Men Over the Age of 50 Should Consider These 9 Lab Tests Done Yearly

Men over 50 are at an increased risk for chronic diseases, yet many don't utilize the healthcare services that can aid in early detection and prevention. As men age, their bodies undergo numerous changes that can predispose them to a variety of health challenges, including cardiovascular diseases, diabetes, and cancer. Proactively managing these risks through regular health screenings is essential for maintaining optimal health and enhancing the quality of life for men entering their golden years.

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Importance of Annual Lab Testing for Men Over 50

In 2022, the life expectancy of men was 74.8 years, which decreased from previous years and was about five years lower than that of women. As men age, the prevalence of conditions such as cardiovascular disease, diabetes, and cancer increases significantly. Cardiovascular diseases, including coronary artery disease and hypertension, are among the leading causes of morbidity and mortality in this age group.

Regular wellness exams increase disease recognition and allow for timely intervention, significantly improving health outcomes and reducing healthcare costs. Additionally, these exams provide opportunities for counseling on lifestyle modifications, such as smoking cessation, diet, and exercise, which are important for preserving long-term health. 

Recommended Annual Lab Tests for Men Over 50

The following tests are those that men 50 and older should have annually.

1. Complete Blood Count (CBC)

A CBC measures different components of the blood, including:

• Red blood cells (RBCs)
• Hemoglobin
• Hematocrit
• White blood cells (WBCs)
• Platelets

A CBC screens for signs of various disorders, including anemia, infection, blood clotting disorders, and cancer. It can help identify nutrient deficiencies, chronic infections, and inflammation that may not be apparent through symptoms alone. Abnormal results should prompt further investigation to determine the underlying cause. (7) 

2. Comprehensive Metabolic Panel (CMP)

A CMP evaluates metabolism, kidney and liver function, electrolyte and acid/base balance, and blood glucose levels. This panel includes:

• Glucose: blood sugar levels
• Electrolytes: sodium, potassium, calcium, carbon dioxide, chloride
• Kidney Tests: eGFR, BUN, creatinine 
• Liver Tests: ALT, AST, ALP, bilirubin, albumin

The CMP assists in the early detection and monitoring of blood sugar imbalances, electrolye imbalances, and kidney or liver issues. Deviations from normal ranges can indicate specific health issues (e.g., reduced eGFR suggests kidney disease) and metabolic dysfunction.

3. Thyroid Function Tests

The prevalence of thyroid dysfunction, including both hypothyroidism and hyperthyroidism, tends to increase with age.

Subclinical hypothyroidism (SCH) is characterized by elevated thyroid-stimulating hormone (TSH) levels with normal free thyroxine (fT4) levels. In older men, subclinical hypothyroidism is relatively common, with studies indicating a prevalence of around 8.6%. Over time, SCH may progress to overt hypothyroidism, especially in cases where TSH is higher at baseline. 

Subclinical hyperthyroidism involves suppressed TSH levels with normal fT4. It is less common than hypothyroidism but is still notable in older men. (68, 69) 

Subclinical thyroid disease has been linked to increased frailty and cardiovascular disease in older populations.

Diagnosing thyroid disease requires thyroid function tests, including:

• TSH
• Free T4 and T3
• Total T4 and T3
• Thyroid antibodies

4. Lipid Profile

A lipid panel is a blood test that measures the levels of lipids in the blood, including:

• Total cholesterol (TC)
• Low-density lipoprotein cholesterol (LDL-C)
• Very low-density lipoprotein cholesterol (VLDL-C)
• High-density lipoprotein cholesterol (HDL-C)
• Triglycerides

Advanced lipid panels will include novel biomarkers, including:

• LDL particle number and size
• Lipoprotein(a) 
• Apolipoprotein B
• Apolipoprotein A1

Dyslipidemia, particularly elevated LDL-C and low HDL-C, is strongly associated with the development of atherosclerotic cardiovascular disease (ASCVD), which includes conditions such as coronary artery disease (CAD), heart attack, and stroke. Elevated triglycerides also contribute to cardiovascular risk, especially when combined with low HDL-C, a condition known as atherogenic dyslipidemia.

Dyslipidemia can lead to the formation of atherosclerotic plaques in the arteries, resulting in reduced blood flow, blood clots, and cardiovascular events. The American Association of Clinical Endocrinologists and the American College of Endocrinology emphasize the importance of managing dyslipidemia to prevent these adverse outcomes. (41) 

Heart disease is highly prevalent in men over 50. According to the American Heart Association, the average age of a first myocardial infarction in men is 65.1 years, and cardiovascular disease is a leading cause of morbidity and mortality in this age group. Regular lipid panel testing allows for early detection and management of dyslipidemia, which can significantly reduce the risk of cardiovascular events and improve long-term health outcomes. (40) 

5. C-Reactive Protein (CRP)

CRP measures inflammation levels in the body. Inflammation is a major driver of chronic disease, and it is estimated that over 50% of all deaths are related to inflammatory disease.

Elevated levels may require further evaluation to identify and address the underlying causes, including infection, autoimmune disease, obesity, ASCVD, and cancer. 

