What Blood Tests Should Men Get?

The standard annual physical for men typically includes a basic blood panel: Complete Blood Count (CBC), Comprehensive Metabolic Panel (CMP), Lipid Panel, and sometimes TSH. That's a reasonable foundation but it's missing several of the markers that actually move the needle for men's long-term health.

The annual foundation (every year, regardless of age):

• Complete Blood Count (CBC) — screens for anemia, infection, immune patterns. Rarely abnormal in healthy men but important baseline.
• Comprehensive Metabolic Panel (CMP) — kidney function (BUN, creatinine, eGFR), liver function (ALT, AST), electrolytes, fasting glucose. Catches the silent issues — early kidney disease, fatty liver, electrolyte imbalances from medications or dehydration.
• Lipid Panel — Total Cholesterol, LDL, HDL, Triglycerides. The basics of cardiovascular risk. Most insurance covers this annually.
• TSH + Free T4 (Thyroid) — TSH alone misses subclinical patterns. Adding Free T4 catches the cases where TSH is normal-ish but Free T4 is in the lower range, which causes fatigue and weight gain.
• Hemoglobin A1c — 90-day average blood sugar. Annual diabetes screening. Pre-diabetes (A1c 5.7-6.4%) affects ~96 million US adults; 80% don't know.
• Vitamin D, 25-Hydroxy — ~40% of US adults are deficient; critical for testosterone synthesis, immune function, bone health.
• Hemoglobin / Hematocrit (included in CBC) — important to track if you start testosterone replacement therapy, which can elevate red blood cell counts.

The General Wellness Panel ($89.99) covers CBC + CMP + Lipid + TSH. The Essential Health Panel ($189.99) upgrades to include A1c + Vitamin D + hs-CRP + Ferritin + Fasting Insulin — our most-recommended annual workup for men in their 30s+.

The traditional lipid panel (Total Cholesterol, LDL, HDL, Triglycerides) was the gold standard 30 years ago. Modern cardiology has identified two markers that are stronger predictors of cardiovascular risk than basic LDL, and one that's a one-time-only genetic test.

ApoB (Apolipoprotein B). The single best blood marker for atherogenic risk. Where LDL measures cholesterol weight in particles, ApoB counts the actual particle number. Two men with the same LDL can have very different ApoB if one has more, smaller, denser particles (worse). ApoB cuts through that and gives a single number that maps directly to cardiovascular risk. Optimal ApoB for primary prevention is below 90 mg/dL; for high-risk individuals, below 80.

Lp(a) (Lipoprotein(a)). Genetically determined cardiac risk marker. Test ONCE in your life — Lp(a) is established by age 5 and doesn't meaningfully change. About 20% of people have elevated Lp(a) (above 30 mg/dL or 75 nmol/L) and don't know it; elevated Lp(a) carries 2-3x normal cardiac risk regardless of LDL or other markers. Most primary care doctors don't order it; cardiologists routinely do. Knowing your Lp(a) early lets you adjust the rest of your cardiac strategy accordingly.

hs-CRP (High-Sensitivity C-Reactive Protein). Vascular inflammation marker. Independently predicts cardiac events even when cholesterol is normal. Optimal hs-CRP is below 1.0 mg/L; 1-3 mg/L is moderate cardiac risk; above 3.0 is high. Two of the most-cited cardiology studies (JUPITER and Women's Health Study) showed hs-CRP independently predicts events when added to standard lipid panels.

The Heart Health Panel ($74.99) bundles ApoB + Lp(a) + hs-CRP with a Lipid Panel and HbA1c — comprehensive cardiac risk evaluation in one draw. Cost via insurance billing typically runs $200-400 for the equivalent.

When to test:

• Lp(a) once in your life, ideally before age 40
• ApoB annually starting age 30-35 (especially if family history of cardiovascular disease)
• hs-CRP annually, especially if you have any cardiac risk factors
• Standard lipid panel annually after age 30; every 4-6 years before that if no risk factors

Testosterone declines gradually from the 30s onward, with substantial individual variation. Some men maintain healthy testosterone into their 60s; others see meaningful decline starting in their 30s. Symptoms of low testosterone include: persistent fatigue, decreased libido, erectile dysfunction, mood changes, difficulty building or maintaining muscle, increased body fat (especially abdominal), poorer recovery from exercise, and decreased motivation.

