Men's Health Blood Tests
Testosterone, prostate health, cardiovascular risk, and iron overload — the blood tests that matter most for men at every age. Know your numbers before problems start.
Core Panel Every Man Needs
Men are statistically worse at getting regular health checks — Australian men are 30% less likely than women to visit a GP. Yet men have higher rates of cardiovascular disease, liver disease, and die on average 4 years earlier. A simple annual blood test catches problems early, when they are most treatable.
| Test | Why It Matters | Men-Specific Note |
|---|---|---|
| Full Blood Count (FBC) | Checks for anaemia, polycythaemia, infection | Men have higher haemoglobin reference ranges (130-170 g/L vs 120-150 for women). Elevated haemoglobin can indicate testosterone excess or haemochromatosis. |
| Lipid Panel (Total, LDL, HDL, Triglycerides) | Cardiovascular risk — the #1 killer of men | Men develop cardiovascular disease 10 years earlier than women on average. Lipid screening should start at 20. |
| HbA1c | 3-month average blood sugar | Men are more likely to develop type 2 diabetes at a lower BMI than women. Visceral (belly) fat is the key risk factor. |
| Liver Function (ALT, AST, GGT) | Liver health, alcohol impact, fatty liver | Men drink more alcohol on average and have higher rates of alcoholic and non-alcoholic fatty liver disease. GGT is particularly sensitive to alcohol. |
| Kidney Function (eGFR, Creatinine) | Kidney filtration and muscle metabolism | Men have higher creatinine due to greater muscle mass — eGFR adjusts for this. Chronic kidney disease is often silent until advanced. |
| Thyroid Function (TSH) | Thyroid regulation | Less common in men than women, but still affects 1-2% of men. Hypothyroidism causes fatigue, weight gain, and erectile dysfunction. |
| Vitamin D (25-OH) | Bone health, testosterone support, immune function | Vitamin D deficiency is linked to low testosterone. Adequate vitamin D supports bone density and muscle function. |
Testosterone and Hormones
Testosterone is the hormone men search for most often. Low testosterone (hypogonadism) affects an estimated 1 in 200 men under 60 and up to 1 in 5 men over 60. But getting an accurate testosterone reading requires understanding when and how to test it.
Total Testosterone
Significance: Primary measure of testosterone production
Key note: MUST be taken between 7-10am when levels peak. Afternoon levels can be 30% lower, leading to false "low T" results.
Free Testosterone
Significance: The active, unbound fraction (~2% of total)
Key note: More clinically useful than total T. You can have normal total T but low free T if SHBG is high.
SHBG (Sex Hormone Binding Globulin)
Significance: Binds testosterone — determines how much is "free"
Key note: High SHBG = less available testosterone. Elevated by ageing, liver disease, hyperthyroidism. Low in obesity, insulin resistance.
LH (Luteinising Hormone)
Significance: Pituitary signal to testes — distinguishes cause
Key note: High LH + low T = testicular problem (primary). Low LH + low T = pituitary/hypothalamic problem (secondary).
FSH (Follicle Stimulating Hormone)
Significance: Spermatogenesis regulation
Key note: Very high FSH suggests testicular damage or failure. Relevant for fertility assessment.
Estradiol (E2)
Significance: Oestrogen in men — balance matters
Key note: Too high: gynecomastia, water retention, mood changes. Too low: bone loss, joint pain. Aromatase converts testosterone to estradiol.
Prolactin
Significance: Pituitary hormone — elevated suppresses T
Key note: Very high levels may indicate pituitary adenoma. Should be checked in all men with unexplained low testosterone.
Age-Related Testosterone Decline
Testosterone declines approximately 1-2% per year from age 30. This is normal ageing, not a disease. However, some men experience a more significant decline that causes symptoms. Here is what to expect.
| Age | Average Total T | What to Expect |
|---|---|---|
| 20-29 | 12-31 nmol/L (peak) | Peak testosterone. Reference point for individual decline. |
| 30-39 | 11-28 nmol/L | Decline begins (~1-2% per year from 30). Usually no symptoms yet. |
| 40-49 | 10-25 nmol/L | Some men notice reduced energy, libido, recovery from exercise. |
| 50-59 | 8-22 nmol/L | More noticeable decline. Muscle mass, bone density, and mood may be affected. |
| 60-69 | 7-20 nmol/L | Increased body fat, reduced muscle, potential mood and cognitive changes. |
| 70+ | 5-18 nmol/L | Many men have levels that would be considered low in younger men. |
Prostate Health: Understanding PSA
Prostate-Specific Antigen (PSA) is the most commonly discussed — and most commonly misunderstood — blood test in men's health. PSA is not a cancer test. It is a prostate health marker that can be elevated by many conditions, most of which are benign.
