5 Critical Blood Tests Every Man Over 45 Should Get (But Very Few Do)

Summary

Dr. Michael Diamonds argues that “normal” lab results do not always mean optimal health, especially for men over 45. He says standard checkups may miss signs of insulin resistance, fatty liver, low usable testosterone, and cardiovascular risk. He illustrates his approach with client Isaac, whose routine results were described as normal, while additional measurements revealed concerns.

The video presents five areas to review. The targets below are Dr. Diamonds’ suggested benchmarks, not universal diagnostic cutoffs.

1. Fasting insulin

• The video distinguishes blood glucose from insulin: glucose measures sugar in the blood, while fasting insulin is presented as a measure of how much insulin the body needs to keep glucose controlled.
• Dr. Diamonds uses a “librarian and books” analogy: insulin helps move glucose into storage. When that system is overworked, he says, insulin resistance and abdominal fat may develop even while glucose remains in the lab’s normal range.
• His preferred fasting-insulin target is below 8. He describes higher levels as a reason to investigate further, rather than relying on glucose alone.
• Isaac’s glucose changed only slightly, from 94 to 93, while his fasting insulin fell from 10 to 5.1 between January and August.
• Preparation, according to the video: Fast for 12 hours. Have only water in the morning, with no coffee.
• If the result is elevated, the video recommends focusing on nutrition, activity, and sleep—not treating the number in isolation.

2. Triglyceride-to-HDL ratio

• Triglycerides are described as fats circulating in the blood; HDL is described as helping carry cholesterol away from arteries.
• Calculate triglycerides ÷ HDL using the values on the blood test. The example given is 150 ÷ 50 = 3.
• Dr. Diamonds’ target is below 2. He says a result above 3.5 may indicate insulin resistance, while noting that this ratio may be less reliable for Black men and that fasting insulin should also be considered.
• Isaac’s ratio improved from 2.3 (triglycerides 74, HDL 32) to 1.8 (triglycerides 68, HDL 37). The video notes that HDL can fluctuate during active weight loss.
• For a ratio above his target, he suggests limiting alcohol and sugary drinks, eating fatty fish such as salmon or sardines, and exercising regularly. He advises against extreme fasting as a way to correct the ratio.

3. Testosterone panel

• The video recommends checking total testosterone, free testosterone, and SHBG (sex hormone-binding globulin), rather than total testosterone alone.
• Total testosterone is presented as the overall amount in the blood; free testosterone is the unbound portion that, in the video’s explanation, is more available to the body’s tissues.
• Isaac’s total testosterone was 469, which the video calls within the lab range, while his free testosterone was 57 and marked low. His SHBG was 53.
• Dr. Diamonds says testosterone tends to decline with age and argues that weight, sleep, nutrition, and stress can affect hormone levels. He also says fat loss may improve testosterone.
• Testing instructions in the video: Have the blood draw between 7 and 10 a.m. If results are low, repeat the test before considering testosterone replacement therapy.
• Suggested lifestyle measures include adequate sleep, strength training at least three times a week, and reducing excess body fat.

4. Liver enzymes: ALT and GGT

• ALT is described as an enzyme that can rise when liver cells are stressed; GGT is discussed in relation to liver fat and alcohol.
• Dr. Diamonds argues that standard lab reference ranges may be too broad. He suggests aiming for ALT below 30, rather than treating values up to 40—or higher—as automatically reassuring.
• Isaac’s ALT decreased from 44 in January to 23 in August. The video says his initial result was still marked normal by his lab.
• The video emphasizes that fatty liver may not cause obvious symptoms and recommends asking about GGT, particularly if ALT is above the creator’s target.
• Suggested steps include taking a break from alcohol, avoiding sugary drinks, and walking for at least 10 minutes after two major meals.

5. ApoB and lipoprotein(a)

• ApoB is presented as a count of cholesterol-carrying particles, while LDL cholesterol measures the cholesterol carried inside them. The video compares this to counting trucks on a road versus measuring their cargo.
• Dr. Diamonds recommends ApoB below 90, or below 80 for people with additional risk factors such as high blood pressure, diabetes, or a family history of early heart disease.
• Isaac’s LDL was 128 and ApoB 117 in January. The video says his ApoB would be checked again later.
• Lipoprotein(a), or Lp(a), is described as largely genetic and generally worth testing once. Isaac’s result was 172, which the video characterizes as high. It says that when Lp(a) is high, other cardiovascular risk factors should be addressed carefully.
• The video recommends asking a clinician to include ApoB and Lp(a) in testing, rather than relying only on standard LDL and total cholesterol results.

Overall approach and recommendations

Dr. Diamonds frames the five areas as connected signs of metabolic and cardiovascular health. His broader routine recommendations for Isaac—and recommendations he offers viewers—include:

• Aim for roughly 1 gram of protein per pound of body weight.
• Walk at least 9,000 steps a day.
• Get at least 7 hours of sleep.
• Do strength training at least three times per week.
• Limit alcohol and liquid sugar; avoid sugary coffee drinks.
• Ask a clinician to explain results and consider repeat testing where appropriate.

He encourages viewers to discuss these tests with a healthcare professional, noting that some may not be part of routine panels. The video also promotes the creator’s paid coaching program. Its thresholds and interpretations are the creator’s recommendations; viewers should not use them as a substitute for individualized medical advice.

Speakers and sources featured

• Dr. Michael “Mike” Diamonds — the video’s narrator and primary speaker.
• Isaac — client whose blood-test results and weight-loss progress are discussed; he does not speak in the subtitles.
• Brian — client whose heart attack and LDL history are recounted; he does not speak in the subtitles.
• Drobi — client shown in a testosterone-related before-and-after example; he does not speak in the subtitles.
• Unnamed research sources referenced by Dr. Diamonds: Stanford researchers studying the triglyceride-to-HDL ratio; studies of testosterone changes with age and weight loss; a study scanning American livers; research on ALT reference ranges among healthy blood donors; and an 11-year UK Biobank analysis of 389,000 people comparing ApoB, LDL, and triglycerides. No individual researchers or study titles are identified in the subtitles.