Well Man Screen

What is Well Man screening?

Well Man screening helps men to assess their current health and well-being, and identify early signs of conditions that may adversely affect their health. This screen assesses some of the main factors leading to health problems in men, including levels of blood lipids (fats) such as cholesterol, glucose (sugar), and the hormone testosterone. These measures are inter-linked in some diseases. Your results will enable you to evaluate your lifestyle, and make adjustments or take action where necessary to prevent or ameliorate major health problems.

What are the main Well Man screening tests?

The tests in the Well Man screen are blood lipid profile, blood HbA1c level, and blood testosterone level.

Blood lipid profile: Measures the main fats in the blood

• Total cholesterol: all types of cholesterol, needed to form cell walls, hormones, fat-soluble vitamins, and bile acids.
• Low density lipoprotein (LDL)-cholesterol (the 'bad' cholesterol): too much leads to fatty deposits in blood vessel walls.
• High density lipoprotein (HDL)-cholesterol (the 'good' cholesterol): takes the excess LDL-cholesterol to the liver for removal from the body.
• Total cholesterol to HDL-cholesterol ratio.
• Non-HDL-cholesterol: all types of 'bad' cholesterol.
• Triglycerides: a fat stored in fat cells as an energy source.

Glycosylated haemoglobin HbA1c (the diabetes test): This is the level of glucose (sugar) molecules bound to haemoglobin (the protein in red blood cells that carries oxygen in the blood to all tissues) in the blood. HbA1c increases as the blood glucose level increases.

Testosterone: The main male sex hormone that has a major role in the development of the male reproductive organs (e.g., testes, prostate), 'secondary' sexual characteristics (e.g., body/facial hair, deepening voice, body shape, and muscle and bone mass), and mood.

Click on the links to read more on the Blood Lipids Profile and Diabetes Testing

Why is Well Man screening important?

Routine checks of blood levels of cholesterol, HbA1c and testosterone are used to monitor male health and prevent complications. Heart disease, diabetes, and testicular cancer are serious health risks for men and a regular health check offers the best chance of early detection.

Cardiovascular disease (CVD) is the leading cause of death worldwide, and 80% of cardiovascular deaths are due to heart attacks and strokes. Too much 'bad' LDL-cholesterol can increase the risk of CVD. Arteries become clogged with LDL-cholesterol, which restrict the oxygen and nutrient supply to the heart and other organs, and cause blood clots that can result in heart attacks and stroke. Triglycerides can also cause artery disease, and can indicate other conditions such as type 2 diabetes and hypothyroidism. Identifying those at high risk of CVDs can help to prevent premature death.

Diabetes is characterised by raised levels of blood glucose (HbA1c), which affects the blood vessels causing heart attacks, stroke, and kidney, eye and nerve damage. Most common is type 2 diabetes, which occurs when the pancreas does not produce sufficient insulin or becomes resistant to insulin, the hormone regulating blood glucose levels. The number of people living with type 2 diabetes has been steadily increasing, linked to the rise in obesity. It is one of the most common chronic health conditions; an estimated 6% of people in the UK have diabetes, many of which are undiagnosed.

Testosterone is needed for normal male physical development as well as to maintain heathy sexual relationships and mood. The level of this hormone declines naturally with age (also known as hypogonadism or 'low T'), at about 1% per year beginning around age 40 years. Testosterone has an important role in libido (sex drive), production of semen (the fluid containing sperm), and erectile function. When levels are reduced prematurely below normal, men can experience a loss of libido, have erectile problems, and a reduced volume of semen. They may also see loss of body/facial hair (such as balding), muscle mass and bone mass, have decreased energy levels, a low mood, lack concentration, and develop larger breasts. However, high testosterone levels may cause testicles to shrink, impotence, low sperm counts, prostate enlargement, high cholesterol and blood pressure, and increased risk of heart attack, aggression, and mood swings.

Who should have a Well Man screen?

Routine Well Man screening is recommended for all men, although the frequency of these health checks may vary if you have related or other health conditions or take medicines. They are particularly important if you have or develop symptoms of CVD (e.g., pain in the chest, arms or legs, shortness of breath, fast/slow heartbeat, and light-headedness), diabetes (e.g., frequent urination, greater thirst, fatigue, weight loss, and blurred vision) or abnormal testosterone levels (see above). Men are advised to get themselves checked if there is a family history of high cholesterol levels, CVD, diabetes, fertility issues or testicular/prostate cancer.

