Men's health after 40

Your 40s are the right time to act on heart risk, because the damage builds silently and is still cheap to slow down. Two blood tests, ApoB and lipoprotein(a), tell you how hard to push.^{[7, 9]} Feeling fine says little here, since plaque in the arteries causes no symptoms while it grows.

That slow buildup of plaque inside your arteries, called atherosclerosis, can start in early adulthood, long before anyone notices. The European cardiology guidelines therefore aim to cut your lifetime exposure to artery-clogging particles instead of waiting for the first warning sign.^{[7, 8]} Both the level and the number of years count.^[7] So a level you lower at 42 has had fewer years to do damage than one you lower at 62.

Those particles can be counted. Apolipoprotein B (ApoB) is a protein that sits on every particle that can clog arteries, so its blood level estimates how many of them you carry.^[7] Standard LDL cholesterol, the 'bad' cholesterol on every routine lipid panel, usually tells a similar story. In around 1 in 5 patients, though, the two point in different directions.^[7] That happens most often with high triglycerides (a type of blood fat), diabetes, obesity or very low LDL.^[7] A baseline ApoB in your 40s shows which group you are in. If it is high or you start treatment, it gets repeated with your regular lipid checks.^[7] The ApoB and Lp(a) guide explains how to read the two side by side.

Lipoprotein(a), or Lp(a), is the second number. Unlike ApoB, it is set mainly by your genes, stays with you for life and is barely touched by statins, the standard cholesterol drugs.^[9] The European Atherosclerosis Society therefore advises every adult to measure it at least once, whether or not heart disease runs in the family.^[9] Older guidance drew a line at about 50 mg/dL, but risk actually rises steadily with Lp(a) rather than switching on at one value.^[9] At about 100 mg/dL (around 250 nmol/L), the risk of heart disease from clogged arteries roughly doubles.^[9]

Those two figures describe the same level in two units: mg/dL weighs the Lp(a) in a set amount of blood, while nmol/L counts its particles. Many labs in Germany, Austria and Switzerland report nmol/L. Because the two units do not convert exactly, compare a new result only with one in the same unit.

A high result raises the obvious question of what to do about it, and for now the answer is indirect. No drug is yet approved specifically to treat a high Lp(a).^[36] The first large outcome trial of such a drug tested pelacarsen in people who already had heart disease.^[36] It lowered Lp(a), but according to results reported in September 2026 it did not reduce the trial's main measure of heart attacks, strokes and related events.^[36] Full results are still pending (as of October 2026).^[36] A high value therefore changes how strictly you and your doctor handle everything you can change: LDL and ApoB, blood pressure, blood sugar and smoking.^[9]

Most men do not have late-onset hypogonadism, the testosterone deficiency that can come with age. Two lab values matter here: total testosterone includes the hormone attached to blood proteins, while free testosterone is the unattached part. A large European study of ageing men defined the deficiency strictly, as three sexual symptoms plus clearly low total and free testosterone.^[1] By that definition it affects about 2% of men aged 40 to 79.^[1]

Low readings on their own are far more common, especially with obesity or diabetes.^[28] In one US primary-care study, a single morning test came back low in about 4 in 10 men aged 45 and over.^[28] Many of those are not a disease, but persistent symptoms still deserve a proper work-up.

Age on its own explains less of those low readings than its reputation suggests. Total testosterone falls only slowly over the years, and men with a higher body weight have lower levels.^[27] The spread between men is large, which is why a lab value only means something next to symptoms.

The diagnosis therefore rests on symptoms and lab values together, as the Endocrine Society's guideline spells out.^[2] You need symptoms of testosterone deficiency and consistently low total testosterone on two fasting morning measurements. If the total is borderline or your SHBG (the protein that carries testosterone in the blood) is unusual, free testosterone is checked as well.^[2] European andrology guidance and the International Consultation on Sexual Medicine take the same symptom-first line.^{[3, 4]} A single borderline result from a week of stress and short nights, by contrast, is a snapshot of that week, not a diagnosis.

