A standard physical checks cholesterol and blood sugar and calls it a day. These ten add the things that actually change what a man in his forties does next.
- Total and free testosterone, drawn before 10 a.m., twice. Free testosterone is the fraction actually available to your tissues, and it can be low while total looks normal. The Endocrine Society guideline asks for two separate morning fasting draws before calling anything low, because a single value moves too much to trust.
- SHBG. The protein that binds testosterone. High SHBG is the usual reason a normal total testosterone still leaves a man symptomatic.
- LH and FSH. These tell you whether a low testosterone is coming from your brain or your testes, which decides the entire treatment path.
- A full thyroid panel, not just TSH. Free T4 and free T3. Thyroid disease imitates low testosterone almost perfectly.
- Hemoglobin A1c and fasting insulin. A1c shows three months of blood sugar. Fasting insulin turns abnormal years before A1c does, which is the whole point of measuring it.
- Ferritin and a full iron panel. Low ferritin causes fatigue at normal hemoglobin. High ferritin with high saturation can mean hemochromatosis, which is common in men of Northern European descent and quietly damages the liver and heart.
- Lipoprotein(a). More than 90 percent genetically determined, measured once in your life, and not on a standard lipid panel. The European Atherosclerosis Society treats it as a causal cardiovascular risk factor, and roughly 20 to 25 percent of people worldwide carry an elevated level.
- ApoB. A direct count of atherogenic particles, since every one of them carries exactly one ApoB molecule. It is a more accurate marker of risk than LDL cholesterol, which measures cholesterol mass rather than particle number, and it is increasingly the number cardiologists actually treat to.
- Vitamin D, 25-hydroxy. Not optional in a state with eight months of cloud cover. Deficiency here is closer to the rule than the exception.
- PSA, with a baseline in your forties. The single value matters less than the trend, and you cannot see a trend without a starting point.
How to actually get them
Bring the list to your primary care provider and ask which ones your insurance will cover. Most of these are ordinary orders. For anything declined, cash pricing at a Quest or Labcorp patient service center is usually modest, and you can order many of them yourself through the lab’s consumer service without a physician visit.
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References
- Kronenberg F, Mora S, Stroes ESG, et al. Lipoprotein(a) in atherosclerotic cardiovascular disease and aortic stenosis: a European Atherosclerosis Society consensus statement. Eur Heart J. 2022;43(39):3925-3946. European Heart Journal
- Sniderman AD, Thanassoulis G, Glavinovic T, et al. Apolipoprotein B particles and cardiovascular disease: a narrative review. JAMA Cardiol. 2019;4(12):1287-1295. PubMed
- Bhasin S, Brito JP, Cunningham GR, et al. Testosterone therapy in men with hypogonadism: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2018;103(5):1715-1744. PubMed
- National Institutes of Health, Office of Dietary Supplements. Vitamin D fact sheet for health professionals. ods.od.nih.gov
Educational content only, not medical advice. Talk to your clinician before making changes.