What to test:

• Total Testosterone — the standard first-line screen. Normal range: typically 264-916 ng/dL (varies by lab). Optimal range for symptom-free function in most men: 500-800.
• Free Testosterone — the unbound, biologically active fraction. About 98% of testosterone in blood is bound to SHBG and albumin and unavailable for use. Free Testosterone measures what's actually accessible to your tissues. Critical because SHBG (the binding protein) increases with age, so total testosterone can look normal while functional/free testosterone is low.
• SHBG (Sex Hormone-Binding Globulin) — the binding protein. High SHBG (often from age, alcohol use, hyperthyroidism, or liver issues) reduces bioavailable testosterone. Low SHBG (often from insulin resistance, obesity, hypothyroidism) increases bioavailable testosterone but also typically correlates with metabolic dysfunction.
• Estradiol — yes, men need estradiol too. Testosterone converts to estradiol via the aromatase enzyme; rates vary widely. Elevated estradiol relative to testosterone causes water retention, mood changes, gynecomastia, and fatigue. Standard reference range for men: 10-40 pg/mL.

For a complete picture, the Men's Hormone Panel ($159.99) covers: Total + Free Testosterone, SHBG, Estradiol, DHEA-S, Cortisol, Prolactin, and IGF-1. This is the workup most andrologists and men's-health specialists would order.

Critical testing details:

• Morning draws (7-10 AM) are essential. Testosterone peaks early in the morning and drops 30-50% by afternoon. Always test in the morning.
• Two readings before treatment decisions. Testosterone is naturally variable; a single low reading should be confirmed with a second test at least 2-4 weeks later before considering TRT.
• Stop biotin supplements 72 hours before the draw. Biotin interferes with hormone assays.
• Avoid testing during acute illness. Testosterone temporarily drops during illness; wait 2-3 weeks after recovery for an accurate baseline.

When to test:

• Baseline in your early 30s if you want longitudinal data
• Test if you have symptoms of low testosterone at any age
• Annual or every 2 years from your 40s onward if monitoring trends
• Every 3-6 months if you start testosterone replacement therapy (TRT) to monitor levels, hematocrit, PSA, and other relevant markers

Prostate-Specific Antigen (PSA) — for prostate cancer screening. The American Urological Association recommends:

• Discuss screening with your doctor starting age 40-45 for men at higher risk (Black men, family history of prostate cancer, BRCA mutations)
• Routine PSA screening considered for men ages 55-69 (with shared decision-making about benefits and risks)
• Generally not recommended after age 70 unless specific risk factors

PSA testing is more nuanced than it sounds — elevated PSA can reflect prostate cancer OR benign prostatic hyperplasia (enlargement that's common with age) OR prostatitis (inflammation/infection) OR recent ejaculation, intense exercise, or DRE (digital rectal exam). PSA results need clinical interpretation. The free vs total PSA ratio adds specificity — the PSA Free + Total test ($48.99) is more informative than total PSA alone.

Metabolic Health (A1c + Fasting Glucose + Fasting Insulin)

The Diabetes Screening Panel ($59.99) covers all three. Critical for men because:

• Insulin resistance and pre-diabetes are extremely common (~38% of US adults)
• Both directly suppress testosterone production (creating a fatigue + low T + weight gain spiral)
• Both dramatically increase cardiovascular risk
• Fasting insulin rises before A1c becomes abnormal — catching the issue at the most reversible stage

Test annually starting age 30; more frequently if family history of diabetes, currently overweight, or have any metabolic syndrome features (high blood pressure, low HDL, high triglycerides, abdominal obesity).

Age-specific additions:

30s:

• Baseline testosterone (Free + Total + SHBG) if you want longitudinal data
• Lp(a) — test once for lifetime cardiac risk stratification
• Vitamin D, B12 if vegetarian/vegan

40s:

• Annual ApoB + hs-CRP for cardiac risk
• Annual testosterone with full hormone profile if symptomatic
• Fasting insulin alongside A1c for early insulin resistance detection

50s+:

• PSA screening discussion with primary care (and consider Free + Total PSA for better specificity)
• Annual cardiac risk markers — patterns established here predict outcomes for decades
• Bone health markers if osteoporosis family history (vitamin D + calcium + sometimes PTH)
• Colon cancer screening through colonoscopy (not bloodwork) starting age 45