Even a confirmed low value is not yet a prescription, because before treating, a clinician needs to establish why the level is low.^[2] Higher body weight goes with lower testosterone,^[27] and untreated severe sleep apnea is itself a reason not to start therapy.^[2] When low levels go along with excess weight or related conditions, European andrology guidance treats those conditions first.^[3] That search for the cause is a job for a urologist, endocrinologist or experienced family doctor. It is also the best argument against clinics that sell testosterone on a single reading.

For men who do have the diagnosis, the big heart-safety question now has a reassuring answer. The TRAVERSE trial randomly assigned 5,246 men aged 45 to 80 to a daily testosterone gel or a placebo gel.^[5] All of them had symptoms, two low fasting testosterone levels and either heart disease or a high risk of it.^[5] Over a mean follow-up of 33 months, heart attacks, strokes and cardiovascular deaths were about as common with testosterone as with placebo, at roughly 7% each.^[5] Treatment itself lasted about 22 months on average, so the trial says less about injections, pellets or longer use.^[5] Nor does it say anything in favour of testosterone as an anti-ageing supplement for men with normal levels, because those men were not in the trial.

The same trial did see more of three other problems in the testosterone group.^[5]:

Source: TRAVERSE trial^[5]

These signals belong in any informed-consent talk, and they weigh more for men who have had blood clots, kidney disease or rhythm problems. US regulators read the same data and drew a practical conclusion. Since February 2025, every testosterone product carries a warning about raised blood pressure, so blood pressure checks belong to any testosterone therapy.^[19] In the same step, based on TRAVERSE, the FDA removed the heart-risk wording from the boxed warning, the top warning on the label.^[19]

The label is still changing. In 2025 the FDA kept the line that testosterone's safety and effectiveness for low levels caused by ageing alone had not been established.^[19] In June 2026 it asked for that limitation to be removed and for the prostate cancer and prostate enlargement warnings to be revised.^[44] Those are requested updates, not finished ones, so check the current label (as of October 2026).^[44]

Who should not start testosterone. Testosterone is a prescription-only medicine.^{[19, 42]} The Endocrine Society advises against starting it if you want to father a child in the near future, because it can suppress sperm production.^[2] It also advises against starting it in these situations.^[2]:

• prostate or breast cancer
• a prostate nodule, or a PSA (a prostate blood value) above 4 ng/mL, until a urologist has checked it
• a PSA above 3 ng/mL in men at higher risk, such as Black men or men with a father or brother with prostate cancer, until a urologist has checked it
• a raised hematocrit (the share of your blood made up of red blood cells)
• untreated severe obstructive sleep apnea, in which the airway keeps collapsing during sleep
• severe urinary symptoms
• uncontrolled heart failure
• a heart attack or stroke in the last six months
• thrombophilia (a tendency to form blood clots)

Men who do start need regular checks, and the HRT and TRT guide covers forms of treatment and follow-up in more detail. During the first year, your doctor should check testosterone levels, hematocrit and prostate risk^[2] Blood pressure belongs on that list too, and it is the one check you can run yourself, with a cuff at home.^[19]

Keeping your muscle past 40 takes strength training on at least two days a week.^[29] It also takes enough protein, about 1.2 to 1.6 g per kg of body weight a day if you lift.^{[20, 24]} Strength is what defines sarcopenia, the age-related loss of muscle, so strength is the thing to protect now.^[6]

The European sarcopenia consensus puts low muscle strength first and uses muscle quantity and quality to confirm it.^[6] Its screening tests are simple: grip strength, and how fast you can stand up from a chair five times without using your arms.^[6] Neither needs a lab, and both reward muscle you have kept working. According to the same consensus, how early sarcopenia appears depends on how much muscle you built by early adulthood and how fast you lose it afterwards.^[6] In your 40s, then, the job is to slow that loss.

