Age 50 Men's Health Assessment

I'll be 50 in a couple of weeks and a conversation with my primary care physician (PCP) drove me to put together this checklist for myself. Our conversation went something like this:

PCP: Your numbers look good.

Me: Right, but there are few things I wanted to discuss. First, it seems my fasting blood sugar seems to be trending upward if you review the past 4 years of data. I don't see that we tested for fasting insulin, and I want to make sure I am not headed towards insulin resistance.

PCP: We don't check insulin under these circumstances and your numbers are in a healthy range.

Me: I'd like to know my fasting insulin numbers. Secondly, I understand the statins I am taking block not only the production of cholesterol, but also a slew of other isoprenoids and biomolecules the body needs. I would like to be tested for CoQ10. I also wanted your opinion on other markers to be concerned about as the statins I am taking block the mevalonate pathway.

PCP: Terry, Stop for a minute. You do realize that I am given 20 minutes to review your labs, talk with you and then dictate my comments into this computer and then get down the hall to my next patient. Your fine. You just need to make sure you eat healthy. Check out myplate.gov to make sure you are making healthy eating choices.

Me: I am turning 50 this year so I want a full review of bloodwork, endocrine system, hormones, and anything else that would affect my vitality and longevity. I know I'm aging but I want to proactive on maintaining where I'm at...

PCP: What you're asking is the beyond my expertise. I suggest you find a specialist...

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So, at this point, I realized I needed to take charge of this myself. What I have summarized here are the aspects of my health I want to quantify, creating a baseline on which to measure myself over the next 50 years. I don't just want to survive. I want to thrive!

Let's cover some of the basics first.

EXERCISE

Am I getting 1 hour of exercise per day, 6-7 days per week? Strength training is just as important as cardio. I have been essentially rotating cardio and strength training every other day to cover these bases. In order to make sure I get a workout in every day; I simply get up at 4:30am so I have a few hours to bang this out before the rest of the world wakes up. A very inspiring book to help motivate me to do this was The 5am Club.

FOOD

Before getting into a disciplined regiment of daily exercise I explored all kinds of fad diets. Where I have settled is on a diet which encompasses a lot of meat, salads and unrefined carbs. I try to avoid pure sugar and high fructose corn syrup as much as possible. I don't count calories since I tend to burn over 1000 calories a day exercising anyway. However, what I do want to avoid is anything that will spike my insulin. After reading the book, The Cases Against Sugar, I am constantly reminding myself of the negative downstream effects of sugar:

Sugar is the number one food source I am now trying to limit as much as possible. I used to think losing weight was as simple as "calories in = calories out. What I failed to consider was the impact sugar has on the endocrine system. Sugary food is like a like punch to your pancreas.

BLOOD PRESSURE

In brief, high blood pressure puts stress on your body. A constant pressure on your arteries will damage/weaken them over time. This could lead to a deadly aneurysm. You can also develop an enlarged heart as its struggles to get oxygen and blood. The stress on this organ will eventually cause angina, arrhythmias, and failure. High blood pressure causing hardening of the arteries in the brain will cause a slew of issues including cognitive impairment, stroke, dementia, and transient ischemic attack (TIA). Over time pressure in your kidneys can cause them to fail leading to dialysis and the need for kidney transplants. Impaired vision, or complete loss of vision? Or how about erectile dysfunction. Now you know why you want to aim for a blood pressure of 120/80 or lower as I am targeting! I am now taking a vasodilator and a diuretic to maintain 120/80 but I am hoping with more discipline reducing sugar intake and consistent exercise I can ween myself down in the years to come.

CHOLESTEROL

If your total cholesterol is above 200 mg/dL you should work with your doctor to lower and manage it. The reason is you are putting yourself at higher risk of developing atherosclerosis. Is that a big deal? Atherosclerosis is the #1 cause of death in the United States. So, get a blood test, have a lipid panel performed and talk with your doctor about statins if necessary. If you want to read more check out my previous post on cholesterol here.

Routine Blood Tests & Urinalysis (UA) from PCP

Below are the tests I was able to have tested and covered by my health insurance provider:

Typically, you will be alerted to any numbers that are out of range. I would encourage you to get familiar with this list and identify areas that need attention. Here are a few sources for abbreviations as I won't get into that here.

COMPREHENSIVE MALE HORMONE PANEL

Age 50 is a great time to get a baseline panel of several hormones which are responsible for so many aspects of life. Your energy level, mood, metabolism, sleep, digestion, etc... The one I was most concerned about being insulin and its impact metabolism of sugar. We now know insulin resistance can lead to diabetes as well as a whole cascade of health issues as illustrated above. I had a comprehensive men's hormone panel run by Ulta Labs which included the following:

Diabetes and Insulin Resistance

HEMOGLOBIN A1c or glycosylated hemoglobin A1c. This is a measurement indicates the average amount of sugar in the blood over the last 2- 3 months. I want this to be under 5.7%.