What does a Well Man screen involve?

The Well Man test can be carried out on a small blood sample taken by you from your little finger. Taking a blood sample is easy and all you feel is a small prick of the skin. A test kit with all the necessary instructions is sent to you by The Online Clinic, which will also supply details of where to send the blood sample for analysis at their associated laboratory. Test results are sent to one of The Online Clinic doctors, who will interpret and present them on your patient dashboard. Results are available on the same day that the sample is received at the lab.

What do Well Man screen test results indicate?

The results of your Well Man screen test will present your lipid profile, and levels of HbA1c and testosterone. The aim is for a low levels of the 'bad' blood lipids (total cholesterol, LDL-cholesterol, non-HDL-cholesterol, and triglycerides) and total cholesterol:HDL-cholesterol ratio, a high level of the 'good' HDL-cholesterol, a low blood glucose (HbA1c) level, and a normal testosterone level with regard to your age.

You are at increased risk of CVD, particularly heart attack and stroke, if cholesterol levels are high. Increased blood glucose levels can suggest that you are at the prediabetic stage, that is when your blood sugar levels are raised above normal but not so high as to diagnose diabetes, or indicate diabetes. Both prediabetes and diabetes increase the chances of CVD and kidney disease, and eye and nerve damage. The risk of CVD is even greater if you have both high cholesterol and blood glucose levels, and particularly if you have other risk factors including being overweight, a smoker, high blood pressure, and a family history of CVD.

Signs that often drive men to have a check-up are loss of libido and erectile dysfunction, which are common. These can occur if men are stressed or tired, but may also indicate reduced testosterone levels. Testosterone levels can be altered if there is a disorder of the pituitary gland, which releases hormones that affect testosterone production, adrenal glands, which also produce testosterone, or if you have other conditions.

It is interesting to note the link between the components of the Well Man screen. Thus, diabetes lowers levels of 'good' cholesterol levels and raises 'bad' cholesterol levels; increased cholesterol levels are associated with low testosterone levels; and low testosterone levels can increase the risk of type 2 diabetes.

What are normal Well Man screen test results?

Test results are shown below; variations will occur depending on whether your blood sample was taken before/after a meal and the time of day it was taken, and on the medicines that you take.

Lipid profile (normal levels):

• Total cholesterol: below 5.0 mmol/l
• HDL-cholesterol: above 1.0 mmol/l, ideally 1.5-1.6 mmol/L.
• LDL-cholesterol: below 3.0 mmol/l
• Total cholesterol:HDL-cholesterol ratio: below 5.0, optimum 3.5
• Non-HDL-cholesterol: below 4.0 mmol/l
• Triglycerides: below 1.7 mmol/l (fasting) and below 2.3 mmol/l (non-fasting)

Blood glucose levels:

• Healthy people: below 5.5 mmol/l before food; below 7.8 mmol/l 2 hours after food.
• Prediabetes: 5.5-6.9 mmol/l before food; 7.8-11.0 mmol/l 2 hours after food.
• Diabetes: 7.0 mmol/l or higher before food; 11.1 mmol/l or higher 2 hours after food (target: 4.0-7.0 mmol/l before food; below 8.5-9.0 mmol/l after food).

Testosterone (normal range):

• 10.0 - 30.0 nmol/L

How Men can maintain or achieve Well-Being

Your test results will give a good indication of your general health condition. Maintaining healthy levels of blood lipids and glucose can be achieved through a balanced diet, an ideal body weight, and exercise. While testosterone levels will gradually decline with age, these measures as well as plenty of rest and avoiding stress can also help to boost testosterone levels. Prediabetes is often reversible with the correct diet, weight loss, exercise, and not smoking.

People with very high unhealthy cholesterol levels or diabetes should seek advice from their healthcare professional regarding a treatment plan to lower cholesterol levels and control blood glucose levels. For men with symptoms of low testosterone, testosterone replacement therapy may be a treatment option. Everyone should make any necessary lifestyle changes to optimise their health and well-being, and treatment is available when additional help is required.