue
0
1
2
3
Mood swings or depression
0
1
2
3
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