The Health Checks Worth Having, by Age

There is a version of men’s health advice that amounts to “get an annual physical” and stops there. It is not wrong, exactly, but it is not useful either — because the annual physical is not one thing, and the evidence for the ritual as a whole is much weaker than the evidence for a handful of specific tests inside it.

Why the annual physical does not do what you think

A Cochrane review pooled 15 randomised trials covering 251,891 people, comparing those invited to general health checks against those who were not. Over follow-up spanning 21,535 deaths, total mortality was identical: risk ratio 1.00, with a confidence interval of 0.97 to 1.03. That is high-certainty evidence for no effect. Cardiovascular mortality and cancer mortality both came out the same way.

The reviewers’ conclusion was blunt: general health checks are unlikely to be beneficial, and may lead to unnecessary tests and treatments.

This surprises people, and it is worth being precise about what it does and does not mean. It does not mean that screening does not work. Colonoscopy works. Blood pressure treatment works. What the trials tested was the bundle — inviting healthy adults in for a general once-over — and the bundle adds nothing beyond the specific evidence-based components, while adding findings that lead somewhere unhelpful.

So the useful question is not “should I get a physical.” It is “which specific tests, at what age, and why.”

The list, by age

The US Preventive Services Task Force grades each screening recommendation by how good the evidence is. Grade A means there is high certainty of substantial benefit. Grade B means high certainty of moderate benefit, or moderate certainty of moderate-to-substantial benefit. Under the Affordable Care Act, A and B services are the ones most insurance plans must cover without cost-sharing — which makes the grade a practical fact and not just an academic one.

Your twenties and thirties

The list here is short, which is the point. Blood pressure, checked at least every few years and annually once you are over 40 or reading high. One HIV test. One hepatitis C test — this one catches people who have no risk factors they can name and no symptoms, which is exactly why it is a blanket recommendation rather than a targeted one.

If you smoke, the single highest-value thing on the entire list is cessation support, which is a Grade A recommendation and outranks every test.

Diabetes screening starts at 35 if you carry extra weight. That is earlier than most men expect, and it matters because the years between prediabetes and diabetes are the years when the condition is most reversible. What that actually looks like is covered in the weight and metabolic section.

Your forties

Two things start here.

First, cardiovascular risk assessment becomes concrete. From 40, the question is whether your ten-year risk of a heart attack or stroke crosses 10% with at least one risk factor present, because that is the threshold at which a statin has Grade B evidence for primary prevention. Calculating that requires a lipid panel, your blood pressure, your smoking status and your diabetes status — which is a real reason to have blood drawn, as opposed to drawing blood because it is a nice round-numbered year.

Second, colorectal cancer screening starts at 45, not 50. This changed in 2021 and a great many men still have the old number in their heads. Colonoscopy every ten years is one option; annual stool-based testing is another and does not require sedation or a day off. The best screening test is a real one you will do, not a theoretically superior one you will keep postponing.

Fifty onward

Colorectal screening moves from Grade B to Grade A at 50 — same test, stronger evidence.

Lung CT enters if you have a 20 pack-year smoking history and either still smoke or quit within the last 15 years. A pack-year is a pack a day for a year, so a half-pack a day for 40 years counts. This is one of the highest-yield screens on the list for the men who qualify, and it is badly underused.

At 65, if you are a man who has ever smoked, there is a one-time abdominal ultrasound for aortic aneurysm. Once. Not annually. It exists because a ruptured abdominal aortic aneurysm is usually fatal and usually gives no warning, and because the ultrasound is cheap and harmless.

And this is where prostate screening arrives — as a conversation rather than a test. The Task Force gives PSA screening a Grade C for ages 55 to 69, meaning it should be an individual decision, and recommends against it entirely from 70. The numbers behind that grade are unusually specific and worth seeing before you decide; we have set them out separately.

What is not on the list, and why

Routine testosterone testing. There is no recommendation to screen asymptomatic men. Testosterone is a test for men with symptoms, done twice, in the morning, before anyone reaches for a prescription pad. More on that here.

Vitamin D. The Task Force concluded that evidence is insufficient to assess the balance of benefits and harms of screening asymptomatic adults — a Grade I, which means “we do not know,” not “it helps.”

Resting or exercise EKGs in low-risk adults. Recommended against, because false positives lead to angiograms, and angiograms have complications.

Whole-body MRI, coronary calcium scans marketed direct-to-consumer, and executive health panels. These are not on the list because they have not been shown to make people live longer, and they reliably find incidental abnormalities that require follow-up. That follow-up is where the harm lives.

None of this means these tests are never appropriate. It means they are not screening tests for men without symptoms, and a clinic that sells them to you as such is selling you something other than evidence.

What to actually do

Print the table. Take it to a doctor once, work out which rows apply to you now and which apply in five years, and get the ones that apply.

Then spend the rest of your attention on the things that actually move mortality, which are not tests at all: not smoking, blood pressure in range, sleeping properly — sleep apnea in particular is common in men and badly underdiagnosed — drinking less rather than more, and moving. The screening list is a safety net. It is not the plan.

This article is for information only and is not medical advice. It cannot account for your individual circumstances. Talk to a doctor about your own situation, particularly before starting or stopping any prescription medication.