From the age of 40, the male body changes in ways that many men initially barely notice. Metabolism slows down, hormone production alters, and the risk of various diseases increases. At the same time, many men of this age are heavily involved in their careers and families and tend to put off health issues. This is a mistake, because investing in one's health is particularly worthwhile from the age of 40 onwards – many problems can be detected and treated early, before they become serious.

Why 40 is a turning point

Statistically speaking, at 40 you've reached midlife. Your body, which has endured and compensated for so much, is starting to show the first signs of aging. Testosterone levels begin to decline slowly, on average by about one percent per year. This decline is perfectly normal, but can be more pronounced in some men and cause symptoms. The prostate gland begins to enlarge, which is initially harmless but should be monitored. The risk of cardiovascular disease increases, especially if risk factors such as being overweight, having high blood pressure, or elevated cholesterol levels are present. Metabolism slows down, which, if your diet remains the same, leads to weight gain, particularly around the abdomen. These changes are not illnesses, but rather part of the normal aging process. However, they do mean that from the age of 40 onward, you should pay more attention to your health.

The typical avoidance attitude

Men are known to visit the doctor less often than women. Many feel they have to be strong and can't show any weakness. Symptoms are downplayed, and preventative care is postponed. This attitude has consequences: men die on average several years earlier than women, and many illnesses are only detected at an advanced stage when treatment is more difficult. It's time to break these patterns. Taking care of your health is not a sign of weakness, but of responsibility – to yourself, your family, and your future.

Testosterone is the most important male sex hormone and influences far more than just sexuality. It plays a central role in muscle mass and strength, bone density, fat distribution, energy levels and drive, mood and mental clarity, libido and sexual function, as well as red blood cell production. Testosterone production peaks around age 20 and then declines slowly. This decline is normal, but in some men it can be more pronounced or begin earlier.

Symptoms of testosterone deficiency

Clinically relevant testosterone deficiency, also known as hypogonadism, affects approximately two to six percent of men between the ages of 40 and 79. Symptoms often develop gradually and are easily attributed to other causes. Classic symptoms include reduced libido and sexual interest, erectile dysfunction, fatigue and lack of energy, loss of muscle mass and strength, increased body fat, especially around the abdomen, depressed mood and irritability, difficulty concentrating and reduced mental acuity, as well as decreased body hair. Individual symptoms can have many causes. If several occur together and persist over a longer period, further investigation is recommended.

When is testosterone truly low?

Not every instance of fatigue or lack of motivation indicates a testosterone deficiency. Diagnosis requires both low blood test results and corresponding symptoms. The normal range for testosterone is broad – what is low for one person may be normal for another. The timing of the measurement is also important: testosterone levels are highest in the morning and should therefore be measured on an empty stomach. If the results are borderline, a second measurement should be taken. Before considering a testosterone deficiency, other causes for the symptoms should be ruled out: sleep disorders such as sleep apnea can cause severe fatigue and also lower testosterone levels. Depression has many overlapping symptoms. Thyroid problems can cause similar symptoms. Chronic illnesses and certain medications can affect testosterone levels.

Cardiovascular diseases are the leading cause of death among men in Germany. The risk increases significantly from the age of 40, especially if risk factors are present. The good news: Many of these risk factors are modifiable, and early detection can save lives.

Know the risk factors

The most important risk factors for cardiovascular disease are high blood pressure, which increases the risk of heart attack and stroke. Elevated LDL cholesterol levels lead to plaque buildup in the arteries. Diabetes or prediabetes damages blood vessels. Being overweight, especially with abdominal fat, significantly increases the risk. Smoking is one of the strongest risk factors. Lack of exercise and a family history of heart disease in first-degree relatives are also significant. Many of these risk factors do not cause symptoms, which is why regular checkups are so important. You may not feel high blood pressure or cholesterol.

Take warning signs seriously

A heart attack can manifest in different ways. The classic symptom is severe chest pain radiating into the left arm. However, men can also experience atypical symptoms: pressure or tightness in the chest, upper abdominal pain, nausea, shortness of breath during exertion or even at rest, unusual fatigue, or cold sweats. If such symptoms occur, do not hesitate to call emergency services. In the case of a heart attack, every minute counts.

Prevention

The risk of cardiovascular disease can be significantly reduced through lifestyle changes. Not smoking or quitting smoking is the single most important measure. Regular exercise, ideally 150 minutes of moderate activity per week, strengthens the heart. A healthy diet rich in vegetables, whole grains, healthy fats, and few processed foods lowers cholesterol. Weight control and stress management are important. Regular checkups help identify risk factors early. If risk factors such as high blood pressure or elevated cholesterol levels are present, medication may be beneficial. Talk to your doctor about your individual risk status.

The prostate is a small gland, about the size of a walnut, located below the bladder and surrounding the urethra. It produces part of the seminal fluid. With increasing age, the prostate enlarges in almost all men – a process called benign prostatic hyperplasia (BPH), which more frequently causes symptoms from around age 50.

