This isn't medical advice. Talk to your doctor before you act on any test result.
Guys my age spend real money on their health. Supplements, protein, wearables, gym memberships, cold plunges, red light panels. Then ask the same guy for his visceral fat, his ApoB or his VO2 max and you get a blank stare.
You can't improve what you've never measured.
The stakes are real. Heart disease is the leading cause of death for American men (CDC). About 39% of U.S. men have obesity (CDC). And most of the damage starts quietly in your twenties and thirties, long before anyone tells you to get checked.
One honest note before the list. Most of these are not routine screenings that guideline groups like the U.S. Preventive Services Task Force tell a healthy 25-year-old to get. They're baseline tests. The point is to know where you stand while you're young, so you can see the trend before it becomes a problem. Here's what each one measures and what the research says.
1. DEXA scan: what you're actually made of
What it measures: Body fat percentage, lean muscle mass, visceral fat (the fat around your organs) and bone density. It's a low-dose X-ray scan. You lie on a table for a few minutes.
Why it matters: Your bathroom scale gives you one number, and it can't tell muscle from fat. BMI has the same problem. The American Medical Association said in 2023 that BMI alone is an imperfect measure (AMA). What matters more is where the fat is. A 2021 American Heart Association scientific statement found that belly and visceral fat are linked to heart disease risk even in people whose BMI looks normal (AHA, Circulation).
Is it safe? The radiation dose is tiny: less than one-tenth of a standard chest X-ray, according to the American College of Radiology and the Radiological Society of North America (RadiologyInfo).
What to do: Get a baseline. Then retest once or twice a year and watch two numbers: visceral fat going down and lean mass going up.
2. Blood work: your heart, your blood sugar and your hormones
What it measures: A good panel covers lipids (cholesterol and ApoB), blood sugar (HbA1c), hormones (including testosterone) and dozens of other markers.
Why it matters:
Cholesterol and ApoB. The AHA says adults should get their cholesterol checked starting at age 20, every four to six years if their risk is low (AHA). ApoB counts the particles that actually carry cholesterol into your artery walls. The 2018 AHA/ACC cholesterol guideline lists an ApoB of 130 mg/dL or higher as a risk-enhancing factor (AHA/ACC guideline).
Testosterone. The American Urological Association uses a total testosterone below 300 ng/dL as the cutoff for low T, confirmed with two early-morning tests and actual symptoms (AUA). A well-known study of Massachusetts men found testosterone fell about 1% a year from the late 1980s to the early 2000s, even after adjusting for age (Travison et al., JCEM).
What to do: Get a full panel, not just the basic one at your physical. Know your ApoB, HbA1c and testosterone. And be careful with the testosterone ads on your feed. The AUA says testosterone therapy shouldn't be prescribed to men trying to conceive, because it can shut down sperm production. Which brings us to test No. 4.
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3. Urine: what you've been exposed to
What it measures: Chemicals your body has absorbed from everyday life: bisphenols like BPA, phthalates, pesticides and heavy metals.
Why it matters: These chemicals are everywhere. CDC scientists found BPA in the urine of 92.6% of Americans age 6 and older in national survey data (Calafat et al., Environmental Health Perspectives). BPA and some phthalates are endocrine disruptors, which means they can interfere with the body's hormones, according to the National Institute of Environmental Health Sciences (NIEHS). Dr. Shanna Swan's book Count Down makes the case that this is part of why sperm counts are falling.
The honest part: Finding a chemical in your urine doesn't by itself mean it's hurting you. No major guideline tells you to get this test. What it does is show you what to cut.
What to do: If your numbers are high, the fixes are boring and cheap. Stop microwaving food in plastic. Use glass or steel containers. Skip the paper receipt. Then retest and see if it worked.
4. Semen analysis: the test nobody wants to talk about
What it measures: Sperm count, motility (how well they swim), morphology (shape) and semen volume.
Why it matters: A 2023 review of 223 studies across 53 countries found sperm concentration fell 51.6% between 1973 and 2018, and total sperm count fell 62.3%. The decline sped up after 2000 (Levine et al., Human Reproduction Update). The World Health Organization estimates about 1 in 6 people worldwide are affected by infertility (WHO).
And it's not just about kids. A 2025 study followed 78,284 Danish men for up to 50 years. Men with the best semen quality lived about 2.7 years longer than men with the worst (Priskorn et al., Human Reproduction). That's a correlation, not proof that one causes the other, but your semen looks like a decent read on your overall health.
What to do: Get a baseline now, years before you're trying to have kids. If the numbers are low, the Mayo Clinic's list is a good place to start: stay at a healthy weight, don't smoke, limit alcohol, skip the hot tub and talk to your doctor about any medications you're on, including steroids (Mayo Clinic). Then retest.
5. VO2 max: the best predictor you're not tracking
What it measures: The most oxygen your body can use during hard exercise. It's the best single measure of cardio fitness. A real test is done on a treadmill or a bike with a mask on. Your watch gives you an estimate.
Why it matters: In 2016 the AHA published a scientific statement arguing that cardio fitness should be treated as a clinical vital sign, like blood pressure (AHA, Circulation). A 2018 study of 122,007 adults who took treadmill tests found that the least fit had about five times the risk of death of the most fit, and the researchers found no upper limit to the benefit (Mandsager et al., JAMA Network Open).
What to do: Get a real test once for your baseline. Then train for it. Walk every day, get your heart rate up hard a few times a week, and retest in six months. It's the one number on this list you can move the fastest.
How to actually get these done
Right now, getting all five usually means up to five appointments: a DEXA studio, a lab draw, a specialty lab for the urine panel, a fertility clinic or a mail-in kit for the semen analysis, and a performance center for VO2 max. Different days, different results, nobody looking at them together. Ask your doctor which ones make sense for you, and whether any are covered.
Full disclosure: this frustration is why I founded Brummell Labs, a preventive men's health clinic with a flagship opening in Chicago. It does all five tests in one 60-minute visit, with a physician reviewing the results. If you're in Chicago, you can join the waitlist.
Wherever you get them done, get them done. Write down the numbers. Retest. Most men find out their numbers at 45, after something goes wrong. You can find out at 25 and do something about it.
For more on how to dress, act and get ahead, browse the archive.
Again: this is not medical advice. Talk to your doctor about which tests are right for you and what your results mean.
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Forward this to a guy who knows his bench max but not his blood sugar.