How much training it takes to slow that loss has a clear official answer. The WHO recommends muscle-strengthening exercise for all major muscle groups on at least two days a week, on top of 150 to 300 minutes of moderate aerobic activity a week.^[29] Most of those aerobic minutes can be zone 2 cardio at a pace where you can still talk, plus the odd harder session. For the strength part, cohort studies, which follow people over years, found that those who did muscle-strengthening exercise had a 10 to 17% lower risk of death, heart disease, cancer and diabetes.^[30] Most of that benefit came at about 30 to 60 minutes a week.^[30] Because these figures come from watching people rather than from experiments, they show a link, not proof. Even so, two to four sessions a week is a practical way to hit the target.

What you do in those sessions can stay simple. Cover five movements: squat, hinge (bending at the hips, as in a deadlift), push, pull and carry. Over time, add a little weight or a few reps. This progressive overload matters more than how you split muscle groups across the week, which settles a fair share of gym arguments in advance.

Lifts like these, done with reasonable form and enough recovery, are not a danger for healthy adults. If you have never trained seriously, six to twelve weeks with a coach is a reasonable start. The technique you learn at 45 is the technique you will use for decades.

The payoff of the training reaches well past your 40s. In people over 60, exercise programmes cut falls by about a quarter, mainly balance and functional exercises or programmes that combine them with strength work.^[31] For strength training alone the effect is uncertain, and the evidence for fewer fractures is weaker.^[31] That makes a few balance exercises a sensible companion to the lifting.

Protein: how much is enough. Protein adds to what lifting builds, up to a point. In trials of healthy adults who lifted, extra protein increased muscle gains up to about 1.6 g/kg a day, and the benefit shrank with age.^[24] For a man in his 40s who lifts, about 1.2 to 1.6 g/kg a day is therefore a sensible range.^{[20, 24]} For an 80 kg man, that means about 96 to 128 g. Our free calorie calculator turns the range into grams for your own weight, alongside your maintenance calories.

For people over 65, the PROT-AGE expert group sets its own targets.^[20]:

• at least 1.0 to 1.2 g of protein per kg of body weight a day as the basic target
• 1.2 g/kg or more for those who are active
• 1.2 to 1.5 g/kg for those with acute or chronic illness

Kidney disease changes the picture: PROT-AGE makes an exception for severely reduced kidney function^[20] If you have kidney disease, agree your protein target with your doctor first.^[20]

In your 40s, check your blood pressure at home, your blood sugar and your waist, and take a hard look at smoking and alcohol. Next to cancer, heart and blood vessel disease is one of the two leading causes of death for men in the US, Germany, Austria and Switzerland. These everyday numbers therefore carry real weight.

These checks sit next to your cholesterol results, which also need a personal reading. The European lipid guidelines set targets for LDL cholesterol and ApoB, a count of artery-clogging particles, by your personal risk, not the lab's normal range.^{[7, 8]} A 'normal' result can still be too high for you if you have a high Lp(a) (a largely inherited risk marker), a strong family history or metabolic syndrome. The ApoB and Lp(a) guide shows how to read the targets.

Blood pressure belongs at home. Readings at the doctor's office often run higher than at home, so a few home readings give a truer picture than one clinic visit. An inexpensive upper-arm cuff (not a wrist one), used correctly, is one of the best-value health purchases you can make. It also doubles as the check that testosterone therapy now calls for.^[19]

Blood sugar: HbA1c does the work. HbA1c reflects your average blood sugar over the last two to three months, and together with fasting glucose it answers the practical blood-sugar question.^[32] Fasting insulin is popular in longevity clinics, often turned into a HOMA-IR score that estimates insulin resistance. If you have those values anyway, our HOMA-IR calculator does the arithmetic. Even so, the US diabetes and lab-medicine societies advise against routine insulin testing in people at risk of diabetes or heart disease.^[32] HbA1c and fasting glucose remain the tests to ask for.