Benign prostatic hyperplasia

Because the prostate gland surrounds the urethra, its enlargement can lead to urinary tract problems. Typical symptoms include frequent urination, especially at night, a weak urine stream, the feeling of not being able to completely empty the bladder, dribbling after urination, and difficulty starting to urinate. These symptoms are bothersome but not dangerous. They can be treated with medication or, in severe cases, surgically. It is important to have the symptoms investigated to rule out other causes.

Prostate cancer

Prostate cancer is the most common cancer among men in Germany. The risk increases with age; most diagnoses are made after the age of 60. If detected early, prostate cancer is often highly treatable. Many prostate tumors grow very slowly and never become a problem – some men die with prostate cancer, not from it. Early detection includes a digital rectal examination, in which the doctor palpates the prostate through the rectum. The PSA test, which measures prostate-specific antigen in the blood, is another method. The PSA test is controversial because it can lead to overdiagnosis and overtreatment. Elevated levels can have many causes, not just cancer. The decision for or against a PSA test should be made on an individual basis and after consultation with a doctor.

When should I start having preventative checkups?

In Germany, statutory prostate cancer screening begins at age 45. If there is a family history of the disease, meaning your father or brother has had prostate cancer, screening should begin earlier, around age 40. Talk to your doctor about the best approach for you.

After 40, it becomes more difficult to maintain or lose weight. Metabolism slows down, muscle mass decreases without targeted exercise, and daily life is often less active than in younger years. At the same time, eating habits usually don't change – the result is weight gain, typically around the abdomen.

The belly fat problem

Not all excess weight is the same. Abdominal fat, medically known as visceral fat, is particularly problematic. It surrounds the internal organs and is metabolically active – it produces inflammatory mediators and hormones that increase the risk of diabetes, cardiovascular disease, and certain types of cancer. A simple indicator is waist circumference, measured at the navel. In men, a circumference over 94 cm is considered excessive, and over 102 cm is considered significantly excessive. The Body Mass Index (BMI) alone is less informative because it doesn't differentiate between muscle and fat.

Maintain metabolic health

Regular exercise is the most important factor in keeping your metabolism active. A combination of endurance training, which burns calories and strengthens the heart, and strength training, which maintains or builds muscle mass, is particularly effective. Muscles consume more energy than fat tissue, even at rest. Your diet must adapt to the altered metabolism. Calorie requirements decrease, but the need for nutrients remains the same or even increases. This means eating less, but more nutrient-rich foods. Limit processed foods, sugar, and alcohol. Increase protein intake to support muscle maintenance. Ensure sufficient fiber for healthy digestion.

Detecting prediabetes

Before the onset of diabetes, there is a phase in which blood sugar levels are already elevated but not yet in the diabetic range – prediabetes. In Germany, it is estimated that many millions of people have prediabetes, most without knowing it. At this stage, diabetes is often still preventable through weight loss and lifestyle changes. Therefore, regular monitoring of blood sugar and HbA1c is particularly important from the age of 40 onwards, especially for those who are overweight or have a family history of diabetes.

Sexual function and satisfaction can change with age. This is normal and doesn't mean that sexual health has to decline after 40. But it's important to notice changes and seek help if problems arise.

Erectile dysfunction

Erectile dysfunction, the persistent inability to achieve or maintain an erection sufficient for sexual intercourse, becomes more common with age. Approximately 20 percent of men between 40 and 49 are affected, with an increasing trend in older age groups. The causes are varied. Vascular problems are common, as erections depend on good blood flow; the same factors that cause heart disease can also impair erectile function. Hormonal factors, such as low testosterone levels, can play a role. Neurological causes, such as diabetes or certain surgeries, can damage the nerves. Medications, such as blood pressure medications, antidepressants, and others, can cause erectile problems as a side effect. Psychological factors, such as stress, anxiety, or relationship problems, also play a role. Erectile dysfunction can also be an early warning sign of cardiovascular disease. Men with erectile problems have an increased risk of heart attack and stroke. Therefore, the evaluation should include not only sexual function but also vascular health.

Changes in libido

Sexual desire can decrease with age. This is normal to a certain extent, but a significant decline can indicate low testosterone, depression, relationship problems, or chronic illnesses. It's important to talk openly about it—with your partner and, if necessary, with a doctor. Shame shouldn't prevent you from seeking help. Sexual health is part of overall health and quality of life.

Mental health is often overlooked in men. Many men struggle to talk about their feelings or seek help when they are experiencing mental health difficulties. This has consequences: The suicide rate among men in Germany is about three times higher than among women.

Depression in men

Depression affects men just as much as women, but often manifests differently. Classic symptoms like sadness are reported less frequently by men. Instead, they more often exhibit irritability and outbursts of anger, risky behavior and increased risk-taking, increased alcohol or drug use, physical complaints such as headaches or digestive problems, overwork and escapism into work, and social withdrawal. These symptoms are often not recognized as depression, neither by those affected nor by doctors. The result: men are diagnosed and treated less often.

Midlife transition

Midlife can be a time of upheaval. Some men experience a crisis when they realize that life is finite, certain dreams haven't been fulfilled, and changes are on the horizon, both professionally and personally. This isn't necessarily negative—it can also be an opportunity to re-evaluate life and make course corrections. It becomes problematic, however, when the crisis leads to depression, destructive behavior, or rash life decisions. In these situations, professional support can be helpful.