6. Hemoglobin A1c (HbA1c)

HbA1c monitors long-term glucose control by measuring an average blood sugar level over the past 2-3 months. It is a primary biomarker used to screen for and monitor diabetes. An HbA1c level below 5.7% is considered normal, 5.7% to 6.4% indicates prediabetes, and 6.5% or higher is diagnostic diabetes.

Elevated HbA1c levels are associated with an increased risk of cardiovascular disease and mortality, even in individuals without diabetes. Lowering HbA1c levels can slow or prevent the development of diabetes-related health complications. (9, 63) 

7. Prostate-Specific Antigen (PSA)

PSA is a blood test that screens for prostate cancer. Elevated PSA levels may indicate prostate cancer but can also be caused by other prostate conditions like benign prostatic hyperplasia and prostatitis. Further diagnostic testing, such as a biopsy, is required to determine the underlying cause of elevated PSA levels. 

Prostate cancer screening recommendations continue to be debated and vary slightly between different health organizations. In general, prostate cancer screening for men aged 50 years and older should involve a shared decision-making process, considering individual risk factors and patient preferences.

• US Preventive Services Task Force (USPSTF): Men between 55 and 69 years should be given the choice to undergo periodic PSA screening (57).
• American College of Physicians (ACP): Clinicians should inform men ages 50 to 69 years about the limited potential benefits and substantial harms of prostate cancer screening. The decision to screen using the PSA test should be based on the patient's risk for prostate cancer, general health, life expectancy, and personal preferences. (58) 
• American Urological Association (AUA): Regular PSA screening every 2-4 years for men aged 50-69, supporting a personalized, risk-stratified screening approach to balance the benefits and harms of screening. (70) 
• American Cancer Society (ACS): Men with at least a 10-year life expectancy should be allowed to make an informed decision about prostate cancer beginning at age 45 (high risk) or 50 (average risk). (64) 

8. Vitamin D

Vitamin D deficiency is linked to various chronic conditions, including osteoporosis, cardiovascular diseases, and certain cancers. One study found that men with vitamin D deficiency had a two-fold increased risk of mortality compared to those with sufficient levels. This underscores the importance of maintaining adequate vitamin D levels to potentially reduce mortality risk.

Serum calcidiol (25-hydroxycholecalciferol) is the test of choice to assess long-term vitamin D status. Vitamin D levels are categorized as: 

• Deficient (<20 ng/mL)
• Insufficient (<30 ng/mL)
• Sufficient (>30 ng/mL)

Deficiency/Insufficiency necessitates supplementation and dietary/lifestyle modifications to restore optimal levels and prevent associated health issues.

9. Testosterone

Testosterone production decreases in aging men by 1–2% per year after the fifth decade. This natural decline in testosterone with age is often called "andropause."

Research has correlated low testosterone in aging men with various adverse health outcomes, including:

• Increased cardiovascular risk and all-cause mortality (3)
• Sexual dysfunction (6, 61) 
• Decreased bone mineral density, osteoporosis, and bone fractures (6, 61)
• Sarcopenia (muscle loss) and reduced physical performance (6, 61)

Regular monitoring of testosterone and related hormone markers and individualized management, including consideration of testosterone replacement therapy (TRT), can help mitigate these risks and improve quality of life.

Additional Tests

The following screening measures are also recommended for men aged 50 and older.

Blood Pressure

The USPSTF recommends screening for hypertension (high blood pressure) in adults with office blood pressure measurements beginning at age 18. Annual screening is recommended for adults aged 50 and older. (38) 

Colorectal Cancer 

The USPSTF recommends that adults aged 45 to 75 be screened for colorectal cancer. Recommended screening strategies include: 

• High-sensitivity guaiac fecal occult blood test (HSgFOBT) or fecal immunochemical test (FIT) every year (24) 
• Stool DNA-FIT every 3 years
• Flexible sigmoidoscopy every 5 years or every 10 years with a FIT every year
• Colonoscopy every 10 years
• Computed tomography (CT) colonography every 5 years

Lung Cancer

Annual low-dose computed tomography (LDCT) is recommended for men aged 50 to 80 years who have a 20-pack-year smoking history and currently smoke or have quit within the past 15 years. (48) 

Depression

Depression is not a normal part of aging, yet it is a common problem among older adults, affecting approximately 28.4% of this population. Depression in older adults often goes undiagnosed and is associated with an increased risk of:

• Morbidity
• Suicide
• Decreased physical, cognitive, and social functioning
• Self-neglect

The Patient Health Questionnaire 2 (PHQ-2) is a validated depression screening tool that is easy to administer in the office. The PHQ-9 or the 15-item Geriatric Depression Scale should follow up a positive PHQ-2. (52) 

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Key Takeaways

• Annual lab testing for men over 50 is an important aspect of preventive health care to detect and manage chronic diseases, enhance quality of life, and promote longevity. 
• A typical annual wellness laboratory panel ordered for men aged 50 and older includes CBC, CMP, thyroid panel, lipid panel, HbA1c, CRP, vitamin D, and testosterone.
• PSA can be included as part of an annual wellness exam following an informed discussion with the patient about the potential benefits and risks of prostate cancer screening.
• Additional screenings for hypertension, colorectal cancer, lung cancer, and depression are important for a comprehensive health assessment. The frequency of these screenings can vary depending on the type of test/imaging used and personal risk factors for disease.