The decision to test PSA should be a shared one between you and your doctor, with a clear understanding of what the result means and what it does not mean. Current Australian guidelines (PCFA) recommend discussing PSA testing from age 50 (or age 40 if you have a family history of prostate cancer).
What Elevates PSA (Not Cancer)
Benign prostatic hyperplasia (BPH) — enlarged prostate
Prostatitis (infection/inflammation)
Recent ejaculation (within 48 hours)
Vigorous cycling
Urinary tract infection
Recent prostate examination
Age — PSA rises naturally with age
When PSA Is More Concerning
PSA >4.0 ng/mL (age-adjusted thresholds vary)
Rapidly rising PSA (velocity >0.75 ng/mL per year)
Free:Total PSA ratio <10% (higher cancer risk)
PSA density >0.15 (PSA adjusted for prostate size)
Family history + elevated PSA
PSA >2.5 ng/mL in men under 60
Cardiovascular Health: The #1 Killer of Men
Cardiovascular disease kills more Australian men than any other cause. Men develop heart disease approximately 10 years earlier than women — a 45-year-old man has the same cardiovascular risk as a 55-year-old woman. The majority of heart attacks occur in people who had “normal” cholesterol on a standard lipid panel. More advanced markers can identify hidden risk.
Standard Lipid Panel
The baseline cardiovascular screen. LDL-C is the primary target for treatment. HDL-C is protective — men tend to have lower HDL than women. High triglycerides (>1.7 mmol/L) are an independent risk factor.
ApoB (Apolipoprotein B)
Each atherogenic (artery-clogging) particle carries one ApoB molecule. ApoB count is a better predictor of cardiovascular risk than LDL-C because it captures ALL dangerous particles, including VLDL and Lp(a). Ask for this if your triglycerides are elevated.
Lipoprotein(a) [Lp(a)]
Genetically determined — test once in your lifetime. Elevated Lp(a) (>50 mg/dL or >125 nmol/L) doubles cardiovascular risk independent of LDL. Diet and exercise do not change it. Affects approximately 20% of the population. Currently no specific treatment, but knowing your level changes risk management strategy.
CRP (High Sensitivity)
Inflammation is a key driver of atherosclerosis. hs-CRP <1.0 mg/L is low risk, 1.0-3.0 is moderate, >3.0 is high risk. Useful when combined with lipids for overall cardiovascular risk assessment.
HbA1c and Fasting Glucose
Diabetes doubles the risk of heart disease in men. HbA1c provides a 3-month average. Pre-diabetes (HbA1c 5.7-6.4%) is a critical intervention window where lifestyle changes can prevent progression.
Homocysteine
Elevated homocysteine is an independent cardiovascular risk factor. Often caused by low B12 or folate — easily correctable with supplementation. More common in men than women.
Haemochromatosis: The Silent Iron Overload
Haemochromatosis is one of the most common genetic conditions in Australia, affecting approximately 1 in 200 people of Northern European descent. It causes the body to absorb too much iron from food, leading to iron deposits in the liver, heart, pancreas, and joints. Men are affected much earlier and more severely than women because women lose iron through menstruation, which delays iron accumulation by 10-20 years.
The screening tests are simple: transferrin saturation and ferritin. Transferrin saturation above 45% is the earliest and most reliable indicator. Elevated ferritin confirms iron overload. If both are elevated, an HFE gene test can confirm hereditary haemochromatosis (C282Y and H63D mutations).
Blood Tests by Age: Your Testing Roadmap
Different health risks emerge at different ages. Here is a practical guide to which tests to prioritise at each stage of life. The “+” symbol means add these to the tests from previous decades.
| Age | Priority Tests | Why Now |
|---|---|---|
| 20s | FBC, Lipids, Vitamin D, STI screen (if sexually active) | Establish baseline. Cardiovascular risk factors start early. 1 in 5 young men are vitamin D deficient. |
| 30s | + Testosterone (baseline), Liver function, HbA1c | Testosterone begins declining. Metabolic risk increases. Liver health check if drinking regularly. |
| 40s | + PSA (if family history), Kidney function, Iron studies | Prostate screening starts earlier with family history. Haemochromatosis typically presents in 40s-50s in men. |
| 50+ | + PSA (routine discussion), Bone markers, more frequent lipids | Prostate cancer risk increases significantly. Cardiovascular events peak. Bone density starts declining. |
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This content is for informational purposes only and does not constitute medical advice. Blood test results should always be interpreted by a qualified healthcare professional in the context of your individual health history.