The 12 labs your annual physical leaves out
The bloodwork checklist most over-40 readers send to their doctor before the next appointment.
A standard annual physical typically covers a basic metabolic panel, CBC, lipid panel, TSH, fasting glucose, and (sometimes) HbA1c. That is fine for general screening. It is not fine for understanding what is happening to a 47-year-old whose energy, sleep, weight, and mood are quietly shifting.
These 12 add the layer your physical leaves out.
The 12
- Total testosterone (men) — before 10am due to diurnal variation
- Free testosterone (men and women) — calculated or direct; SHBG-adjusted
- SHBG — rises with age, with thyroid disorders, and with alcohol
- Estradiol (sensitive assay) — standard estradiol assays are inaccurate for men and post-menopausal women
- DHEA-S — adrenal androgen reserve; drops faster than T with age
- Fasting insulin — rises years before fasting glucose; use to calculate HOMA-IR
- HbA1c — 3-month average glucose; under 5.4 ideal, 5.4-5.6 watch, 5.7+ pre-diabetes
- ApoB — better cardiovascular risk marker than LDL-C alone; growing standard-of-care
- hs-CRP — systemic inflammation marker; under 1 mg/L ideal
- 25-OH Vitamin D — aim 40-60 ng/mL; deficiency is widespread and silently corrosive
- Ferritin — iron stores; pre-menopausal women and endurance athletes especially
- TSH, free T3, free T4 (full thyroid panel, not TSH alone)
How to use this list
Print it. Take it to your annual physical. Hand it to your physician with: "Could we add these to my next blood draw? I would like to track them as I get older." Most clinicians will run them; some will push back on cost or insurance coverage. If your clinician will not order them, direct-to-consumer services (Quest, Labcorp, Marek Health, Function Health) can.
The optimal ranges
Reference ranges from the lab are not optimal ranges — they are the middle 95% of the (often unhealthy) population that gets blood drawn. Optimal is tighter. We walk through them by sex and decade in the bloodwork letter and the men's edition.
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