Testosterone (TRT) consultation

01Have you experienced a decrease in sexual desire / libido?

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02Have you experienced physical exhaustion or a lack of energy?

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03Have you experienced a decrease in muscular strength or endurance?

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04Have you experienced a loss of height?

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05Have you experienced a decline in your feeling of general wellbeing?

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06Have you experienced increased irritability or grumpiness?

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07Have you experienced a decrease in the strength of erections?

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08Have you experienced a deterioration in your ability to play sports?

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09Do you find yourself falling asleep after dinner?

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10Have you experienced a deterioration in your work performance?

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11Are you experiencing a depressive mood?

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12Are you experiencing a decrease in the number of morning erections?

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13I am over 18 and this is for my sole use. I understand this is a non-emergency online service. I confirm I have answered all questions accurately and understand the doctor will use this information to prescribe safely for me.

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14I consent to treatment, identity check and for the pharmacist to access and store relevant information from my NHS summary care record which may be needed to safely prescribe. I also agree to read the Patient Information Leaflet supplied with my medication.

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15By providing us with your details you confirm that you have read, understood and agreed to the legal terms, and you consent to the sharing of your data to use our service.

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