Burnout risk

Men in their 40s are often at the peak of their professional responsibilities, while simultaneously fulfilling family obligations. This double burden can lead to exhaustion. Burnout symptoms such as chronic fatigue, cynicism, and decreased performance should be taken seriously. Men tend to ignore such signs and carry on until they reach a breaking point.

Regular check-ups are the best investment in your health. Many illnesses initially cause no symptoms and are only discovered through routine examinations. The earlier the check-up, the better the treatment options.

What kind of retirement planning is required from age 40?

An annual check-up with your family doctor should include blood pressure measurement, basic lab tests such as blood sugar, cholesterol, liver and kidney function, and a physical examination. From age 45, prostate cancer screening with a digital rectal exam and optional PSA test is added. From age 50, colorectal cancer screening with a stool test is recommended, and from age 55, a colonoscopy is advised. Individual adjustments may be beneficial in cases of risk factors, such as earlier or more frequent check-ups. Dental check-ups every six months and skin cancer screening every two years from age 35 are also recommended.

Understanding lab results

Blood tests provide important information about health. The most important for men over 40 are cholesterol, consisting of LDL, HDL, and triglycerides, with elevated LDL being a risk factor for heart disease. Blood sugar and HbA1c indicate the risk of diabetes. Liver function tests such as ALT (GPT) and AST (GOT) can indicate liver problems caused by alcohol or fatty liver. Kidney function tests such as creatinine and GFR show kidney function. TSH indicates thyroid function. Testosterone should be measured if symptoms of deficiency are present. PSA can be measured as an optional prostate test after consulting a doctor.

self-observation

In addition to medical checkups, self-awareness is important. Pay attention to changes in your body, such as unintentional weight changes, persistent fatigue, changes in urination, skin changes like new or altered moles, and persistent discomfort of any kind. If something is different than usual and doesn't improve on its own, get it checked out. It's better to see a doctor too often than not often enough.

Hormones play a central role in energy levels, mood, body composition, and many other aspects of men's health. A comprehensive hormone check can provide valuable insights when nonspecific symptoms such as fatigue, lack of motivation, or mood swings occur.

Which hormones are relevant?

Testosterone is the most important male hormone and should be measured if a deficiency is suspected. Free testosterone is the biologically active form and can also be measured. SHBG, or sex hormone-binding globulin, influences how much testosterone is freely available. A high SHBG level can still lead to deficiency symptoms even with normal total testosterone levels. Estradiol is also present in men in small amounts and is produced from testosterone. An imbalance between testosterone and estradiol can lead to symptoms, especially in overweight men. DHEA-S is a precursor hormone that declines with age and is often considered a marker of biological aging. Cortisol is the stress hormone and is relevant in cases of chronic stress. The thyroid hormones TSH, fT3, and fT4 significantly influence metabolism, energy levels, and mood.

When is a hormone check advisable?

A hormone test can be useful in cases of unexplained chronic fatigue not caused by lack of sleep, loss of libido or erectile dysfunction, mood swings or depression, muscle loss despite exercise, stubborn abdominal fat despite a healthy lifestyle, and as part of a comprehensive health check from age 40 onwards. The results should always be interpreted in the context of the symptoms and the overall health situation. A single slightly low or high value without symptoms often requires no treatment but should be monitored.

What to do if the readings are unusual?

Before considering drug therapies such as testosterone replacement, lifestyle factors should be optimized. Sleep, diet, exercise, and stress management significantly influence hormone levels. In cases of a clear deficiency and corresponding symptoms, hormone therapy may be beneficial, but it should be supervised by an experienced physician.

A new chapter in men's health begins after age 40. The body changes, risks increase, but with the right knowledge and proactive measures, many problems can be avoided or treated early. It's up to you to take responsibility for your health.

Key points summarized

Prevention is more important than cure. Take advantage of preventative care services and get regular checkups for things you don't notice: blood pressure, blood sugar, cholesterol. Know your body and pay attention to changes. Don't hesitate to see a doctor if something seems wrong. Hormonal changes are normal but can cause symptoms. A hormone check can be helpful for nonspecific complaints such as fatigue, loss of libido, or mood swings. Lifestyle is medicine. Many illnesses can be prevented or improved through exercise, a healthy diet, not smoking, and moderate alcohol consumption. Mental health matters. Don't be afraid to talk about your feelings or seek help. Depression and burnout also affect men and are treatable.

Specific recommendations for action

Schedule your next health check-up now if you don't go for regular check-ups. Honestly assess your lifestyle and identify an area you can improve—exercise, diet, sleep, alcohol, or stress. Talk to your doctor about individual risk factors in your family or medical history. Take symptoms seriously instead of ignoring or normalizing them. Invest in your health like you would in any other important thing in your life.

A personal thought

Many men define themselves by their performance. That's precisely why health should be a priority – it's the foundation for everything you want to do and achieve. A few hours a year for preventative care and self-care can give you many healthy years. It's a worthwhile investment.