Men's Health Blood Test After 40: What You Should Check

Turning 40 does not come with a warning siren, but biologically it probably should. Testosterone begins declining at roughly 1–2% per year from the early thirties. Cardiovascular risk starts climbing. Prostate cancer moves from theoretical to statistically relevant. Metabolic rate slows while visceral fat accumulates more easily. None of this is inevitable destiny — but all of it is measurable, and catching changes early is the difference between prevention and damage control.

What changes after 40 in men

The NHS Health Check programme invites men over 40 for a basic cardiovascular screen every five years. That check covers cholesterol, blood pressure, BMI and blood glucose — useful but nowhere near comprehensive. It misses testosterone, prostate markers, thyroid function, vitamin status and the liver markers that reflect decades of accumulated wear. A proper blood panel fills those gaps.

Testosterone, free testosterone and SHBG

Total testosterone in adult men typically ranges from 8.64 to 29 nmol/L, but by 45 the average sits closer to 15–18 nmol/L. The real picture, however, depends on free testosterone — the 2–3% not bound to SHBG or albumin. SHBG (sex hormone-binding globulin) tends to increase with age, effectively sequestering more testosterone and reducing the amount available to tissues.

A man with a total testosterone of 14 nmol/L and a high SHBG of 65 nmol/L may have a free testosterone well below the reference range, despite his total looking "acceptable." Symptoms of low free testosterone include fatigue, reduced libido, difficulty building muscle, increased body fat (particularly abdominal), irritability and poor concentration.

If testosterone is low, checking LH and FSH distinguishes between primary hypogonadism (testicular failure — LH will be elevated) and secondary hypogonadism (pituitary or hypothalamic — LH will be low or inappropriately normal). This distinction matters because treatment differs significantly.

PSA — prostate screening

Prostate cancer is the most common cancer in men in the UK, with around 52,000 new cases diagnosed each year. Risk increases substantially after 50 (after 45 for Black men and those with a family history). PSA (prostate-specific antigen) is not a perfect test — it can be elevated by benign prostatic hyperplasia, infection, recent ejaculation or vigorous cycling — but it remains the most accessible screening tool available.

A PSA below 3.0 ng/mL is generally considered normal for men under 60. Between 3 and 10 ng/mL warrants further investigation. Above 10 ng/mL significantly raises concern. Tracking PSA over time (velocity) is more informative than any single reading — a rapid rise, even within the "normal" range, deserves attention.

Starting PSA monitoring at 40 establishes a baseline. If it is low (below 1.0 ng/mL at 40), your lifetime risk is substantially reduced and less frequent testing may suffice. If it is already above 1.5 ng/mL at 40, closer monitoring is warranted.

Full lipid panel

Cardiovascular disease remains the leading cause of death in UK men. A basic cholesterol check measures total cholesterol and HDL, but a full lipid panel adds LDL, triglycerides, total cholesterol/HDL ratio and, ideally, non-HDL cholesterol. Non-HDL cholesterol (total minus HDL) is increasingly considered a better predictor of cardiovascular risk than LDL alone because it captures all atherogenic particles.

Key targets: LDL below 3.0 mmol/L (below 2.0 if high risk), triglycerides below 1.7 mmol/L, HDL above 1.0 mmol/L, non-HDL below 4.0 mmol/L. After 40, even small elevations in LDL compound over time — a concept called "cumulative LDL exposure." Early intervention with diet, exercise or statins prevents decades of arterial damage.

HbA1c — diabetes risk

Type 2 diabetes affects around 4.3 million people in the UK, with an estimated 850,000 more undiagnosed. Risk rises sharply after 40, particularly for men carrying visceral fat. HbA1c measures average blood sugar over the preceding 2–3 months, expressed in mmol/mol:

• Below 42 mmol/mol: Normal
• 42–47 mmol/mol: Pre-diabetes — a critical window where lifestyle changes can reverse the trajectory
• 48 mmol/mol and above: Diabetic range

Pre-diabetes is the single most valuable early warning in a blood test. Roughly 50% of people with pre-diabetes progress to type 2 within 10 years without intervention, but structured lifestyle changes reduce that risk by 58%.

Liver function

By 40, the liver has absorbed decades of alcohol, paracetamol, processed food and, increasingly, non-alcoholic fatty liver disease (NAFLD). An estimated 1 in 3 UK adults has some degree of NAFLD, and most are unaware. Key markers include:

• ALT (alanine aminotransferase): The most liver-specific enzyme. Above 35 U/L warrants investigation. Some labs use 41 U/L as the upper limit, but emerging evidence suggests even levels above 25 U/L may indicate early fatty liver.
• GGT (gamma-glutamyl transferase): Sensitive to alcohol and metabolic liver stress. Elevated GGT with normal ALT often indicates alcohol-related strain; elevated GGT with elevated ALT suggests NAFLD or other hepatocellular damage.
• ALP, bilirubin and albumin complete the picture.

Thyroid function

Thyroid disorders are less common in men than women but far from rare — around 1 in 20 men over 60 has subclinical hypothyroidism. Symptoms overlap heavily with "normal ageing" and low testosterone: fatigue, weight gain, cold intolerance, brain fog, depression. A TSH, Free T4 and Free T3 panel distinguishes thyroid from testosterone as the root cause.

Vitamin D

Vitamin D below 50 nmol/L is associated with increased cardiovascular risk, reduced testosterone production, impaired immune function and higher rates of depression. Men who work indoors, have darker skin, or live in northern regions of the UK are at highest risk. Optimal levels sit between 75 and 150 nmol/L.

Full blood count

A full blood count (FBC) screens for anaemia, infection, and haematological abnormalities. Haemoglobin, haematocrit, MCV and platelet count provide a baseline that makes future changes easier to interpret. In men over 40, a high haematocrit (above 0.52 L/L) can indicate polycythaemia — sometimes caused by testosterone replacement therapy, sleep apnoea or chronic hypoxia.

Recommended Lola Health tests

• Peak Insights 70 — £185 — The most comprehensive option: 70 biomarkers including PSA, total and free testosterone, SHBG, full lipid panel, HbA1c, liver function, kidney function, thyroid (TSH, Free T4, Free T3), vitamin D, B12, folate, iron studies and full blood count. This is the test built for men over 40 who want a complete annual screen.
• Core Health 45 — £120 — Covers 45 biomarkers including thyroid, vitamins, liver, kidney, HbA1c and full blood count. A strong general health check, though it does not include PSA or the full hormone panel.
• Male Hormones Clarity 14 — £110 — Focused on the hormonal picture: total testosterone, free testosterone, SHBG, oestradiol, prolactin, DHEA-S, LH, FSH and thyroid markers. Ideal if testosterone-related symptoms are the primary concern.

How often should men over 40 test?

Annually is the standard recommendation. If your first panel reveals anything borderline — PSA above 1.5, HbA1c above 40, testosterone below 12 nmol/L, or elevated liver enzymes — retest in 6 months to establish a trend. A single result is a snapshot; two or more results over time reveal whether something is stable, improving or deteriorating.

The bigger picture

Men in the UK are statistically less likely to visit a GP, less likely to act on symptoms and more likely to die from preventable conditions. A comprehensive blood test at 40 is not hypochondria — it is the minimum due diligence for a body that is starting to accumulate risk. The numbers do not lie, and they do not require a referral. Order, test, read your results, and take the appropriate action. That is how you stay ahead of the curve rather than behind it.