Annual Blood Work: Which Tests to Get by Age and Sex (and What Physicals Miss)

When should you be screened for diabetes?

The USPSTF recommends screening for prediabetes and type 2 diabetes in adults aged 35 to 70 who have overweight or obesity, defined as a body mass index of 25 or higher and 30 or higher^[10]. The ADA goes further: screening should begin at age 35 for everyone, and if results are normal, repeating it at least every 3 years is reasonable, sooner if your weight or risk changes^[1].

This matters because prediabetes is common and silent. An estimated 13% of US adults have diabetes and 34.5% meet criteria for prediabetes^[10]. Most adults with prediabetes do not know they have it^[19]. The ADA cutoffs are an A1c of 5.7–6.4% or a fasting glucose of 100–125 mg/dL for prediabetes, and an A1c of 6.5% or higher or a fasting glucose of 126 mg/dL or higher for diabetes^[1]. See what a high A1c means and the A1c normal range.

How often should cholesterol be checked?

The 2019 ACC/AHA prevention guideline says that for adults aged 20 to 39, it is reasonable to assess traditional heart-risk factors, including cholesterol, at least every 4 to 6 years^[11]. That is less often than yearly. From age 40, the lipid panel feeds a 10-year risk estimate.

The USPSTF recommends a statin for adults aged 40 to 75 with at least one risk factor (high cholesterol, diabetes, high blood pressure or smoking) and a 10-year risk of 10% or more. It suggests selectively offering one when that risk is 7.5% to under 10%. For adults 76 and older, it found the evidence insufficient^[12]. A yearly lipid panel makes more sense if you are near a treatment threshold, already take a statin, or your numbers are changing. More on high cholesterol.

Which infection tests are recommended for adults?

• HIV: screening for everyone aged 15 to 65, younger and older people at increased risk, and all pregnant people (grade A)^[2].
• Hepatitis C: screening for all adults aged 18 to 79 (grade B)^[3].
• Hepatitis B: the CDC recommends screening with three lab tests at least once in a lifetime for adults 18 and older, and says anyone who asks for the test should get it^[16]. The USPSTF recommends screening people at increased risk^[15].
• Syphilis: screening for people at increased risk (grade A)^[17].
• Chlamydia and gonorrhea: screening for sexually active women 24 and younger, and women 25 and older at increased risk. Evidence is insufficient for screening men^[20]. These are urine or swab tests.

Infection screening is where physicals most often fall short, because many people assume these tests are only for high-risk groups. Hepatitis C screening applies to nearly every adult, and up to 60% of people with hepatitis B do not know they have it^[3][15].

Should men get a PSA test every year?

The USPSTF does not recommend automatic yearly PSA tests. For men aged 55 to 69, the decision to have periodic PSA screening should be an individual one, made after talking through benefits and harms with a clinician. It recommends against PSA screening at 70 and older^[18].

The numbers behind that: screening men aged 55 to 69 may prevent about 1.3 prostate cancer deaths and about 3 cases of metastatic cancer per 1,000 men screened over about 13 years. The harms include false positives, biopsies and overtreatment; about 1 in 5 men who have a radical prostatectomy develop long-term urinary incontinence^[18]. Black men and men with a family history of prostate cancer have higher risk, which can change the balance^[18]. See the PSA test.

Which popular tests lack evidence for routine screening?

Two tests that often appear on wellness panels have no routine screening recommendation for people without symptoms. The USPSTF concluded the evidence is insufficient to weigh benefits and harms of screening for thyroid dysfunction in nonpregnant adults without symptoms^[6], and of screening for vitamin D deficiency^[7].

“Insufficient evidence” is not the same as “harmful.” A TSH test makes sense with fatigue, weight change, hair loss or a family history of thyroid disease. A vitamin D test makes sense with bone loss, malabsorption or limited sun exposure. Read more about high TSH and low vitamin D.

Is a CBC part of annual blood work?

Usually, yes. Most clinicians include a CBC with differential at a physical, though it is not on the USPSTF list of screening tests. A CBC counts red cells, white cells and platelets and measures hemoglobin. It is good at spotting anemia and big shifts in blood cells.

Its blind spot is iron. Iron deficiency moves from low stores to anemia over time, so hemoglobin can be normal while stores are already low^[5]. In high-income countries, about 38% of nonpregnant, reproductive-age women have iron deficiency without anemia, compared with about 13% who have iron-deficiency anemia^[5]. A normal CBC alone would miss most of them.

What does a CMP tell you?

The CMP bundles glucose, kidney markers (creatinine, BUN, eGFR), liver markers (ALT, AST, alkaline phosphatase, bilirubin, albumin, total protein), electrolytes and calcium. The glucose value is only comparable to the ADA cutoffs of 100–125 mg/dL (prediabetes) and 126 mg/dL or higher (diabetes) if you fasted^[1].

The eGFR on a CMP is calculated from creatinine, which comes from muscle. KDIGO lists bodybuilders, high-protein diets and creatine supplements among situations where creatinine-based eGFR is less accurate^[13]. If that sounds like you, read about creatine and blood tests.

Lipoprotein(a): the once-in-a-lifetime test

Lipoprotein(a), or Lp(a), is a cholesterol-carrying particle whose level is mostly set by your genes. The National Lipid Association (NLA) says there is now enough evidence to measure Lp(a) at least once in every adult. It classes under 30 mg/dL (75 nmol/L) as low risk, 30–50 mg/dL as intermediate and 50 mg/dL (125 nmol/L) or higher as high risk^[4]. The European Atherosclerosis Society agrees, ideally in the first lipid profile^[21].

