A men’s health assessment, and which tests are worth having

What a men’s health assessment is

A men’s health assessment is an appointment with a doctor about the conditions most likely to affect you over the next ten or twenty years, and what you can do about them. For most men that means blood pressure, weight and waist, cholesterol, blood sugar, smoking and alcohol, sleep, mood and sexual health, with screening added at the right age.

At its centre is a heart risk score. NICE recommends the QRISK3 tool to estimate the 10-year risk of heart attack and stroke for adults aged 25 to 84 without heart disease, and the tool counts erectile dysfunction among its risk factors, so it is worth mentioning [1].

Why it is done and who it is for

It suits a man who feels well and wants a clear view of his risks, including one who has not seen a doctor for some years, and a man with a particular concern such as tiredness, low desire, erection problems, passing urine more often or a strong family history. NICE encourages a type 2 diabetes risk assessment for all adults aged 40 and above, and from 25 for people of South Asian, Chinese, African-Caribbean or Black African family origin [2].

What the evidence supports at each age

In your twenties and thirties the doctor checks blood pressure, weight, waist and lifestyle, and talks through sexual health and mood. After a normal reading, NICE advises measuring blood pressure at least every 5 years, and confirming any clinic reading of 140/90 or higher with home or ambulatory monitoring before a diagnosis is made [3].

From 40, heart and diabetes risk come to the front. NICE advises reviewing heart risk on an ongoing basis for people over 40 [1]. An HbA1c of 42 to 47 mmol/mol marks a high risk of type 2 diabetes, and 48 or above suggests diabetes itself [2].

From 50, bowel screening with a stool test called FIT is offered every 2 years up to 74 [4]. At 65, men are offered an ultrasound scan for an abdominal aortic aneurysm, a swelling of the main artery in the abdomen, because the scan is reliable and an aneurysm found early can be monitored or treated [5]. NICE advises a fracture risk assessment for all men aged 75 and over [6].

PSA and testicular checks

There is no PSA screening programme for all men in the UK. The UK National Screening Committee recommends PSA testing every 2 years only for men aged 45 to 61 with a harmful BRCA2 variant and a family history of related cancers [7]. For other men it is a personal decision made with a doctor, weighing early detection against false positives and overdiagnosis, which our PSA guide explains.

The US Preventive Services Task Force recommends against screening men without symptoms for testicular cancer [8]. A painless swelling, or a change in the shape or texture of a testicle, is different, and NICE advises considering a fast referral for it [9].

Why more tests are not always better

A long panel of blood tests in a man who feels well finds unusual numbers more often than it finds illness. In a trial of patients with unexplained tiredness in general practice, 8% had an illness that blood tests could detect, and a larger set of tests mainly added false positives [10]. Each unexpected number can bring repeat tests, scans, referrals and worry before it is set aside.

Testosterone is a common example, and our guide to hormone tests explains when it is worth measuring and how the time of day changes the result. A test chosen for a reason gives an answer you can act on.

Mood, sleep and asking for help

Mood belongs in a men’s health assessment as much as blood pressure does. A doctor can talk through low mood, stress, alcohol and sleep in confidence, and arrange treatment or a specialist where it helps.

Who it is not for

A routine assessment is the wrong setting for a sudden or severe symptom. If you have chest pain, sudden weakness of the face or an arm, difficulty speaking, sudden severe pain in a testicle, or you cannot pass urine, call 999 in the UK or the local emergency number elsewhere [11].

How you prepare and what to expect

Bring a list of your medicines and supplements, with any recent results. Note too what you know about illness in your parents and siblings, with their ages at diagnosis. The appointment lasts 30 minutes. The doctor takes a history, examines you where it helps, measures your blood pressure, pulse, weight and waist, and agrees with you which tests, if any, are worth doing.

• What is my 10-year risk of heart attack and stroke, and what would lower it?
• Which screening am I due at my age?
• Is a PSA test right for me, given my family history?
• Which of these tests would change what we do?
• When should we check again?

How The Wellness can help

A GP appointment gives you time with a GMC registered doctor who can examine you, prescribe, arrange tests and refer you to a named specialist [12]. Where a fuller picture helps, the Advanced Health blood test adds full thyroid, iron studies, fasting glucose and insulin, a hormone profile and PSA for men, with a consultation included. The executive physical gives a full day with one physician, an ECG, advanced bloodwork and a written plan.

Our clinics are on Baker Street in Marylebone and Eccleston Street in Belgravia, open 7am to 9pm every day, and a doctor can come to your home or hotel in London.