INSULIN, A healthy fasting insulin level is at or below 19.6 uIU/mL. Insulin is a hormone that is produced and stored in the beta cells of the pancreas. It is vital for the transportation and storage of glucose at the cellular level, helps regulate blood glucose levels, and has a role in lipid metabolism. Without insulin, glucose cannot reach most of the body's cells. Without glucose, the cells starve, and blood glucose levels rise to unhealthy levels. This can cause disturbances in normal metabolic processes that result in various disorders, including kidney disease, cardiovascular disease, and vision and neurological problems.

More on Insulin

Insulin resistance is a condition in which the body produces insulin but does not use it effectively. When people have insulin resistance, glucose builds up in the blood instead of being absorbed by the cells, leading to type 2 diabetes or pre-diabetes. Most people with insulin resistance don’t know they have it for many years—until they develop type 2 diabetes, a serious, lifelong disease. The good news is that if people learn they have insulin resistance early on, they can often prevent or delay diabetes by making changes to their lifestyle.

When people without diabetes eat, the pancreas automatically produces the right amount of insulin to move glucose from blood into the cells. In people with diabetes, however, the pancreas either produces little or no insulin, or the cells do not respond appropriately to the insulin that is produced. Glucose builds up in the blood, overflows into the urine, and passes out of the body in the urine. Now you know why one of the UA tests is looking for glucose in your urine. Thus, the body loses its main source of fuel even though the blood contains large amounts of glucose.

Metabolic Hormones in the Men's Comprehensive Panel

The endocrine system consists of glands and organs which release hormones into your circulatory system. These hormones direct among other things mood, metabolism, and growth. Your overall health requires that this system is operating smoothly and we can get valuable information by measuring specific hormone levels in your blood. Below are hormones critical to optimum well-being which we want to know are present at healthy levels.

CORTISOL, A.M., Cortisol is a steroid hormone released from the adrenal gland. It plays a role in: bone, circulatory system, immune system. metabolism of fats, carbohydrates, and protein. nervous system and stress responses. Healthy levels are between 4 and 22 (mcg/dL).

GROWTH HORMONE (GH), In an adult male, a healthy range is between 0.4 to 10 nanograms per milliliter (ng/mL). This is a hormone produced in the pituitary gland. High or low values for GH could be indicative of problems such as benign tumors of the pituitary. Although GH is not as active in adults, it does play a role in regulating bone density, muscle mass, and lipid metabolism. Deficiencies can lead to decreased bone densities, less muscle mass, and altered lipid levels. Excess GH in adults can lead to acromegaly, marked not by bone lengthening but by bone thickening.

IGF-1, LC/MS, Insulin Growth Factor 1 is produced in the liver and many other tissues in response to GH stimulation. IGF-1 stimulates the growth of bones and other tissues and promoting the production of lean muscle mass. Since its levels are more stable in the body, its useful measurement of GH.

Reproductive Hormones

DHEA SULFATE – An androgen or male-type hormone produced in the adrenal cortex of the kidneys. It is produced in both men and women and is tested primarily to test the function of the adrenal glands. Levels should be between 61- 442 (mcg/dL).

ESTRADIOL. In a male, this hormone is produced in the testes, adrenal glands as well as peripheral tissues. It's now understood that this is NOT a female only hormone and low levels of estradiol affect male fertility. Healthy levels will be at or below 39 (pg/mL).

FSH – Follicle stimulating hormone is produced by the pituitary gland. Levels are typically constant throughout your life. Low levels will affect male fertility affecting sperm production. Abnormally high or low FSH levels could indicate pituitary tumor. Healthy levels will fall between 1.6 and 8 (mIU/mL).

LH, luteinizing hormone is also produced by the pituitary and triggers the testicles to make testosterone. Low levels of LH result in low sex drive in men as well as infertility. Healthy levels will fall between 1.5 and 9.3 (mIU/mL).

TESTOSTERONE, TOTAL, MS, & TESTOSTERONE, FREE. Testosterone levels in the blood are controlled by a feedback loop between the brain, pituitary and testes. The testes produce testosterone which is drives male attributes such as masculine development during puberty, muscle and bone strength, male libido, mood and sperm production. Low testosterone may result is loss of body hair, weakening of muscles and bone, depression and poor concentration.

SEX HORMONE BINDING GLOBULIN, SHBG is produced mainly in the liver and binds to free testosterone. Low levels of SHBG have been associated with diabetes, obesity, and hypothyroidism. High levels have been associated with hepatitis, HIV, and hyperthyroidism.

PROLACTIN, A hormone produced by the anterior pituitary gland. This hormone is typically only elevated in pregnant or breast-feeding women. High levels of prolactin in men could be the result of a pituitary tumor and may results in issues associated with low testosterone.

Vitamin D Hormones

VITAMIN D, 25-OH, TOTAL, VITAMIN D, 25-OH, D3, VITAMIN D, 25-OH, D2. These hormones are produced in your kidneys and by exposure to sunlight outside or taken as supplements. Low Vitamin D levels are associated with general fatigue, poor sleep, muscle weakness, and getting sick more often.

