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ASMH/SMSNA Men's Health Checklist

The checklist items are applicable to an individual patient based on their age and risk (either normal or increase risk)

Provided by EVAL Foundation
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Instructions
  • The checklist items are applicable to an individual patient based on their age and risk (either Normal Risk or Increased Risk). 
  • For each AGE Milestone as listed, if the patient is at least this AGE, consider the following checklist items. 
  • Note, the AGE Milestones are NOT the frequency of any particular screening test. SEE RESULT COMMENTS for each specific item recommendation.
  • Shared decision between the clinician and the patient is always recommended for testing decisions.

Default Section

For each AGE Milestone as listed, if the patient is at least this AGE, consider the applicable checklist items.

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On behalf of the American Society for Men’s Health (ASMH) and the Sexual Medicine Society of North America (SMSNA), we would like to present the ASMH/SMSNA Men’s Health Checklist.

 

Given the concerning trends in male health care statistics, both organizations felt a need to develop a current, comprehensive checklist to guide clinicians and patients as they work together to optimize health. Steering committee and workgroups were created to develop the list without the influence or involvement of outside stakeholders.  

 

The checklist is organized based on the age and risk factors of patients, with specific recommendations and references. It is important to read the instruction page carefully for proper interpretation.

 

We would like to thank the following steering and workgroup committee members who contributed to the project:

 

  • ASMH Steering Committee and Workgroup: Martin Miner (lead), Joel Heidelbaugh, Mehran Movassaghi, Bruce Kava
  • SMSNA Steering Committee: Gregory Broderick, Serge Carrier, Mohit Khera, Hossein Sadeghi-Nejad
  • SMSNA Workgroup: Jesse Mills (lead), Helen Bernie, Miquel Pineda, Hossein Mirheydar, Juan Andino
  • Project Lead: Jason Jameson

 

View the checklist here.

All questions & possible results

Default Section
AGE Milestone (in years)

For each AGE Milestone as listed, if the patient is at least this AGE, consider the applicable checklist items.

Select one option:

  • 18y
  • 20y
  • 35y
  • 40y
  • 45y
  • 50y
  • 60y
  • 65y
  • 69y
  • 80y
Select the categories of interest

Select all that apply:

  • Screening
  • Preventative Medications
  • Vaccine
  • Counseling
  • Potential dangers of OTC/supplements/stimulants
  • Male Hygiene
  • Penile Disorders (phimosis, Peyronie's Disease, etc.)
  • Thyroid Function
  • Transgender Men
  • Transgender Women (prostate cancer screening)
Possible results
Screening (18y/20y): Abnormal Glucose/Diabetes - If identified under obesity screening (BMI >30) or clinically indicated, consider screening.
  • Per USPSTF, age 35-70 if overweight or obesity (Grade B - USPSTF, 2021)
  • American Diabetes Association recommends screening at age 45 for all. Subsequent testing as clinically indicated. 
  • If identified under obesity screening, consider screening 

 

Reference

Screening: Alcohol Misuse - Normal Risk
  • USPSTF determined that 1- to 3-item screening instruments have the best accuracy for assessing unhealthy alcohol use in adults 18 years or older. 
  • These instruments include the abbreviated Alcohol Use Disorders Identification Test–Consumption (AUDIT-C) and the NIAAA-recommended Single Alcohol Screening Question (SASQ). 
  • Grade B, USPSTF (2018)

 

References

Vaccine: Tetanus - Normal Risk.
  • Tetanus: 1 dose Tdap, then TD or Tdap booster every 10 years

 

Reference

Screening: Body Dysmorphic Disorder (Muscle Dysmorphia/"Bigorexia") - Normal Risk

Body dysmorphic disorder

  • Preoccupation with one or more perceived defects or flaws in physical appearance that are not observable or appear slight to others. 
  • Expert Opinion.

 

Muscle dysmorphia/”Bigorexia”

  • Also known as BOD subtype “muscle dysmorphia”
  • Perceiving the body as too small. 
  • Expert Opinion.

