If you're a man over 40, you've likely heard of the importance of having optimal testosterone levels. However, many other hormones play a role in your overall health too, such as DHEA, cortisol, and thyroid hormones.
That's why it's important to get labs for hormones done,not just for testosterone,but also for overall hormonal balance. In this article, we'll reveal the five hormone labs every man over 40 should run. This added insight allows you to make the best possible decisions moving forward, so you can experience the energy, drive, and vitality you're after while supporting long-term hormone optimization.
At Genesis Lifestyle Medicine, we take into account your hormone results, any other lab tests, medical history, and other pertinent information to ensure you receive the most personalized care possible. Using this personalized approach, we've helped many men reclaim their energy, vitality, and all-around wellness. Our team offers male hormone therapy when appropriate and guides lifestyle strategies for thoughtful hormone optimization.
Introduction
Hormones are essentially the body's chemical messengers. Your body uses a variety of hormones to maintain balance among all body systems, while also ensuring the proper messages are sent from the brain to all organs and cells of the body, and vice versa. As a result, hormone balance is absolutely essential for maintaining energy levels, metabolism, immunity, cognitive functioning, vitality, and overall wellness.
While all hormones are important, there are several hormones that have particular importance for men, especially as you age. This includes:
- Testosterone
- Cortisol
- Dehydroepiandrosterone
- T3 (and other thyroid hormones)
Furthermore, it's important to understand that hormones are interconnected, so imbalances or dysfunctions in one hormone can cause issues to other hormones, leading to greater dysfunction. For example, high cortisol is known to negatively impact total and free testosterone levels and thyroid function.
In the next sections, we'll take a look at the five hormone labs every man over 40 should run, along with key information about the hormones that are tested and why they're so important.
Testosterone and Free Testosterone
Testosterone is one of the most important hormones for men. You're likely aware of testosterone's role in sex drive and libido. But testosterone has so many other roles too, such as in mood and confidence, bone density, cardiovascular health, cognitive function, and muscle growth, among others.
Unfortunately, testosterone levels tend to decline with age, especially after age 35. On average, men experience a decrease of around 0.5% total testosterone and over 1% free testosterone per year. Over time, these decreases can negatively impact energy levels, sex drive, sleep, and mood, while making it harder to build muscle and stay active.
At Genesis Lifestyle Medicine, we offer bioidentical testosterone replacement therapy (TRT) for men with low testosterone as part of our male hormone therapy programs. For some men, lifestyle changes may be enough. But for others, TRT can be highly valuable.
Now, when it comes to hormone testing, you want to get tested for both total and free testosterone levels.
Total Testosterone
Total testosterone measures the total amount of testosterone in the blood stream. It is a good general marker of testosterone production in the body. However, most of your testosterone is bound by sex-hormone binding globulin (SHBG) or other proteins. And when it's in the bound form, your body cannot actively use it. This is why measuring free testosterone is important too.
The normal reference range for total testosterone is 300 to 1,000 ng/dL.
What is Free Testosterone?
Free testosterone measures the unbound, bioavailable testosterone that your body can actively use. Low levels here can be a reason for many common age-related issues (e.g. low drive, poor mood) even if total testosterone levels are in the normal range.
The normal reference range for free testosterone is approximately 5 to 21 ng/dL, although this varies slightly by age.
How Does Free Testosterone Impact Energy Levels and Metabolic Health?
Free testosterone plays vital roles in energy levels and metabolic health. Higher free testosterone levels improve carbohydrate, fat, and protein metabolism, while supporting muscle protein synthesis and inhibiting fat storage. Healthier testosterone levels are associated with better glucose tolerance, insulin sensitivity, and triglyceride levels, as well as improved body composition (e.g. more muscle, less fat).
Testosterone also supports cellular energy production, red blood cell formation, and oxygen-carrying capacities. In turn, these processes promote better energy levels, stamina, and overall physical and mental endurance.
