Guide

Longevity for men

Men’s longevity considerations differ from women’s primarily in cardiovascular timing (earlier risk), prostate-related screening, testosterone management, and a higher fall-risk-from- injury history. The big interventions overlap heavily; the emphasis shifts.

Cardiovascular trajectory starts earlier

Men accumulate cardiovascular risk a decade earlier on average than women. Aggressive apoB management, BP control, and CAC scoring in the 40s are particularly high-leverage.

Testosterone

Total testosterone declines ~1–2% per year after 30. The clinically meaningful question is symptomatic hypogonadism, not the lab number alone. See testosterone and TRT.

Off-label TRT for "low-normal" levels in asymptomatic men is common and not well-supported by outcomes data. TRAVERSE (2023) was reassuring on cardiovascular safety but raised modest atrial fibrillation and PE signals.

Prostate

• PSA screening: shared decision, typically starting age 50 (or 45 with risk factors). Discuss with primary care.
• BPH symptoms eventually affect most men; multiple effective treatments.
• Prostate cancer detection and over-treatment have evolved substantially over the past decade.

Often-missed considerations

• Lp(a): one-time test before age 40 if not done.
• Sleep apnea is more prevalent in men and substantially under-diagnosed.
• Alcohol use disproportionately affects male mortality.
• Mental-health help-seeking is lower; midlife suicide rates are elevated in men.
• Smoking is more prevalent and the lipid + BP synergy with smoking is catastrophic for CV risk.

Areas of caution

• Off-label peptides marketed to men ("research" peptides via grey-market suppliers): variable purity, unclear safety, no outcomes data. See peptides overview.
• Aggressive TRT without symptoms: risk-benefit shifts unfavourably.
• GH/GHRH analogues for "anti-aging": evidence runs opposite to longevity (see GH/GHRH).