What are the key recommendations for maintaining overall wellness in an adult male?

Adult Male Wellness: Evidence-Based Recommendations

Adult men should prioritize cardiovascular risk reduction through lifestyle modification, targeted cancer screening beginning at age 45-50, and metabolic disease prevention, as these interventions demonstrably reduce morbidity and mortality. 1, 2

Lifestyle Modifications for Cardiovascular Health

The foundation of adult male wellness centers on cardiovascular disease prevention, which remains the leading cause of mortality. All adult men should engage in at least 150 minutes per week of moderate-intensity aerobic physical activity (or 75 minutes of vigorous-intensity activity), as this reduces cardiovascular mortality by 30-50%. 1

Dietary Pattern

• Follow a DASH-style dietary pattern emphasizing vegetables, fruits, whole grains, low-fat dairy products, poultry, fish, legumes, and nuts while limiting red meat, sweets, and sugar-sweetened beverages. 1
• Consume whole grains (whole wheat, oats, brown rice, quinoa) rather than refined carbohydrates to reduce colon cancer risk and improve metabolic health 1
• Limit red and processed meats high in saturated fat; choose lean cuts and prepare by baking, broiling, or grilling rather than frying 1
• Use liquid vegetable oils instead of solid fats 1
• Reduce sodium intake to <2,400 mg/day, ideally 1,500 mg/day, which lowers systolic blood pressure by approximately 5-6 mmHg 1, 3

Weight Management

• Maintain BMI between 18.5-24.9 kg/m²; each 1 kg weight loss reduces systolic blood pressure by approximately 1 mmHg. 1, 3
• Balance caloric intake with physical activity expenditure 1

Substance Use

• Completely cease all tobacco product use, as smoking cessation reduces total mortality by 36% in patients with coronary heart disease. 1
• Limit alcohol to ≤2 drinks daily (12 oz beer, 5 oz wine, or 1.5 oz distilled spirits), which reduces systolic blood pressure by approximately 4 mmHg 1, 3

Cancer Screening

Colorectal Cancer

Begin screening at age 45 using one of these options: 1, 2

• Annual fecal immunochemical test (FIT) 2
• Colonoscopy every 10 years 1, 2
• CT colonography every 5 years 2
• Flexible sigmoidoscopy every 5 years 1, 2
• Multitarget stool DNA test every 3 years 2

All positive non-colonoscopy tests require timely colonoscopy follow-up 2. Continue screening until at least age 75 1.

Prostate Cancer

Beginning at age 50 for average-risk men (age 45 for African American men or those with first-degree relatives diagnosed before age 65), offer annual PSA testing and digital rectal examination through shared decision-making for men with ≥10-year life expectancy. 1, 2, 4

This recommendation acknowledges that prostate cancer screening reduces mortality but carries risks of overdiagnosis and treatment complications. The decision must weigh individual risk factors, patient values, and life expectancy 1, 2.

Lung Cancer

For men aged 55-80 years with ≥30 pack-year smoking history who currently smoke or quit within the past 15 years, perform annual low-dose CT screening. 4, 5

Metabolic and Cardiovascular Screening

Laboratory Testing

• Lipid profile (total cholesterol, LDL, HDL, triglycerides) for all men aged 40-75 years; non-fasting samples are acceptable 2, 4
• Hemoglobin A1C screening for diabetes, especially in men with BMI ≥25 kg/m² plus additional risk factors (first-degree relative with diabetes, high-risk ethnicity, cardiovascular disease history, hypertension, HDL <35 mg/dL, triglycerides >250 mg/dL) 1, 2
• For prediabetes (A1C 5.7-6.4%), repeat testing annually; for normal results, repeat every 3 years 2
• Blood pressure measurement at every clinical encounter 1, 2, 4

Additional Screening

• One-time abdominal aortic aneurysm screening ultrasonography for men aged 65-75 years who have ever smoked 4
• Complete blood count, comprehensive metabolic panel, and urinalysis with albumin-to-creatinine ratio to assess for anemia, organ function, and kidney disease 2

Testosterone Assessment

Measure testosterone levels in men presenting with decreased libido or erectile dysfunction. 1

• Testosterone >350 ng/dL does not usually require replacement 1
• Testosterone <230 ng/dL typically benefits from testosterone replacement therapy (TRT) if no contraindications exist 1
• For symptomatic men with testosterone 231-346 ng/dL, consider a 4-6 month trial of TRT after discussing risks and benefits; continue beyond 6 months only if clinical benefit is demonstrated 1

Low testosterone associates with increased cardiovascular and all-cause mortality, though this may reflect poor general health rather than direct causation 1.

Immunizations

Update all immunizations according to Advisory Committee on Immunization Practices guidelines, including influenza, pneumococcal, tetanus-diphtheria-pertussis, and herpes zoster vaccines as age-appropriate 4.

Common Pitfalls to Avoid

• Do not delay colorectal cancer screening beyond age 45—guidelines recently lowered the starting age from 50 2
• Avoid ordering extensive screening laboratory tests not supported by evidence; general health checks increase disease detection but do not reduce mortality 6, 7
• Do not fail to confirm abnormal lipid or glucose results before establishing a diagnosis 2
• Recognize that comprehensive annual physical examinations, while popular, lack mortality benefit and may lead to overdiagnosis 6, 7
• Exercise caution with TRT in men with congestive heart failure history due to fluid retention risk 1

Risk Stratification Approach

Rather than applying uniform screening to all men, prioritize interventions for those at highest cardiovascular risk (10-year CVD risk ≥10%), as this approach maximizes benefit while minimizing harm from overdiagnosis and overtreatment 1. Men with multiple risk factors (hypertension, diabetes, smoking, family history) derive greater absolute benefit from intensive lifestyle modification and screening 1.

The evidence demonstrates that lifestyle modification—particularly physical activity, dietary pattern changes, and smoking cessation—provides greater mortality benefit than general health checks or extensive laboratory screening 1, 6, 7. Focus clinical time on counseling regarding diet, physical activity, tobacco cessation, and alcohol use rather than comprehensive physical examinations of asymptomatic organ systems. 2, 7