Men's Health After 40: The Blood Tests That Matter Most

Something shifts after 40. Maybe your recovery from exercise takes longer. Perhaps your waistline has expanded despite eating the same as a decade ago. Your energy dips in the afternoon, your sleep deteriorates, or your mood flattens for no obvious reason.

These aren't just signs of getting older — they're signals. And the right blood tests can tell you exactly what's driving them.

For men, the decade after 40 is when the risk of heart disease, type 2 diabetes, prostate cancer, and hormonal decline climbs sharply. Every one of these conditions is either preventable or far more treatable when caught early. Yet most men don't get tested until symptoms become impossible to ignore.

Why 40 Is the Turning Point

Your body at 40 is fundamentally different from your body at 30. Testosterone has been declining at roughly 1–2% per year since your late twenties. Your metabolic rate has slowed. Insulin resistance may be building silently. Arterial plaque that began forming in your twenties is now clinically relevant.

The NHS Health Check programme invites men over 40 for a basic cardiovascular risk assessment every five years. It catches problems once they're fairly advanced but misses the early warning signs that could have prompted intervention years sooner. A comprehensive annual blood test covers the gaps: advanced cardiovascular markers, hormonal health, prostate screening, metabolic resilience, and nutritional status.

Practical takeaway: Don't wait for an NHS invitation. A proactive annual blood test from age 40 is one of the highest-return investments in your health you can make.

Heart Health: Beyond Basic Cholesterol

Cardiovascular disease is the leading cause of death in men in the UK. The British Heart Foundation estimates that 1 in 8 men will die from coronary heart disease. Yet the standard cholesterol test your GP orders — total cholesterol, HDL, LDL, triglycerides — gives only a partial picture.

The markers that matter most for men over 40 include:

• ApoB (apolipoprotein B) — counts the actual number of atherogenic particles in your blood. Superior to LDL cholesterol for predicting heart attacks. The ESC guidelines recommend targeting below 0.65 g/L for high-risk individuals
• Lp(a) (lipoprotein-a) — a genetically determined risk factor that standard cholesterol treatment doesn't address. Test it once; if elevated (above 75 nmol/L), your overall risk profile needs recalibrating
• hsCRP (high-sensitivity C-reactive protein) — measures the chronic inflammation that drives atherosclerosis. Below 1.0 mg/L is optimal; above 3.0 mg/L doubles cardiovascular risk independently of cholesterol
• Triglyceride:HDL ratio — a simple calculated marker of metabolic health and cardiovascular risk. Optimal is below 1.0 (in mmol/L units); above 1.7 suggests insulin resistance and elevated risk

Most men get their first cholesterol test at 40 and are told it's "fine." Without ApoB and Lp(a), that reassurance may be premature.

Practical takeaway: Ask for ApoB alongside your standard lipid panel. If your GP won't add it, a private blood test can fill the gap. It's the single most informative upgrade to a basic cholesterol check.

Prostate Screening: PSA Explained

Prostate cancer is the most common cancer in men in the UK, with around 52,000 new diagnoses annually according to Prostate Cancer UK. Yet the NHS does not offer routine PSA screening — you have to request it.

PSA (prostate-specific antigen) is a protein produced by the prostate gland. Elevated levels can indicate prostate cancer, but also benign prostatic enlargement (BPH) or prostatitis. Here's how to interpret it:

• PSA below 1.0 µg/L at age 40–50 — very low risk, predicting low lifetime risk of clinically significant prostate cancer
• PSA 1.0–3.0 µg/L — normal for most men, but worth tracking. A rising trend matters more than any single reading
• PSA above 3.0 µg/L — warrants investigation, but doesn't necessarily mean cancer. Infection, recent ejaculation, vigorous cycling, and BPH can all raise PSA
• PSA velocity — a rise of more than 0.75 µg/L per year is more concerning than a single mildly elevated reading

The key is establishing a baseline PSA at 40 and tracking it over time.

Practical takeaway: Request a PSA test at 40. If it's below 1.0 µg/L, test every 2–3 years. Above 1.0, annual testing establishes your personal trend. Avoid ejaculation and vigorous exercise for 48 hours before the test.

Testosterone Decline: What to Watch For

Testosterone declines gradually from the late twenties, but the effects typically become noticeable in the forties and fifties. According to the BSSM guidelines, clinically significant testosterone deficiency affects approximately 2–6% of men aged 40–79.

The symptoms — fatigue, reduced libido, difficulty concentrating, low mood, increased body fat — are frustratingly non-specific, which is why blood testing is essential.