Cortisol Levels
Another hormone lab you should get tested for is your cortisol levels. There are a variety of ways to measure cortisol levels. Here are common tests:
Serum cortisol: Measures the amount of cortisol in your blood at a given time point. Reference ranges depend on the time of day, and usually are:
- 6 to 8 am: 10 to 20 mcg/dL
- Around 4 pm: 3 to 10 mcg/dL
Salivary cortisol: Measures active (free) cortisol, usually at several time points throughout the day
24-hour urinary free cortisol: Measures the total amount of cortisol collected in urine over an entire day.
How are Stress and Cortisol Related?
Cortisol is known as the body's primary stress hormone because it is increased during times of stress, whether that's physical (e.g. hard workout), mental (e.g. worry/anxiety), or environmental (e.g. toxin exposure).
Cortisol often gets a bad rap because of this, but you need adequate cortisol levels to be healthy. In fact, cortisol is necessary for metabolism, immune function, inflammation responses, blood pressure regulation, and other components.In the short-term, increases in cortisol can also help your body manage stress via improvements in mental and physical capacities.
However, chronically elevated cortisol is where many problems can come in. So, if you tend to experience highly stressful situations on a regular basis, there's a good chance that your cortisol may be high, especially if you don't engage in strategies to actively reduce stress.
Effects on Hormone Balance and Overall Health
Over time, chronically high cortisol levels can negatively impact hormone balance and overall health. For example, excessive cortisol decreases thyroid hormone production and the conversion of T4 to T3. It also reduces the production of testosterone and growth hormone, which are so vital for energy and vitality in men.
Regarding overall health, chronically elevated cortisol levels may lead to (or exacerbate):
- Poor immune function
- Worsened sleep
- Anxiety, depression, or other mental health issues
- Impaired gut health
- High blood pressure
- Decreased muscle mass
- Increased fat mass
In addition to diet and lifestyle strategies, sermorelin is a promising option that may help with cortisol dominance by promoting your own growth hormone production.
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DHEA
The third hormone worth looking into is DHEA, which stands for dehydroepiandrosterone. DHEA is a steroid hormone produced by the adrenal glands. It also exists in the body in its sulfated form, known as dehydroepiandrosterone sulfate (DHEAS).
DHEA is a precursor to androgens (e.g. testosterone, dihydrotestosterone [DHT]), and estrogens, making it very important for general hormone balance. For men, adequate DHEA levels are essential for testosterone and DHT production throughout life, helping to maintain energy levels, muscle mass, vitality, and erectile function, among other benefits.
DHEA also has antioxidant and anti-inflammatory properties. And it also plays many important roles in the brain, where it can help with mood, cognitive functioning, and mental well-being.
Does Aging Impact DHEA Levels?
Aging leads to significant decreases in DHEA levels. DHEA levels are highest in men in their 20s and 30s, but levels decrease by approximately 10% per decade. By age 70 to 80, DHEA levels often are only 10 to 20% of what they were in youth.
This decrease in DHEA is associated with many age-related chronic diseases and other symptoms, including cognitive impairment, muscle loss, decreased bone density, obesity, and poor mood. Testing for DHEA thus remains essential for aging men, especially those 40 and beyond.
The most common lab for DHEA is the DHEA Sulfate Test. This measures the amount of DHEAS in your blood, which is a good marker of adrenal health, reproductive function, and hormone balance.
The normal reference range for DHEA varies by age. Here are common reference values for men:
- 31 to 40 years old: 57-522 mcg/dL
- 41-50 years: 34-395 mcg/dL
- 51-60 years: 20-299 mcg/dL
- 61-70 years: 12-227 mcg/dL
- ≥71 years: 6.6-162 mcg/dL
You could also get tested for unbound DHEA, or undergo a salivary DHEA test, but these are less common, and may not be as reliable.
Free T3 (Triiodothyronine)
The fourth test worth running for a man over 40 is free T3 (along with other thyroid hormone tests as needed or recommended by your doctor).
