Tests for men after 40: testosterone and what matters more

Many men want to start with "hormones" — get testosterone checked and see the answer in a number. But the most useful tests after 40 are about something else: the heart, blood vessels and metabolism. They're the ones that catch what doesn't hurt for years and then decides a lot.

Testosterone — how to test so you're not misled

• In the morning. The level changes during the day, so the morning test is the one that counts.
• Twice. One test says little — low testosterone is judged only on two morning results, together with a doctor.
• Not while you're ill. A cold, the flu or any acute illness temporarily lowers testosterone, and the result is misleading.

And remember: low testosterone after 40 more often shows that the body is struggling than causes it. More in the article "Andropause: what really happens to men after 40".

Know your numbers: what matters most for the heart and metabolism

• Blood pressure — regularly, with a validated upper-arm cuff.
• Blood sugar — fasting glucose or HbA1c.
• Lipids, and if possible ApoB: it shows the particles that harm blood vessels more accurately than ordinary "bad cholesterol".
• Lp(a) — once in a lifetime is enough. It's inherited and raised in about one in five people.
• hs-CRP — a marker of low-grade inflammation, if your doctor orders it. Guide values: below 1, from 1 to 3, above 3 mg/L. Above 10 usually means an acute infection: the test is repeated in 2–3 weeks. A single result is unreliable.

If your heart risk is intermediate, your doctor may suggest a coronary artery calcium scan (CAC) — a short test that helps decide whether you need a statin.

What else, by age and by signals

• Bowel cancer screening — from age 45. A colonoscopy or a stool test. No diet or supplement replaces it.
• PSA is a personal decision made together with a doctor. There's a benefit, but also plenty of unnecessary worry and procedures. If prostate cancer runs in your family — discuss it earlier.
• The thyroid — thyroid disease is rare in men, so TSH is tested when there are signals and a doctor orders it. Biotin from "hair and nail" supplements distorts the result — it's stopped a few days before.

What you don't need to test

• Cortisol "to check stress". It's a test for specific diseases, not for how you feel: in a tired man it gives false alarms.
• Paid microbiome tests. The same sample gives different answers in different labs.
• A glucose sensor "for optimisation" if your sugar is normal: rises after meals are normal in healthy people, and the sensor only adds worry.

What about watches and rings?

They give trends and flags, but they don't see plaque in the arteries or cholesterol, and they don't measure blood pressure reliably. An irregular rhythm notification is worth showing a doctor. But no notification rules nothing out — neither rhythm problems nor apnea. A "perfect" dashboard doesn't replace tests.

What to try this week

• Measure your blood pressure at home, morning and evening, two or three days in a row.
• Find your latest test results: what from the list you already have, and what's missing.
• Write a list for your doctor of what you want to discuss.

This is general information, not a prescription. Which tests to take is decided by a doctor.