Inflammation: a marker for selected cases. An inflammation marker can sometimes refine your heart-risk estimate. High-sensitivity CRP (hsCRP) picks up low-grade, silent inflammation in the blood. The updated European lipid guideline counts a persistently raised hsCRP above 2 mg/L as one factor that can move someone into a higher risk group.^[8] Still, it is not a screening test everyone needs.

Waist: the check without a lab. Your waist offers a simpler check that needs no blood test at all. A growing one is a crude but useful warning sign that costs only a tape measure. Excess weight is also one of the situations in which LDL and ApoB more often disagree.^[7]

Alcohol: lowest risk is not no risk. In nearly 600,000 drinkers without heart disease, the risk of dying was lowest at about 100 g of alcohol a week or less.^[11] That is about 7 US drinks, 12 UK units or 8 to 10 German drinks of 10 to 12 g each.^[11] Above that, life expectancy at 40 fell by about six months at 100 to 200 g a week.^[11] Even the lowest point is not a safe dose, since stroke and heart-failure risk rose with every extra drink.^[11] The authors argue for lower limits than most guidelines set.^[11] The German Nutrition Society goes further and says no amount is risk-free.^[34] It counts under 27 g a week as low risk and more than 81 g a week as high risk.^[34]

If your social life runs through Wiesn, Stammtisch, après-ski or the office Friday round, the aim is awareness rather than moralising. Turning one or two heavy weeks a month into light or alcohol-free ones is a realistic start, and alcohol-free beer is an easy swap.

Smoking. If you still smoke, quitting is one of the most worthwhile changes on this page. Nicotine e-cigarettes help more people quit than nicotine patches or gum, and that evidence is rated high-certainty.^[35] Use them as a bridge off cigarettes, not as a long-term habit.

After 40, three quiet problems deserve a check even when you feel fine: your sleep, your mood and your prostate. Each needs a different kind of attention, from counting your hours of sleep to a talk with your doctor about PSA, a blood test for prostate cancer.

Sleep and sleep apnea

The US National Sleep Foundation recommends 7 to 9 hours a night for adults aged 26 to 64.^[21] If you regularly get six, you are below that range, however used to it you feel.

Snoring is the clue to the second sleep problem. In obstructive sleep apnea (OSA), the airway repeatedly collapses during sleep, so breathing keeps stopping for a moment. It is common in men, and the risk rises with age between 40 and 70 and with a higher body weight.^[47] Because it happens while you sleep, it is easy to miss, even though it is linked to daytime sleepiness, heart disease, stroke and high blood pressure.^[47] If your partner reports snoring or pauses in your breathing, or you wake up unrefreshed, ask your family doctor about a sleep study. The main treatment is CPAP, a mask that keeps the airway open at night.^[47] Weight loss is recommended if you carry extra weight, and a mouth splint that holds the lower jaw forward is an alternative.^[47]

Sleep apnea often shows up together with low testosterone, since both are more common with excess weight.^{[27, 47]} Treating the apnea is no shortcut to higher testosterone, though: in small, mostly uncontrolled studies, CPAP alone did not raise it.^[22] Untreated severe OSA is also on the Endocrine Society's list of reasons not to start testosterone.^[2]

Mood and where to get help

Tiredness and irritability are not always about sleep or hormones. Depression in midlife men often shows up as irritability, withdrawal, loss of interest, heavier drinking and a feeling of being 'flat' rather than as classic sadness. Many men blame it on work stress or low testosterone for years. If something has felt wrong for more than a couple of weeks, talk to your doctor.

If you are in immediate danger or thinking about ending your life, call the emergency number now: 112 in Germany and Austria, 144 in Switzerland, 911 in the US. In the US you can also call or text 988, the Suicide & Crisis Lifeline, if you are thinking about suicide or are in emotional crisis. For a confidential talk at any time, these lines are open:

• Germany: Telefonseelsorge 0800 111 0111 (free, 24/7)
• Austria: Telefonseelsorge 142
• Switzerland: Die Dargebotene Hand 143
• US: 988 Suicide & Crisis Lifeline

If violence is part of the picture, call Germany's Hilfetelefon Gewalt an Männern (Männerhilfetelefon) at 0800 123 99 00.

