Turning 40 isn’t just a milestone—it’s a health pivot point. You may still feel strong, focused, and resilient, but beneath the surface, subtle physiological changes are taking shape. Hormonal rhythms shift, metabolism slows, cardiovascular risk rises, and cognitive resilience starts to depend more on lifestyle than luck.
The good news? With smart screening and strategic changes, you can stay ahead of these shifts and add both years and vitality to your life.
Hormone Health
Testosterone starts to decline by about 1% per year after age 30, and by your 40s, many men experience symptoms like low energy, weight gain, decreased libido, and poor sleep. But testosterone isn’t the only hormone that matters. Cortisol, DHEA, and estradiol also influence mood, body composition, and recovery.
These hormones work in harmony—or disharmony. Measuring them provides insights into whether you’re running on stress hormones, overproducing SHBG (which binds up testosterone), or under-converting testosterone to estradiol, which supports bone, brain, and vascular health in men.
- Total & free testosterone
- SHBG, DHEA-S, estradiol
- LH, FSH (to evaluate primary vs secondary low T)
- Morning cortisol (for adrenal-HPA axis function)
Cardiometabolic Health
Cardiovascular disease is still the #1 killer of men—and its earliest signs often appear silently in the 40s. A 2020 study showed that 70% of men over 45 have some form of plaque in their coronary arteries, even without symptoms. Meanwhile, insulin resistance and metabolic syndrome now affect nearly 1 in 3 American men and are major contributors to heart disease, stroke, and erectile dysfunction.
Basic cholesterol tests can miss up to 40% of people at risk. Advanced lipid panels—including ApoB and LDL particle number—give a much clearer picture of risk. Fasting insulin is often elevated for years before glucose rises. If caught early, most cardiometabolic issues are reversible.
- ApoB, LDL-P, Lipoprotein(a)
- Fasting insulin, fasting glucose, HbA1c
- hs-CRP (inflammation), homocysteine (vascular risk), uric acid
Cognitive and Neurological Health
Alzheimer’s doesn’t start in your 70s—it starts in your 40s. Cognitive decline is driven by chronic inflammation, vascular damage, insulin resistance, and genetic vulnerabilities like ApoE4. Men tend to experience faster cognitive decline post-diagnosis and are more likely to develop vascular and Lewy body dementia.
Even subtle changes in memory, focus, or processing speed can reflect early dysfunction. Genetics and methylation-related nutrient status (B12, folate, B6) play a big role in how your brain ages. Early screening gives you the upper hand in protecting your mind.
- ApoE genotype, TOMM40, KLOTHO
- Vitamin B12, Folate, B6, Homocysteine
- Baseline cognitive assessment (MoCA, CNS Vital Signs)
Prostate & Urological Health
Prostate cancer is the second most common cancer in men, with 1 in 8 diagnosed in their lifetime. The good news? It’s often highly treatable—especially when caught early. Benign prostatic hyperplasia (BPH) also becomes more common after 40, leading to urinary frequency, urgency, and disrupted sleep.
Proactive screening (like PSA, 4Kscore, and MRI if indicated) helps identify who needs further evaluation and who can safely monitor. Urinary and sexual health are core quality-of-life issues—and they’re preventable and manageable when caught early.
- PSA, PSA velocity
- 4Kscore or multiparametric prostate MRI (for elevated PSA)
Thyroid & Nutrient Health
Even mild thyroid dysfunction can cause symptoms—fatigue, brain fog, weight gain, and cholesterol changes—especially in men over 40. Subclinical hypothyroidism is often missed by standard TSH testing alone. Similarly, nutrient deficiencies (like vitamin D, iron, and omega-3s) can contribute to inflammation, low energy, and even depression.
These labs are often overlooked in conventional checkups but provide critical insights into how your body is functioning and what it needs.
- TSH, Free T3, and Free T4
- Ferritin, iron saturation, total iron binding capacity (TIBC)
- Vitamin D (25-OH), Omega-3 index
How to Stay Strong, Sharp, and Resilient
Nutrition
- Prioritize whole, nutrient-dense foods: lean protein, colorful vegetables, healthy fats.
- Limit ultra-processed carbs and sugars—they drive insulin resistance and inflammation.
- Consider intermittent fasting or time-restricted eating to improve insulin sensitivity.
Exercise
- Strength training 2–4x/week boosts testosterone, maintains muscle, and enhances glucose control.
- Add zone 2 cardio (brisk walking, cycling) for heart and brain health. Aim for at least 150 minutes weekly.
- Include mobility work to reduce injury risk and stay functional into your 70s and beyond.
Sleep
- Sleep is hormonal medicine. It supports testosterone, immunity, memory, and metabolic health.
- If you snore or feel unrefreshed, get evaluated for sleep apnea—it’s more common than you think and strongly linked to heart disease and low testosterone.
Stress Management
- Chronic stress elevates cortisol, suppresses testosterone, increases visceral fat, and impairs cognition.
- Practices like breathwork, meditation, resistance exercise, or using adaptogens (e.g., ashwagandha) can rebalance the nervous system.
Final Thoughts
Your 40s are the perfect time to shift from reactive care to proactive strategy. A comprehensive check-in with a provider isn’t just about avoiding disease; it’s about optimizing energy, strength, focus, and longevity. This is your chance to take control, get the right labs, and create a health plan tailored to you—before symptoms ever show up!
