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I confirm that I do not have any of the following:

Known allergy to testosterone
Known or suspected male breast cancer
I still want to have children
Metastatic or high risk prostate cancer
Uncontrolled heart disease (eg. angina, blood pressure, arrhythmia)
Recent stroke, heart attack or DVT/clot

If your bloodwork results indicate that you do not qualify for the program, you will only be required to pay $100, and a $299 refund will be issued to you.

Yes, I confirm No, I do not qualify

By submitting the form, you certify that your answers are an honest reflection of your medical record

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I confirm that I do not have any of the following:

I confirm that I do not have any of the following: