Men’s health after 40: a proactive approach to protecting sexual, hormone and prostate health in midlife  

One of the earliest signs of declining testosterone is often a drop in energy. Men may feel more fatigued than usual, take longer to recover after exercise or notice that their stamina just isn’t what it used to be. Alongside this, they may notice that their strength and muscle mass may be declining at a more rapid pace, especially without regular resistance training.  

Many men also notice an increase in abdominal fat, even without major changes to their diet or activity levels, since hormonal changes can also affect how the body stores fat. And the issue isn’t just cosmetic. Body fat plays an active role in hormone production. Dr. Murray, who works with many men in midlife, often explains to his clients, “The more body fat you have, the more your testosterone gets converted into other hormones like estrogen through a process called aromatization.” 

This creates a cycle where lower testosterone contributes to higher body fat and higher body fat further reduces testosterone. 

Testosterone also plays a role in cognitive function and mood. Some men experience lower motivation, irritability or difficulty focusing – changes that are often subtle but meaningful over time. 

A decline in testosterone can also affect libido and sexual performance. Still, it’s important to understand that these changes are also often multifactorial.  

 “Sexual dysfunction isn’t only hormonal. It can also reflect underlying metabolic or cardiovascular health and should be treated with an integrated approach,” says Dr. Poirier. 

Erectile dysfunction and its link to heart health 

Erectile dysfunction, which is defined as difficulty achieving or maintaining an erection sufficient for sexual activity, can be the result of numerous factors, from psychological stress to hormonal issues and vascular disease. 

From a physical perspective, erectile dysfunction is often related to blood flow.  As Dr. Poirier explains, “The same processes that affect arteries in the heart can affect the smaller arteries supplying the penis.”

This is why for some men, erectile dysfunction is the first warning sign of emerging vascular disease, prompting a broader look at blood pressure, cholesterol, diabetes and family history of early heart disease. 

Cardiovascular disease is a major concern for men. Risk rises with age, and men tend to develop cardiovascular disease earlier than women. Research shows men develop cardiovascular disease about 7 years sooner than women, with risk beginning to rise as early as the mid-30s and heart attacks occurring, on average, several years earlier. In Canada, cardiovascular disease is more common in men, with nearly 1 in 10 living with heart disease and consistently higher rates of hospitalization and death compared to women. 

Non‑modifiable risks include age, sex, family history and genetics. Modifiable risks include: 

1. High blood pressure 
2. High cholesterol 
3. Smoking or vaping 
4. Physical inactivity and poor diet 
5. Excess alcohol use and chronic stress 

When it comes to understanding heart health risk, an important place to start is by gaining a detailed understanding of cardiovascular biomarkers, which are detailed metrics that reflect how the cardiovascular system is working.  

Important tests, like those taken during our comprehensive Annual Health Assessment, can help evaluate where there may be issues under the surface. A comprehensive evaluation can help you identify heart risks early and take proactive steps before chronic or more serious conditions set in. Our doctors can also then provide targeted recommendations to address personal risks or symptoms. These may include lifestyle factors, medications, or deeper screening tests that assess arterial health, heart function, and genetic predispositions. To learn more about heart health screening, visit Medcan’s Heart Health Guide. 

The prostate: a small gland with big impact 

By midlife, many men may find themselves more preoccupied with concerns related to prostate health, such as prostate enlargement and prostate cancer. 

The prostate is a gland in the male reproductive system that produces fluid for semen, helping transport and liquefy sperm. It is essential for fertility early in life, then tends to become more of a clinical focus as men age. Over time, the prostate often commonly enlarges, a benign process known as benign prostatic hyperplasia, which is a non‑cancerous prostate enlargement that can narrow the urinary passage.  

As the gland grows, it can constrict the urethra, the “pipe” that carries urine from the bladder. This is when men may notice: 

• Slower urinary stream 
• The feeling of not being able to empty the bladder completely 
• Increased urgency and frequency to urinate, especially at night 

These symptoms can disrupt sleep, affect daytime performance, and often raise worries about cancer because the same symptoms can also occur in prostate cancer, especially when the prostate is enlarged and a tumour is pressing on the urethra.  

