Questionnaire - Page 8(f) of 9 (1015 maximum possible questions)

Last updated: Oct 09, 2008

This section deals with hormone use.
904.	Are you currently taking birth control pills?	Don't know No Yes, for a year or less Yes, for 2-4 years Yes, for more than 4 years
905.	If not currently using birth control pills, have you used them in the past 5 years?	Not applicable / don't know Never used them For less than a year For 1-2 years For over 2 years
906.	Have you used testosterone?	No / don't know For under 1 year, but not any more For 1 or more years, but not any more Current use for under 1 year Current use for 1 or more years
907.	Have you used growth hormone?	Don't know No Yes, but no longer Current use, supplemental doses Current use, full replacement doses
908.	Have you used cortisol (hydrocortisone)? Only include tablets of cortisol taken orally, not cortisone shots or creams.	Don't know No In the past only Current use for less than 6 months Current use for 6 months or longer
909.	If you are currently using cortisol, what is your total daily dose?	Don't know Less than 9mg 10 to 20mg 21 to 30mg Over 30mg
910.	Have you used DHEA?	No / don't know For under 1 year, but not any more For 1 or more years, but not any more Current use for under 1 year Current use for 1 or more years
911.	Are you using glucophage or glucophageXR (Metformin - a biguanide agent)? This is a blood sugar and insulin-lowering medication?	Don't know No Less than 1000mg per day 1000mg to 1500mg per day Over 1500mg per day
912.	Have you used melatonin? Please specify if you have tried it but found that it does not help.	Never used it / not within past year / don't know I tried it, but it makes me agitated I tried it, but it does not help Current / recent occasional use Current / recent regular use
913.	Are you using a desiccated thyroid product such as Armour? Desiccated products come from animal glands and contain both T4 and T3. One grain equals 65mg.	Don't know No Using 1 grain or less per day Using between 1 and 2 grains per day Using over 2 grains per day
914.	Are you using a product containing synthetic T4 (levothyroxine or L-thyroxine) such as Synthroid, Liotrix and Thyrolar?	Don't know No 50 to 120mcg per day 125 to 150mcg per day Over 150mcg per day
915.	Are you regularly using any synthetic T3 (liothyronine or triiodothyronine) product? This includes brand names such as Cytomel. Products like Liotrix and Thyrolar contain both synthetic T4 and T3. This may be in a "sustained" form also.	Don't know No 19mcg or less per day 20 to 40mcg per day Over 40mcg per day
916.	Have you used natural progesterone? This does not not include wild yam products which normally have no progesterone in them.	Don't know No Yes    More questions later...
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