Thyroid hormones are highly important for metabolic health and function. They also affect the heart, central nervous system, lungs, muscles, skin, and several other areas of the body.
There are two main thyroid hormones:
- Triiodothyronine (T3): The active form
- Thyroxine (T4): The relatively inactive form
In the body, thyroid-stimulating hormone (TSH) signals the body to produce T4. Once T4 is released, it can travel to a variety of organs, such as the liver, kidneys, muscles, and thyroid glands. which then can transform it into T3, its more active form.
It's important to understand that both T3 and T4 can be in bound or free forms. The free (or unbound) forms are the forms that have direct physiological effects.
Therefore, for thyroid hormone testing, any of the following thyroid tests may be implemented (with the normal reference range for adults listed below for each one):
- Free T3: 2.3 to 4.1 pg/mL.
- Free T4: 0.7 to 1.9 ng/dL
- Total T3: 80 to 220 ng/dL
- Total T4: 5 to 12 mcg/dL
- TSH: 0.5 to 5.0 mIU/L
How Does Free T3 Affect Energy and Metabolism?
Since T3 is the main active form, it has the greatest effects on overall functioning, especially for energy levels and metabolism. For one, T3 increases metabolic rate, which makes the body more efficient at burning calories and using nutrients for energy, rather than storing them as fat. T3 also directly influences cellular energy metabolism and oxygen consumption, which further impact energy levels in a positive way.
Low T3 can cause a variety of symptoms, such as weight gain, fatigue, or depression. Conversely, high T3 can cause negative symptoms too such as anxiety, trouble sleeping, or weight loss.
Comprehensive Hormone Panel
The fifth lab test you should look into is the comprehensive hormone panel. Usually, this is a blood test, which measures the concentrations of a variety of hormones in your blood at a given point in time. This set of labs for hormones helps reveal broader patterns related to hormonal balance.
The exact markers analyzed in this panel vary depending on where you get it from. But, in general, the comprehensive hormone panel usually analyzes most (or all) of the following markers:
- Total testosterone: The total amount of testosterone in your bloodstream
- Free testosterone: The amount of free, unbound testosterone that your body can use.
- SHBG: A protein that binds to testosterone, which affects how much is available.
- Estradiol: The main form of estrogen in men.
- Albumin: Another protein that can bind to testosterone, thus affecting free T levels.
- Prolactin: A hormone that impacts sexual function.
- Luteinizing hormone (LH): A hormone that stimulates testosterone production.
- Follicle-stimulating hormone (FSH): A hormone that stimulates the testes to produce sperm
The comprehensive hormone panel can be very valuable because it provides potential insights into any hormonal issues you may be having, and the reasons for these issues. For example:
Elevated SHBG and/or albumin can decrease free testosterone levels
Excessive prolactin can suppress testosterone production
Low levels of LH or FSH may indicate root causes of various testosterone or reproductive-related concerns
Elevated estradiol can negatively impact mood, sleep, body composition, and vitality
Knowing these comprehensive values gives you more insight into what's actually going on in your body. From this enhanced knowledge, you can work with a healthcare provider to figure out root-cause solutions that align with sensible hormone optimization.
Conclusion
Hormonal health is important to keep track of for all men, but it becomes especially important as you get older. If you're a man over 40, it's worth running lab tests for total and free testosterone, cortisol, free T3 (and other thyroid hormones), and DHEA. You may even consider a comprehensive hormone panel for even more detailed results. These labs for hormones can form the basis of a personalized plan for thoughtful hormone optimization.
All of these hormones affect your energy levels, drive, cognition, mental well-being, vitality, and overall wellness. Therefore, getting tested can help identify if there are certain issues that need to be corrected. And from there, you can take direct action to solve the root causes.
If you're a man struggling with low energy, poor libido, high stress, or other concerns, you don't have to accept these as simply a "part of aging". At Genesis Lifestyle Medicine, we offer personalized consultations based on your lab results, medical history, symptoms, and goals. When indicated, male hormone therapy may be part of your plan, alongside lifestyle measures to support sustainable hormonal balance. Reach out for a consultation to see how we can help you bring back that energy and vitality once again.