Key markers include:

• Total testosterone — measured before 10am when levels are highest. Below 12 nmol/L is considered low; 12–15 nmol/L is a grey zone where symptoms and free testosterone matter
• Free testosterone — more clinically relevant than total testosterone after 40, when rising SHBG traps more testosterone in an inactive state
• SHBG — high SHBG means less bioavailable testosterone even if total levels appear adequate
• LH (luteinising hormone) — distinguishes between primary testicular failure (high LH) and secondary pituitary/hypothalamic causes (low or normal LH)

Practical takeaway: Get a morning testosterone panel including total testosterone, free testosterone, SHBG, and LH. One test isn't diagnostic — if low, confirm with a repeat test on a separate morning.

Thyroid and Metabolic Health

Men tend to think of thyroid problems as a women's issue. They're not. While women are affected more frequently, thyroid dysfunction in men is under-diagnosed precisely because clinicians don't look for it.

Hypothyroidism in men causes fatigue, weight gain, constipation, cold intolerance, low mood, and reduced libido — symptoms that overlap almost entirely with low testosterone. Testing both simultaneously is essential to avoid misdiagnosis.

For metabolic health, the markers that matter most after 40 are:

• HbA1c — average blood sugar over 2–3 months. Below 42 mmol/mol (6.0%) is non-diabetic; 42–47 mmol/mol is pre-diabetic and the ideal window for lifestyle intervention
• Fasting insulin — rises years before blood sugar does. Elevated fasting insulin (above 60 pmol/L) signals insulin resistance, even when glucose and HbA1c look normal
• TSH, Free T4, Free T3 — a complete thyroid assessment rather than TSH alone

The interaction between metabolic health, testosterone, and thyroid function is bidirectional. Insulin resistance lowers testosterone. Low testosterone worsens insulin resistance. Thyroid dysfunction amplifies both. Testing all three systems together gives a coherent picture rather than isolated data points.

Practical takeaway: Never test testosterone in isolation. Always include thyroid function and metabolic markers. The three systems are deeply interconnected, and optimising one without checking the others leads to incomplete answers.

The Vitamin Gaps Men Miss

Men are notoriously poor at addressing nutritional deficiencies. The assumption that a "decent diet" provides everything you need is, unfortunately, often wrong — particularly after 40 when absorption efficiency declines and nutrient requirements for tissue repair increase.

The most commonly missed deficiencies in men over 40:

• Vitamin D — critical for testosterone production, bone health, and immune function. Deficient in an estimated 40% of UK adults during winter. Optimal is above 75 nmol/L; below 25 nmol/L is clinically deficient
• Magnesium — essential for muscle function, sleep quality, blood pressure regulation, and testosterone production. Deficiency causes cramps, poor sleep, and irritability
• Vitamin B12 — neurological function, red blood cell production, and energy metabolism. Risk increases with age due to declining stomach acid. Below 200 ng/L is deficient
• Ferritin — men rarely think about iron, but ferritin is also a marker of inflammation when elevated. Paradoxically, both very low and very high ferritin warrant investigation
• Zinc — directly involved in testosterone synthesis. Deficiency impairs immune function and wound healing

Practical takeaway: Include a nutritional panel alongside your hormonal and cardiovascular tests. Deficiencies are cheap to identify and cheap to correct, but the impact on energy, mood, and physical performance can be transformative.

Building Your Annual Blood Test Routine

Here's a practical framework for men's health testing after 40:

Annually:

• Full lipid panel with ApoB
• HbA1c and fasting glucose
• Fasting insulin
• Full thyroid panel (TSH, Free T4, Free T3)
• Testosterone (total and free), SHBG, LH
• PSA
• Vitamin D, B12, folate, ferritin, magnesium
• Liver function (ALT, AST, GGT)
• Kidney function (creatinine, eGFR)
• Full blood count (FBC)
• hsCRP

Once (or as directed):

• Lp(a) — genetically fixed; one test gives lifetime information
• HbA1c trend over time — building a multi-year picture

Timing matters: Book your blood test for first thing in the morning, fasted for at least 10 hours. This ensures accurate readings for glucose, insulin, lipids, and testosterone (which peaks in the morning and declines throughout the day).

Practical takeaway: Treat your annual blood test like a vehicle MOT — non-negotiable, scheduled in advance, and acted upon. The difference is that, unlike your car, you can't replace the engine.

Book Your Test

Ready to take control of your health? Book your men's health after 40: the blood tests that matter most test today and get results within days.