Those experiencing these types of symptoms should consult a physician to determine the cause. However, benign prostatic hyperplasia is not life-threatening and can be easily controlled with medication. 

Prostate cancer is also very common. In Canada, prostate cancer is the most commonly diagnosed cancer in men, with nearly 30,000 new cases each year. About 1 in 9 men will develop prostate cancer in their lifetime. However, due to high survival rates, many continue to live with and beyond the disease. 

Most men are diagnosed at an early stage, where the cancer is highly treatable or even curable. The cancer is slow-growing and if it's confined to the prostate, doctors may recommend surveillance (monitoring with no immediate treatment), surgery (removal of the prostate), or radiation therapy. 

If the cancer is early-stage and only in the prostate (localized) the 5-year survival is ~100%. If it has spread to bones or organs (metastasized) the 5-year survival drops to ~30–40%. 

Even when not life-limiting, treatment can have lasting effects, particularly on urinary and sexual function, requiring ongoing management and support. 

Given the high rates of prostate cancer, Medcan male health experts recommend a prostate‑specific antigen (PSA) blood test for men starting at age 40.  

Prostate-specific antigen is a protein that normally leaks into the blood in small amounts, and a PSA test measures how much of that protein is in your blood. As PSA levels rise, the likelihood of prostate cancer increases. 

Currently, in Canada there is no standard screening protocol for PSA testing in men and it is done on an individualized basis at a physician’s discretion. It is often suggested for men who meet the following criteria: 

• are over age 50 
• have a family history of prostate cancer 
• are of African ancestry 

Medcan takes a proactive, early‑detection approach and includes PSA as a routine men’s health screening test starting in mid‑life.

When we do a PSA test we look at:  

• Total PSA – used in the diagnosis and management of prostate cancer. 
• Free PSA* – the portion of PSA that’s not bound to proteins in the blood. 
• PSA ratio* – ratio of free to total PSA; a lower ratio is associated with a higher likelihood of prostate cancer when total PSA is higher than expected. 
  (*Used in selected cases as part of more detailed assessment.) 

PSA is included in Medcan’s Annual Health Assessment lab panel for men aged 40+ as age‑ and gender‑specific testing. PSA testing can also be paired with a prostate exam for men 40+ as part of Medcan’s men’s health offering. 

If PSA is low, Medcan experts may recommend a test every 2-4 years. If it’s high, testing every 1-2 years is recommended.   

There are also times that PSA can be higher simply because the prostate is larger from benign enlargement, not cancer. That is why context matters. Rather than a single “normal” number, physicians look at: 

1. Whether the prostate feels enlarged on examination 
2. How PSA has changed over time 
3. Family history and other risk factors 

Our men’s health experts emphasize the value of a baseline PSA in middle age, often in the 40s – or 35 and older for those with a family history of prostate cancer – so that future results can be compared over time. 

Prostate health is also a key consideration when discussing testosterone replacement therapy. As Dr. Murray explains, “Prostate size is influenced by dihydrotestosterone (DHT), a more active metabolite of testosterone. Testosterone therapy can increase DHT levels, which may contribute to prostate growth in some men. For this reason, urinary symptoms and prostate health should be monitored during treatment.” 

It’s important to have confidence that there is no underlying prostate cancer before starting testosterone hormone therapy, which includes reviewing PSA trends and, when indicated, digital rectal exams.  

After confirming a baseline PSA prior to initiation, Dr. Murray suggests tracking PSA every three to six months for the first year after initiating testosterone therapy, then annually, to ensure there are no PSA trend concerns. Current evidence indicates that testosterone replacement therapy does not increase the risk of developing prostate cancer. However, as prostate cancer growth may be influenced by androgen exposure, men should undergo appropriate prostate cancer screening before starting treatment and be monitored regularly thereafter. 

Treatments like testosterone therapy and medication exist to manage symptoms related to these common physiological changes, and those options should be discussed with a trained physician as part of an overall treatment plan.  

In addition to medications, there are also three powerful lifestyle factors that can make a major difference to how a man may feel through this stage of life. 