Thyroid Hormones

Thyroid hormones control the rate of many activities in your body. These include how fast you burn calories and how fast your heart beats. All of these activities are your body's metabolism. My test panel included: TSH, T4, FREE, T3, FREE, T3 UPTAKE, T4 (THYROXINE), TOTAL, FREE T4 INDEX (T7).

Thyroid Stimulating Hormone or TSH. A TSH test is a lab test that measures the amount of thyroid stimulating hormone (TSH) in your blood. TSH is produced by the pituitary gland. It tells the thyroid gland to make and release thyroid hormones into the blood.

Tumor Marker

PSA, TOTAL. PSA stands for prostate-specific antigen. It is a protein produced by prostate cells is a known tumor marker. Tumor markers are substances that are produced by cancer or by other cells of the body in response to cancer or certain benign (noncancerous) conditions. The PSA test is done to help diagnose and follow prostate cancer in men. Levels above 4 (mIU/mL) may be of concern.

If you are interested in pursuing this, I recommend Ulta Labs. They were recommended by the local lab I used to draw the blood. I was tapped of 8 test tubes of blood. I needed to fast overnight and blood had to be drawn before 9am so it could get to the test lab in Massachusetts for analysis the same day.

Cancer Screen

The top 3 cancers for men are prostate, colorectal, and lung cancer. Make sure you are regularly checking your prostate-specific antigen (PSA) numbers with routine blood screens. With regard to lung cancer, your best bet is to not smoke. If you do smoke, then it's time to have a low dose CT scan. With regard to colorectal cancers, guidance from the American Cancer Society now recommends that colorectal screening begin at 45 instead of 50. The majority of colon cancers start as polyps. These can be removed during a colonoscopy.

At or around 50 is a good time to give yourself a good look over for any moles or spots that are changing. Skin cancer caught early can almost always be cured. Its recommended that once per month you perform a full body evaluation.

Family History

Now is a good time to talk with your parents and grandparents about health issues and diseases which run in the family. This is a good way to determine what other ailments to look for now and in years to come.

Whole Body Scanning

On the subject of preventative whole body scanning. A whole body scan is an examination of the body in order to detect any potential disease or dangers that could be problematic now or potentially in the future. It may consist of a Pet/CT scan and/or MRI scan from the brain to the pelvis in order to detect any potential abnormalities. Full body scanning may detect non-serious diseases as well as serious diseases such as cancer. This is an elective procedure that many people get in order to identify diseases in early stages, before symptoms are prevalent or damage has occurred. I am quite interested in this strategy and was surprised to read the controversy around it. So, of course, I had to look a bit deeper. I completely understand the concern with exposing otherwise healthy people to relatively high doses of radiation with such techniques as X-ray and CT.

However, the company Prenuvo is using magnetic resonance imaging (MRI) which uses a strong magnetic field and radio waves to image the body. No radiation. In a 2021 Forbes article, one of the co-founders, Dr. Raj Attariwala shares that although the current cost of a whole-body MRI scan is about $2,500, the company has a goal of $300. In a meta analysis by Kwee et al., it was concluded that benefits of whole body MRI on patients was "unclear" and the number of false positive findings were significant. Nonetheless, Prenuvo has a compelling product, and I am interested to follow the evolution of this screening strategy. I contacted the company to receive their information package. You can access here if you would like to learn more about their service and costs:

Prenuvo Customer Info

Good luck on your next 50 years!

Terry

References

1. High blood pressure dangers: Hypertension's effects on your body - Mayo Clinic

2. Blood Chemistry Tests for Blood Disorders - Ulta Lab Tests

3. Urinalysis Urine Test: Types, Results, Nitrites/Nitrates, pH, & More (webmd.com)

4. Ulta Lab Tests | Get Blood Tests Near You | Any Lab Test Now | Ulta Lab Tests - Direct Labs Online

5. HGH (Human Growth Hormone): What It Is, Benefits & Side Effects (clevelandclinic.org)

6. DHEA-sulfate test Information | Mount Sinai - New York

7. Estrogen in the adult male reproductive tract: A review - PMC (nih.gov)

8. Pituitary Tumor Diagnosis: Blood Tests & MRI | Memorial Sloan Kettering Cancer Center (mskcc.org)

9. Luteinizing Hormone (LH) Levels Test: MedlinePlus Medical Test

10. Testosterone — What It Does And Doesn't Do - Harvard Health

11. Sex Hormone Binding Globulin (Blood) - Health Encyclopedia - University of Rochester Medical Center

12. Colorectal Cancer Screening Increases in People Under 50 After ACS Updates Guideline

13. Who Should Be Screened for Lung Cancer? | CDC

14. Skin Cancer: Types, Symptoms, Risk Factors & Treatment (clevelandclinic.org)

15. Whole‐body MRI for preventive health screening: A systematic review of the literature - PMC (nih.gov)