It is open Monday to Thursday from 08 to 20 and Friday from 08 to 15, and it supports men affected by any form of violence, including:

• domestic, sexualised, psychological or digital violence
• stalking and bullying
• childhood abuse
• violence in public spaces
• forced marriage

PSA: a small benefit with a real price

PSA screening divides experts because both its benefit and its harms are real. The European ERSPC trial invited men aged 55 to 69 to regular PSA tests. After 23 years, deaths from prostate cancer were about 13% lower in the invited group, and one prostate-cancer death was prevented for every 456 men invited.^[25] The 13% is a relative figure: in absolute terms, the risk of dying from prostate cancer fell by 0.22 percentage points.^[25] For men aged 45 to 54, the benefit is extrapolated from these older men.

The price of that benefit is overdiagnosis. About 30% more prostate cancers were found in the screened group, many of which would never have caused harm.^[25] For each death prevented, about 12 extra men were diagnosed with prostate cancer.^[25] A US trial, PLCO, seems to contradict the benefit, since it found no reduction in prostate-cancer deaths. But about 86% of men in its control group had a PSA test anyway, so it compared organised with opportunistic screening rather than screening with none.^[26]

Whether a screen-found cancer does harm depends a lot on what happens next. The PIVOT trial followed men with localised cancer, still confined to the prostate, for up to 19.5 years.^[12] Surgery did not significantly lower deaths compared with observation, but it caused more incontinence and erectile problems.^[12] A screen-detected cancer therefore does not automatically need surgery. The ERSPC authors conclude that the benefit of screening lasts, and that future screening should be risk-based, tailored to each man's risk, to cut overdiagnosis.^[25]

When to start depends on where you live and on your genes. Germany's S3 guideline offers counselling and a PSA test from 45 to men with at least 10 years of life expectancy.^[13] Men whose father or brother had prostate cancer start at the same age.^[13] A pathogenic (disease-causing) variant in the BRCA2, MSH2 or MSH6 genes moves the start earlier, and those men should be offered a risk consultation from 40, with PSA plus a prostate MRI.^[13]

US advice starts at the same age or later, depending on who gives it. US urologists suggest a baseline PSA between 45 and 50, or from 40 to 45 for Black men, gene-variant carriers and men with a strong family history.^[14] The US Preventive Services Task Force waits longer: it frames screening as a personal choice from 55 to 69 and advises against it from 70.^[15] Its statement dates from 2018 and is being updated (as of October 2026).^[15]

Under the German guideline, your first value sets the rhythm.^[13]:

• under 1.5 ng/mL: retest in 5 years
• 1.5 to 2.99 ng/mL: retest every 2 years
• 3 ng/mL or more: a repeat test within three months and, if confirmed, a urologist and an MRI

The same guideline drops the finger exam for screening, because it is less accurate than PSA^[13] Statutory insurance still pays only for that finger exam, once a year from 45.^[37] The screening PSA test is therefore a self-pay extra (IGeL), about 25 to 35 EUR including counselling according to the IGeL-Monitor.^[39] That page was last updated in 2017, so ask your practice for its current price.^[39] If there is a concrete suspicion, such as a palpable nodule, or to monitor a known cancer, insurance pays for the PSA test.^[39] In practice, that means booking the PSA talk at 45 in Germany, or at 40 with a pathogenic gene variant. You then decide with your doctor whether you want a baseline value and follow the interval it sets.

A useful check-up in your 40s starts with the free statutory exam, the Gesundheitsuntersuchung in Germany or the Vorsorgeuntersuchung in Austria.^[38] It then adds two heart-risk blood tests, a one-off Lp(a) and a baseline ApoB.^{[7, 9]} The rest of the lab menu can wait until there is a reason. The plan works best when it is built around one doctor who sees your numbers over the years.

