The High-Performance Man's Screening Checklist: What Every Man Over 40 Should Ask

By Dr. Steven Long, DO, MHA, CPT
 Beyond Health | Precision Medicine for High-Performance Living

For many men, their 40s mark the beginning of an uncomfortable truth: the body no longer performs on autopilot. Energy drops, recovery slows, and subtle changes in muscle mass, endurance, and focus begin to appear.

But there’s good news — with the right testing and lifestyle strategy, those shifts are neither inevitable nor irreversible.

Modern longevity and performance medicine aren’t about waiting until something breaks. They’re about early detection, precision tracking, and proactive optimization — using data to build a stronger, longer, and higher-performing life.

Here’s what every man over 40 should ask when it comes to health screening and performance management.

1. Cardiovascular Risk: Beyond the Basic Cholesterol Test

Heart disease remains the leading cause of death for men, yet traditional testing often misses early risk.

What to Ask For

• ApoB – Measures the number of atherogenic lipoprotein particles; a stronger predictor of heart disease than LDL cholesterol (Sniderman et al., JAMA, 2019).
• Lp(a) – A genetically determined lipoprotein linked to premature coronary artery disease; unaffected by diet or exercise (Tsimikas, J Am Coll Cardiol, 2017).
• High-Sensitivity CRP (hs-CRP) – Marker of vascular inflammation and plaque instability.
• Coronary Artery Calcium (CAC) Score – A CT-based scan quantifying calcified plaque; one of the best tools for assessing subclinical atherosclerosis.
• Resting blood pressure and heart rate variability (HRV) – Vital indicators of autonomic and vascular health.

Why It Matters

Cardiovascular disease begins decades before symptoms appear. Identifying early endothelial dysfunction or elevated ApoB gives men the opportunity to reverse risk before a heart attack occurs.

2. Metabolic and Hormonal Optimization

After age 40, declining insulin sensitivity and testosterone levels often go hand in hand. Together, they can drive loss of muscle, increased fat mass, and metabolic decline.

Key Lab Markers

• Fasting glucose, insulin, and HOMA-IR – To assess early insulin resistance.
• HbA1c – Reflects 3-month glucose control (but remember: a normal A1c doesn’t guarantee optimal metabolic health).
• Free and Total Testosterone, SHBG, DHEA-S – Low free testosterone can impact energy, libido, and recovery.
• Estradiol (E2) – Important for bone and cardiovascular health even in men.
• Thyroid panel (TSH, Free T3, Free T4) – Subtle thyroid dysfunction often goes unnoticed but influences metabolism, cognition, and lipid profiles.

Why It Matters

Low testosterone or unrecognized insulin resistance doesn’t just impact mood or libido — it predicts cardiometabolic disease, frailty, and mortality (Kelly et al., Lancet Diabetes Endocrinol, 2016).
 Optimizing these markers can profoundly improve strength, cognition, and long-term vitality.

3. Cancer Screening: Early Detection Without Overreaction

Early detection saves lives, but over-screening creates anxiety and unnecessary interventions. The goal is precision screening, not blind testing.

Key Considerations

• PSA (Prostate-Specific Antigen) – Still the standard for prostate cancer screening; discuss baseline testing at age 40–45, especially with family history.
• Colorectal Cancer – Begin colonoscopy at 45 (USPSTF, 2021) or earlier with family risk.
• Skin Exam – Annual dermatology screening for skin cancers, particularly in men with fair skin or outdoor exposure.

Emerging tools like multi-cancer early detection (MCED) blood tests (e.g., Galleri) show promise but remain adjunctive, not replacements for guideline-based screening.

4. Body Composition, Fitness, and Bone Health

Performance is not about weight — it’s about composition and capacity.

Essential Measurements

• DEXA Scan – Measures lean mass, fat distribution, and bone density.
• VO? Max or Zone 2 Fitness Testing – A key metric for longevity; higher VO? max strongly predicts lower all-cause mortality (Kodama et al., JAMA, 2009).
• Grip Strength – A simple but powerful predictor of frailty and cardiovascular outcomes (Leong et al., Lancet, 2015).
• Resting Metabolic Rate (RMR) – Informs individualized nutrition and training programs.

Why It Matters

Muscle is metabolic currency. After 40, men can lose 3–5% of lean mass per decade if untrained. Strength training, protein adequacy (1.6–2.0 g/kg/day), and adequate sleep are non-negotiable for longevity.

5. Cognitive and Emotional Health

Performance isn’t just physical. Cognitive sharpness, emotional resilience, and stress recovery determine both longevity and quality of life.

Recommended Screenings

• Sleep Quality Assessment – Screen for apnea and circadian disruption.
• Depression and Anxiety Screening – Chronic stress elevates cortisol and accelerates metabolic disease.
• Cognitive Baseline Testing – Digital or neuropsychological assessments can detect subtle decline early.

Why It Matters

Poor sleep, burnout, and chronic stress impair testosterone, immune function, and insulin sensitivity. Prevention begins with recognition.

6. Lifestyle, Environment, and Supplement Strategy

Screening extends beyond labs — it includes daily exposures that influence long-term biology.

• Alcohol Intake – Moderate or less; chronic use increases risk for hypertension, cancers, and testosterone suppression.
• Micronutrient Testing (Vitamin D, B12, Ferritin, Zinc, Magnesium) – Suboptimal levels are common and impact energy and immunity.
• Environmental Exposures – Review occupational, heavy metal, and endocrine-disrupting chemical risks when relevant.

At Beyond Health, we often integrate wearable data (HRV, sleep stages, CGM) to build a full physiologic map of performance — allowing early intervention before dysfunction appears.

7. The Beyond Health Framework for Men Over 40

We view screening not as a yearly checkbox, but as an ongoing performance metric.

• Foundations Tier: Inexpensive plans for those with some knowledge in longevity but are looking to push it to the next level.
• Performance Tier: Fully customized plans from a physician, dietician, and exercise specialist.  Personal coaching to reach your goals. We also manage prescriptions with this plan.
• Pinnacle Tier: Everything with the Performance Tier but we also mail labs to your home for completion.  Monthly check ins with the team to make sure you are on track and consistent coaching.

Our clients aren’t waiting for disease — they’re optimizing physiology for a longer healthspan, improved performance, and higher quality of life.

Conclusion

Men in midlife stand at a crossroads: either let physiology drift into decline or take ownership of their data and future health.
 The most powerful interventions — strength training, metabolic optimization, early screening, and sleep — are not glamorous, but they work.

Ask better questions. Get better data. Build the foundation of high performance that carries you into your 50s, 60s, and beyond.

At Beyond Health, we don’t treat age — we treat potential.

Bibliography

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2. Tsimikas, S. (2017). A test in context: Lipoprotein(a): Diagnosis, prognosis, controversies, and emerging therapies. Journal of the American College of Cardiology, 69(6), 692–711.
3. Kelly, D. M., & Jones, T. H. (2016). Testosterone: A metabolic hormone in health and disease. Lancet Diabetes & Endocrinology, 4(10), 873–888.
4. Kodama, S., et al. (2009). Cardiorespiratory fitness as a quantitative predictor of all-cause mortality and cardiovascular events. JAMA, 301(19), 2024–2035.
5. Leong, D. P., et al. (2015). Prognostic value of grip strength: Findings from the Prospective Urban Rural Epidemiology (PURE) study. The Lancet, 386(9990), 266–273.
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