FAQs
Does aging cause hormone levels to drop in men?
Yes. Aging can cause several hormones to decrease in men. In particular, men experience roughly a 0.5% and over 1% decrease in total and free testosterone each year, respectively, starting after age 30 to 35. DHEA levels also decrease on average of 1 to 2% per year after a man reaches his mid 20s to early 30s.
Does chronic stress worsen men's hormonal health?
Yes. Chronic stress increases cortisol, which can negatively impact testosterone, DHEA, T3, and other hormones. In turn, this can lead to issues with sleep, mood, fat gain, muscle loss, brain fog, and other concerns.
What is free testosterone?
Free testosterone is the unbound form of testosterone that actually exerts its physiological effects. So, even if a man has normal total testosterone, he may experience symptoms if his free testosterone is low.
What hormones besides testosterone should aging men get checked for?
Besides testosterone, it's beneficial to get tested for cortisol, T3 (and other thyroid markers), and DHEA. Other useful hormones to check for in some cases include SHBG, LH, FSH, prolactin, and estradiol.
Why measure both total and free testosterone,what’s the difference, and how does SHBG factor in?
Total testosterone reflects all testosterone in your bloodstream, most of which is bound to proteins like sex hormone–binding globulin (SHBG) and albumin. Bound testosterone isn’t readily usable. Free testosterone is the unbound, bioavailable fraction that drives effects like libido, mood, muscle maintenance, and energy. Because high SHBG (or albumin) can lower free testosterone even when total testosterone looks “normal,” checking both total and free testosterone,often alongside SHBG and albumin,gives a clearer picture of your androgen status.
What are the main ways to test cortisol, and why might timing matter?
Cortisol can be measured via serum (blood), saliva, or a 24‑hour urine collection. Serum cortisol has time‑of‑day–specific reference ranges (for example, higher in the early morning and lower in the afternoon), salivary cortisol captures free cortisol and is often collected at several points across the day, and 24‑hour urinary free cortisol totals daily output. Because cortisol follows a daily rhythm and responds to stress, using methods that account for timing can better reveal patterns like chronically elevated levels that can disrupt testosterone, thyroid function, sleep, mood, body composition, and immunity.
Should I test DHEA or DHEA‑S, and how do levels change with age?
The DHEA‑S (DHEA sulfate) blood test is the most common and practical way to assess DHEA status and broader adrenal/hormone balance. DHEA declines substantially with age,roughly about 10% per decade,so by the 70s–80s, levels may fall to 10–20% of youthful values. This drop is linked with issues like reduced vitality, muscle and bone loss, cognitive changes, and mood concerns. Unbound DHEA or salivary DHEA testing exists but is less common and may be less reliable.
Why include free T3 (and other thyroid markers) instead of relying on TSH alone?
TSH stimulates thyroid hormone production, but T3 is the active hormone driving metabolism, energy production, and oxygen use in tissues. T4 is a precursor that must be converted into T3, and both hormones can be bound or free; only free forms exert direct effects. Measuring free T3 (and, as appropriate, free T4, total T3/T4, and TSH) helps identify low‑T3 states that can cause fatigue, weight gain, and low mood,or high‑T3 states that can cause anxiety, sleep issues, and weight loss.
What extra insight does a comprehensive hormone panel provide beyond single tests?
A comprehensive panel looks at interacting hormones,typically total and free testosterone, SHBG, estradiol, albumin, prolactin, LH, and FSH,so you can see both the “what” and the “why.” Examples: elevated SHBG or albumin can lower free testosterone; high prolactin can suppress testosterone production; low LH/FSH may point to upstream causes of low testosterone; and elevated estradiol can affect mood, sleep, body composition, and vitality. These patterns guide more precise, root‑cause interventions.
Medically reviewed by Dr. Alex Spinoso
References
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