 

Reference

  • Body Dysmorphia & Muscle Dysmorphia/“Bigorexia”: DSM-5.
Screening (40y): Prostate Cancer - Increased Risk
  • Shared Medical Decision Making about PSA screening for prostate cancer is recommended for all patients. 
  • Age 40 if increased risk (Black ancestry, germline mutations, strong family history) (Grade B; AUA, 2023).
  • Age 45-69 for all (Grade B; AUA, 2023). 
  • See AUA Guideline reference for further details on interval recommendations. 
  • Note: USPSTF (2018) is Grade C. 
  • In select healthy patients with an estimated life expectancy of at least 10 years, ongoing screening can be considered for men over age 69. 
  • DRE can be offered as part of screening in asymptomatic men at any age, but men with voiding symptoms should have annual DRE to assess for significant changes that may reflect clinically significant prostate cancer even in men over the age of 69
  • Expert Opinion (AUA, 2023)

 

References

Preventative Medications: Preexposure Prophylaxis (PreP) for HIV - Increased Risk.
  • If increased risk includes MSM non-monogamous, inconsistent condom use, history of STI’s, IV drug use.
  • Grade A (USPSTF, 2019)

 

Reference

Screening: Social Determinants of Health - Normal Risk
  • Includes income, educational attainment, employment status, access to food and housing. 
  • Multiple screening tools, see reference. 
  • Expert Opinion.

 

Reference

  • SDOH & Practice Improvement. Content last reviewed August 2023. Agency for Healthcare Research and Quality, Rockville, MD. https://www.ahrq.gov/sdoh/practice-improvement.html      
Potential Dangers of OTC/Supplements/Stimulants - Normal Risk.
  • Many OTC products can be adulterated and are not regulated and can pose risk to patients. 
  • Expert Opinion 
Screening: Sleep Apnea - Normal Risk
  • Use Validated Questionnaire (STOP-BANG or Berlin), per American Academy of Sleep Medicine (2017). 
  • Grade I, USPSTF (2022). 
  • A sleep study should be considered if increased risk (daytime fatigue, testosterone deficiency).

 

Reference

Screening (65y+): Abdominal Aortic Aneurysm - Normal Risk

USPSTF (2019): Age 65

  • Grade B (If smoking history)
  • Grade C (for non-smokers).
  • Subsequent testing as clinically indicated.28

 

Reference

 

 

Screening (20y+): Lipid Disorder - If identified under obesity screening (BMI >30), consider screening - Normal Risk
  • Per American Heart Association, age 20 and every 4-6 years (note, USPSTF does not recommend)
  • If identified under obesity screening, consider screening. 
Screening: Syphilis - Increased Risk
  • If increased prevalence in the community, MSM, HIV+, Young Adults, history of incarceration, sex work, military service, illicit drug use. 
  • Grade A (USPSTF, 2022) 
  • Subsequent testing based on further risk exposure. 

 

Reference

Vaccine (60y+): Hepatitis B (start at 19) - Increased Risk.
  • 2, 3, or 4 doses depending on vaccine or condition 

 

Reference

Screening: Chlamydia & Gonorrhea - Increased Risk
  • Increased risk if they have a new sex partner, more than 1 sex partner, a sex partner with concurrent partners, or a sex partner who has an STI; practice inconsistent condom use when not in a mutually monogamous relationship; or have a previous or coexisting STI.
  • Expert Opinion. 
  • Note: Grade I (USPSTF, 2021)

 

References

Screening (45y-69y): Prostate Cancer - Normal Risk
  • Shared Medical Decision Making about PSA screening for prostate cancer is recommended for all patients. 
  • Age 40 if increased risk (Black ancestry, germline mutations, strong family history) (Grade B; AUA, 2023).
  • Age 45-69 for all (Grade B; AUA, 2023). 
  • See AUA Guideline reference for further details on interval recommendations. 
  • Note: USPSTF (2018) is Grade C. 
  • In select healthy patients with an estimated life expectancy of at least 10 years, ongoing screening can be considered for men over age 69. 
  • DRE can be offered as part of screening in asymptomatic men at any age, but men with voiding symptoms should have annual DRE to assess for significant changes that may reflect clinically significant prostate cancer even in men over the age of 69
  • Expert Opinion (AUA, 2023)

