Are you age 35 or older?  Yes  No

Do you tire more easily? Yes  No

Is it more difficult to get and stay in shape? Yes  No

Is there less desire to be active and/or exercise and
the time to recover is longer?  Yes  No

Have you lost some of the Zest for life -- the old attack the day attitude?
Yes  No

Are you eating the same or less and putting on weight? Yes  No

Irritability -- are you sad and/or grumpy? Yes  No

Have you lost some of your mental quickness and reaction time? Yes  No

Do you have a decrease in libido (sex drive)?  Yes  No

Decrease in number of morning erections? Yes  No

Are your erections less strong? Yes  No

Are you falling asleep after dinner? Yes  No

Has there been a deterioration in your work performance?
Yes No