Men's health after 40: values worth following every year

Why yearly values beat one off checks

Your forties are the decade when silent risks take hold. Blood fats, blood sugar and blood pressure can sit wrong for years without being felt, and most of what later becomes a heart attack, a stroke or type 2 diabetes builds slowly through exactly these years. It is also the decade when early discovery pays off most, because nearly everything found can still be influenced by habits or straightforward treatment.

The strongest argument for a yearly measurement, though, is not any single value but the trend. A one off result is compared against a reference range built on the population, and reference ranges are wide. An HbA1c creeping upward year by year, or a PSA rising faster than expected, can be worth acting on long before any single value crosses a line. Without a history of your own, that information is invisible.

A yearly measurement gives you two things, in other words: a baseline that is yours, and a direction. The direction is often more telling than the level.

This guide covers the areas that are sensible to follow yearly from around 40: heart and blood fats, blood sugar and liver, hormones, prostate, and kidneys and blood count. In each area it is a small number of well established values, not an attempt to measure everything measurable.

The heart and the blood fats

Cardiovascular disease is still the most common cause of death among men, and the blood fats are the part of the risk that is easiest to measure and follow. The base values are LDL cholesterol (the cholesterol deposited in artery walls), HDL cholesterol, total cholesterol and triglycerides. The link between LDL and atherosclerosis is well established, and it is the accumulated exposure over decades that matters, which is the whole argument for knowing your levels early rather than late.

Beyond the base panel, two values deserve to be better known. ApoB (apolipoprotein B) counts the number of particles that can lodge in the artery wall, a measure many consider to reflect risk at least as well as LDL, particularly when triglycerides are high. Non-HDL cholesterol captures something similar and comes along for free in an ordinary lipid panel.

Lp(a) is a special case. The level is largely genetically set, a clearly raised level means increased cardiovascular risk, and the value changes little over a lifetime. The usual recommendation is therefore to measure it once in a lifetime, not yearly; if it is high, a doctor weighs it into the overall risk picture.

Two more things belong here even though they are not blood values: blood pressure, which deserves a yearly measurement as much as the blood fats do, and hs-CRP (a sensitive measure of low grade inflammation), which can add context but is read with caution since passing infections affect it.

Blood sugar, liver and the metabolic picture

Type 2 diabetes rarely arrives suddenly. It is usually preceded by years in a grey zone where blood sugar runs raised without reaching diabetes level, and it is in that grey zone that measuring is most useful, because the trajectory there can often be slowed or turned around with habits.

HbA1c (long term blood sugar) is the workhorse: it reflects the average level over the past two to three months and is not affected by what you ate yesterday. Fasting glucose adds a snapshot. Read together year by year, an upward drift shows itself early, while it is still easy to act on.

The combination of raised triglycerides and low HDL is worth recognising, since it is often an early trace of insulin resistance (the body's cells responding more sluggishly to insulin), sometimes ahead of blood sugar itself.

The liver values belong to the same picture. ALAT and GT are simple measures of liver strain, and the most common cause of raised values in middle aged men is fat accumulation in the liver, which is closely tied to weight and insulin resistance and in its early stage often reverses with weight loss. Alcohol particularly affects GT and is the other common explanation. Urate (uric acid), finally, is the value behind gout and often rises in the same metabolic pattern; a high value is a reason to review habits before the first gout attack, not after.

The hormones: testosterone and thyroid

Testosterone declines gradually in most men, on average by roughly one percent per year from the thirties onward. The decline is slow and not in itself a disease, but it interacts with another change: SHBG (the protein that binds testosterone) rises with age, which means the free, working portion often falls faster than the total. A total value that looks stable can therefore hide a real decline in available hormone.

That is why testosterone should be followed in full: total and free values plus SHBG with their ratio, rather than as a single number. And it is also where the yearly perspective earns its keep. Where your levels sat at 42 is the natural comparison point at 52, far more precise than a population interval.

At the same time, one thing deserves to be said plainly: the number is not the goal. Low energy, reduced drive and slower recovery can come from testosterone, but just as often from sleep, stress, weight or something else entirely, and a value within the reference range in a man without symptoms is nothing to fix. The value is a puzzle piece that gets its meaning next to how you feel, and interpreting an abnormal result belongs with a doctor.

The thyroid is the other hormone axis worth a yearly look. TSH (the pituitary's signal to the thyroid) catches most of it, and an imbalance can produce exactly the tiredness and sluggishness otherwise easily blamed on age.

The prostate and PSA, without simplifications

PSA (prostate specific antigen) is a protein from the prostate, and it is the most debated value in men's health checks. It deserves an honest description rather than a selling one.

First the limitations. PSA is not a cancer test. The value also rises with benign prostate enlargement, which is very common from middle age, and with inflammation in the prostate; recent ejaculation can affect it too. A raised PSA therefore most often means something other than cancer. At the same time, PSA measurement can find slow growing tumours that would never have caused trouble in a man's lifetime, which is the real downside of screening: the risk of investigating and treating something that could have been left alone. And in the other direction, a normal value does not fully rule disease out.

Then the benefit. Regular PSA measurement can, according to large studies, reduce the risk of dying of prostate cancer, and the ratio between free and total PSA makes a raised value easier to interpret, since benign enlargement and cancer tend to produce different ratios. Several Swedish regions now offer organised prostate cancer testing with invitations in certain age groups. Age and family history carry real weight: a father or brother with prostate cancer is a reason to start following the value earlier.

The conclusion is not to abstain, but to go in with open eyes. For men without symptoms, PSA testing is an informed individual decision. Socialstyrelsen, the Swedish National Board of Health and Welfare, advises against unorganised population screening, but supports testing for men who have weighed the pros and cons, with interpretation adjusted for age. From around 50, regular PSA measurement is a reasonable choice for anyone who wants to follow his value, and a father or brother with prostate cancer is a reason to start already around 45. How often to test is best agreed with a doctor, and a raised value means unhurried investigation, not a verdict.

The yearly values in this guide are included in Health Check Man, a yearly test taken without a referral whenever it suits you.

The rest of the picture, and how to make it a habit

A few more areas belong in a yearly review, even if they are rarely dramatic. Kidney function is followed with creatinine, ideally complemented by cystatin C, a measure that unlike creatinine is not affected by muscle mass and therefore gives a fairer picture in well trained men. A blood count with hemoglobin catches anemia, which in men is always worth taking seriously and investigating. Ferritin (the body's iron stores) is informative in both directions: low with iron deficiency, but a clearly raised value is also worth a doctor's visit, since it can reflect inflammation or inherited iron loading. Vitamin D earns its place at northern latitudes, especially after the winter months.

What makes the values useful, though, is the routine rather than the list itself. Three simple principles are enough. Measure at roughly the same time of year, so seasonal effects do not disturb the comparison. Keep the results, because your own history is the reference material no population interval can replace. And act on directions, not only on limits: a value that has drifted the wrong way three years in a row is worth a conversation with a doctor even if it still sits within the reference range, and then the trend is what matters most.

A yearly blood test never replaces care when something feels wrong; new symptoms are always a reason to see a doctor regardless of what the last test showed. But as habits go, the yearly measurement is hard to beat: one hour a year to know where you stand, and which way things are heading.

This article is general health information, not medical advice and not an assessment of your values. If you have symptoms or concerns, contact your healthcare provider.