About 1 in 5 people have an elevated Lp(a), but measurement rates are low^[4]. The AHA/ACC cholesterol guideline lists Lp(a) of 50 mg/dL or 125 nmol/L or more as a risk-enhancing factor, and names a family history of premature heart disease as a reason to measure it^[8]. Order it as a stand-alone Lp(a) test or within the heart health panel.

ApoB: a better count of risky particles

Each LDL and VLDL particle carries one ApoB protein, so ApoB counts the particles that can lodge in artery walls. The AHA/ACC guideline names ApoB of 130 mg/dL or higher as a risk-enhancing factor and says a relative reason to measure it is triglycerides of 200 mg/dL or higher^[8]. That is the common pattern with insulin resistance, where LDL cholesterol can look fine while particle number is high.

A1c vs. fasting glucose: why the physical may not catch prediabetes

Many physicals report glucose only through the CMP. If you did not fast, that number cannot be judged against fasting cutoffs. An A1c test needs no fasting and reflects longer-term average glucose. The ADA accepts either for diagnosis: A1c 5.7–6.4% or fasting glucose 100–125 mg/dL for prediabetes^[1].

A1c has limits. The ADA notes it may not be suitable in some hemoglobin variants, in pregnancy and in people with anemia^[1]. In those cases, glucose-based tests are used instead. For a deeper look at insulin and glucose together, see labs for insulin resistance.

Ferritin: the iron test a normal CBC can't replace

A JAMA review lists heavy menstrual bleeding, pregnancy and inflammatory bowel disease as risk factors where iron testing should be considered. Iron deficiency is usually diagnosed by a ferritin under 30 ng/mL when there is no inflammation, or a transferrin saturation under 20%^[5]. Symptoms include fatigue, poor focus, exercise intolerance and restless legs^[5]. A ferritin test and an iron panel answer that question; a CBC does not.

Urine albumin and cystatin C: earlier, sharper kidney checks

KDIGO, the global kidney guideline group, says people at risk for chronic kidney disease should be tested with both a urine albumin measurement and an assessment of GFR^[13]. It names high blood pressure, diabetes and heart disease as the highest-priority conditions^[13]. The ADA recommends a urine albumin-to-creatinine ratio and eGFR at least yearly in everyone with type 2 diabetes; 30 mg/g or more is moderately increased albuminuria^[14]. A CMP alone checks only the eGFR half.

The 2024 KDIGO update puts more weight on cystatin C^[22]. It recommends a combined creatinine–cystatin C eGFR when creatinine-based eGFR is less accurate and the result affects decisions^[13]. That is common in muscular people, those on creatine and those with very low muscle mass. More in labs for kidney disease.

In your 20s and 30s

• Lipid panel at least every 4–6 years as part of a heart-risk check^[11], and Lp(a) once^[4].
• HIV and hepatitis C screening^[2][3], and hepatitis B at least once^[16].
• Chlamydia and gonorrhea for sexually active women 24 and younger^[20]; syphilis if at increased risk^[17].
• Ferritin if you have heavy periods or fatigue^[5].
• A1c from age 35^[1], or earlier if your clinician flags risk factors.

What blood tests should a 40-year-old get?

Forty is when heart-risk math starts to drive decisions. A lipid panel feeds the 10-year risk estimate that the USPSTF uses for statin advice from age 40^[12]. If you never had Lp(a) measured, now is a good time. Diabetes screening should already be under way, with an A1c at least every 3 years if normal^[1]. Add a urine albumin test and eGFR if you have high blood pressure or diabetes^[13]. The comprehensive wellness panel covers the CBC, CMP, lipids, A1c and ferritin in one draw.

In your 50s and 60s

• Lipids and diabetes screening continue; this is the peak window for statin decisions^[12].
• PSA for men aged 55–69, as a shared decision^[18].
• Kidney checks (uACR and eGFR, with cystatin C if creatinine may mislead) if you have diabetes, high blood pressure or heart disease^[13].
• HIV screening runs through age 65^[2]; hepatitis C through 79^[3].

At 65 and older

Several screens taper off. The USPSTF recommends against PSA screening at 70 and older^[18], finds the evidence insufficient for starting a statin at 76 and older^[12], and limits its diabetes screening recommendation to age 70^[10]. HIV screening after 65 is for people at increased risk^[2]. Tests tied to medications and existing conditions, such as kidney function and A1c, often matter more now than new screening.

Women: pregnancy plans, heavy periods and menopause

• Planning a pregnancy: HIV screening is recommended in every pregnancy^[2]. Lp(a) can roughly double during pregnancy, so a baseline is best measured beforehand^[21]. The USPSTF thyroid statement covers only nonpregnant adults, so ask your clinician about thyroid testing before or during pregnancy^[6].
• Heavy periods: consider ferritin even when the CBC is normal^[5]. Timing tips are in our menstrual cycle and blood tests guide.
• Pregnancy history: preeclampsia and premature menopause (before 40) are heart risk-enhancing factors, worth mentioning when lipids are reviewed^[8].
• Menopause: LDL often rises around this time; Lp(a) changes little with menopause, so an earlier result still applies^[21]. See labs for perimenopause.

Men: PSA and early heart disease in the family

For men, PSA is the main sex-specific decision. A family history of heart disease in a father or brother before 55, or a mother or sister before 65, counts as premature heart disease and is a reason to check Lp(a)^[11][8]. Evidence is insufficient for routine chlamydia and gonorrhea screening in men^[20]. If you take testosterone, monitoring is different; see the TRT blood work guide. If you take a GLP-1 medication, see the GLP-1 blood work guide.