Germany. Statutory insurance pays for the health check (Gesundheitsuntersuchung, formerly Check-up 35) every three years from 35. It includes blood pressure, a lipid profile, fasting plasma glucose, a urine test and a physical exam.^{[38, 46]} ApoB, Lp(a), HbA1c and hormone tests are not part of it.^[46] You have to ask for them as self-pay extras (IGeL) through your family doctor or a preventive-medicine practice. Our self-pay longevity testing guide lists what each add-on costs and whether it is worth it.

The statutory programme covers more than the health check alone. This table shows what German statutory insurance pays for men in their 40s:

Sources: G-BA, Krebsfrüherkennungs-Richtlinie, Gesundheitsuntersuchungs-Richtlinie, IGeL-Monitor; as of October 2026, PSA price from the IGeL-Monitor (2017). On 15 October 2026 the G-BA started reviewing the health check and skin cancer screening, so ages and intervals may change^{[17, 38]}

Since April 2026, insurance has paid for lung cancer screening in people who have smoked for at least 25 years and for at least 15 pack-years.^{[17, 43]} Former smokers qualify if they quit no more than 10 years ago.^{[17, 43]} A pack-year means smoking one pack of cigarettes a day for one year, so the count combines how long and how much you smoked.

Austria. The Vorsorgeuntersuchung is free for insured residents from 18.^[18] From 45 it adds a stool test for hidden blood every two years and a screening colonoscopy every ten years.^[18] Many men also see a Wahlarzt, a private doctor outside the insurance contract system, for faster access to a urologist or andrologist. Their Krankenkasse (health insurer) refunds part of the bill, and for testosterone or PSA decisions this is often the most practical route.

Switzerland and the United States. In Switzerland, basic insurance pays for doctor visits once you have paid your deductible (Franchise).^[41] After that you still pay 10% of further costs, up to CHF 700 a year.^[41] For prevention it pays for the measures listed in the benefits ordinance (KLV),^[45] so extra preventive blood panels outside that list are usually self-pay. In the US, ask at your annual physical for Lp(a) and ApoB by name. If you use a direct-to-consumer lab, bring the results to your doctor.

Whichever system you are in, the lab menu itself looks the same:

• Once: Lp(a), the mostly inherited heart-risk marker, and a full lipid panel with ApoB, which counts artery-clogging particles.^{[7, 9]} Add HbA1c (your average blood sugar over two to three months) or fasting glucose.^[32] Repeat ApoB with your lipid checks if it is high or you start treatment.^[7]
• Only with symptoms or a reason: morning testosterone with SHBG, its carrier protein.^[2]; TSH for the thyroid; ferritin for iron stores; vitamin D. Routine vitamin D tests are not recommended for healthy adults^[33]
• Not routine: fasting insulin is not recommended as a routine test.^[32] hsCRP, an inflammation marker, can refine the heart-risk estimate in selected people but is not a test everyone needs.^[8]
• PSA: a talk about this prostate blood test from 45 in Germany, from 40 with a pathogenic gene variant.^[13]
• Regularly: home blood pressure, weight and waist, plus a look at your sleep and your drinking. Lipids and blood sugar are repeated at the interval your doctor sets from your results and risk; the German health check measures lipids and fasting glucose every three years.^[46]
• From the late 40s: a coronary artery calcium (CAC) score, a CT scan of the calcium in your heart arteries, if your doctor is unsure how to rate your heart risk.^[7]
• Bowel cancer screening: from 45 in Austria,^[18] and the US^[40] from 50 in Germany,^[17] earlier with a family history. In Switzerland, ask your doctor which screening your basic insurance covers.^[45]
• Resting ECG: only if your doctor sees a reason.

For the appointment itself, bring any earlier results and agree with your doctor which of these tests to add and when to repeat them.