3 very powerful, preventative measures not to overlook 

1. Sleep: the foundation too many men underrate 

Sleep is often the first factor sacrificed in a busy life. But it’s also one of the most important aspects to reclaim. 

“A lot of men are incredibly busy and routinely getting an average of five to six hours of sleep a night,” says Dr. Murray. “Consistently getting at least seven hours of quality sleep is a crucial part of optimizing testosterone levels, recovery and overall health.” 

Hormone production, including testosterone, is closely tied to sleep quality and duration. When sleep is consistently cut short, the body simply doesn’t have the time it needs to regulate these systems effectively. And it’s not just about hormones. Poor sleep also impacts: 

• Energy and motivation to exercise 
• Appetite and weight regulation 
• Stress and mental health 

All of these impact one another and can have a significant impact on vitality. Yet sleep remains one of the most common gaps we see in our male clients. “Sleep is one of those things that is just too commonly skipped over, and it can have significant consequences,” Dr. Murray notes. 

2. Weight management: it’s about more than just pounds  

When it comes to men’s health, weight alone doesn’t tell the whole story. Body composition -particularly body fat percentage - plays a critical and often underappreciated role in hormone balance. 

Fat cells contain an enzyme (aromatase) that converts testosterone into estrogen. The more there is fat tissue present, the more this conversion occurs, effectively lowering available testosterone. This relationship has ripple effects across multiple aspects of health, including: 

• Energy levels and muscle mass 
• Metabolic health 
• Sexual function 

In fact, improvements in body composition can lead to meaningful clinical outcomes. Dr. Murray points to research showing that in men with obesity and erectile dysfunction, “one-third of the participants had resolution of erectile dysfunction…after significant weight loss and exercise intervention.”  

Maintaining a healthy weight looks different for everyone, but a balanced diet with the right calorie intake remains foundational. When weight is difficult to manage, a GLP‑1 medication may be an appropriate option. Our physicians work closely with men to develop personalized prevention plans, tailoring weight management strategies to fit their lifestyle, goals, and overall health. For those who need additional support, our comprehensive weight management program can deliver meaningful, lasting results. 

3. Strength training and how it activates testosterone 

Exercise is widely recommended for overall health, but not all exercise impacts hormones in the same way. Resistance training, in particular, plays a unique role.  

“Resistance training is one of the most effective lifestyle tools for supporting healthy testosterone levels and maintaining vitality as men age.” says Dr. Murray. 

He notes that many men overlook some of the most important muscle groups: “Leg and back workouts are often neglected. And those are the two biggest muscle groups that create the highest overall training stimulus and provide the most support for healthy hormone levels.”  

Training large muscle groups like the legs and back produces a greater acute hormonal response- particularly increases in testosterone and growth hormone - because of the higher total muscle recruitment and metabolic demand involved. 

When resistance training is paired with improvements in sleep and body composition, the results can be significant. “I’ve seen some men make dramatic improvements in baseline testosterone levels, including doubling or even tripling their free testosterone, simply by improving sleep, optimizing body composition and incorporating resistance training by targeting 3-4 sessions per week.” he says. 

A preventative approach that adds up to better health and vitality 

One of the most important shifts in men’s health today is moving from reactive care to proactive care and addressing risk factors before they become symptoms.  

Our Medcan male health experts encourage men to take a proactive approach by assessing their health regularly rather than waiting for symptoms to appear or become disruptive. That said, when symptoms do arise, seeking support early is key, as there are many effective treatment options available. While medications can play an important role, we also emphasize the impact of lifestyle changes, which can be highly effective in improving outcomes and, in some cases, may reduce the need for pharmacological intervention. 

These habits don’t require perfection. But over time, they can change the trajectory of your health. By focusing on sleep, body composition, and strength training you can support hormone health, reduce risk, and feel better day to day.  

Just as important is knowing where you stand. Don’t wait for symptoms to push you to act. Make regular check-ins with your physician as part of your routine, so you can catch risks early, track changes over time, and make informed decisions about your health. Early, proactive care is one of the most powerful tools you have to stay well and on top of your health.