 

References

Vaccine (20y-50y): Hepatitis B (start at 19) - Normal Risk.
  • 2, 3, or 4 doses depending on vaccine or condition 

 

Reference

Transgender Women (prostate cancer screening) (45y-69y) - Normal Risk.
  • if prostate present, needs screening as per AUA guideline
Screening (18y): Lipid Disorder - If identified under obesity screening (BMI >30), consider screening.
  • Per American Heart Association, age 20 and every 4-6 years (note, USPSTF does not recommend)
  • If identified under obesity screening, consider screening. 
Screening (18y-35y): Fertility Screening - Increased Risk.
  • Age 18 -25 consider in post-pubertal boys with varicocele
  • Per SMSNA workgroup, consider one-time screening semen analysis for men ages 18-25 to screen for male factor infertility. 
  • Expert Opinion.
Screening: Polypharmacy - Normal Risk
  • 5+ medications qualifies as potential polypharmacy. 
  • Recommend using STOPP/START criteria to identify. 
  • Expert Opinion (AHRQ, 2020).

 

Reference

Screening (45y+): Colorectal Cancer - Normal Risk

USPSTF (2021): 

  • Age 45 (Grade B)
  • Age 50-75 (Grade A)
  • Age 76-85 (Grade C) 
  • This assessment of net benefit applies to stool-based tests with high sensitivity, colonoscopy, computed tomography (CT) colonography, and flexible sigmoidoscopy. 
  • See reference for further details.

 

Reference

Vaccine (18y-45y): Shingles- Increased Risk.
  • 2 doses. age 19-49 if immunocompromised, age 50+ for all 

 

Reference

Screening: Testosterone Deficiency - Increased Risk

Consider testing with 

  1. Signs/ symptoms of chronic fatigue, chronic stress, depression, erectile dysfunction, low sex drive. 
  2. Asymptomatic men with history of unexplained anemia, bone density loss, diabetes, exposure to chemotherapy, exposure to testicular radiation, HIV/AIDS, chronic narcotic use, male infertility, pituitary dysfunction, and chronic corticosteroid use. 

 

Grade B (AUA Guideline, 2018)

 

Reference

Screening (50y+): Lung Cancer - Increased Risk
  • Annual screening for lung cancer with low dose computed tomography (LDCT) in adults aged 50 to 80 years who have a 20 pack-year smoking history and currently smoke or have quit within the past 15 years. 
  • Screening should be discontinued once a person has not smoked for 15 years or develops a health problem that substantially limits life expectancy or the ability or willingness to have curative lung surgery. 
  • Grade B (USPSTF, 2021).

 

Reference

Screening: Hepatitis B Virus Infection - Increased Risk

Criteria

  • Increased risk (born in countries with high prevalence such as Asia, Africa, Pacific Islands, parts of South America
  • US born but not vaccinated and parents from high-risk countries
  • HIV +
  • IV drug use
  • Men who have sex with men
  • Exposure to Hep B

 

Grade B (USPSTF, 2020)

 

Reference

Preventative Medications (65y+): Fall Prevention (Vitamin D) - Increased Risk.
  • Age 40-59 if increased risk (10% or greater 10-year CVD risk)
  • Grade C (USPSTF, 2022)
  • But recommend against those age 60+ 
  • Grade D (USPSTF, 2022)

 

Reference

Screening: Hypertension - Normal Risk
  • BP annually and at every visit and then confirm outside of clinical setting before starting treatment. 
  • Grade A, USPSTF (2021).

 

Reference

Screening (50y+): Bladder Cancer - Increased Risk
  • Age 50 if increased risk.
  • Consider UA for high risk, smokers (current and previous), family history. 
  • Expert Opinion.

 

 

Preventative Medications (40y-60y): Aspirin For Cardiovascular Risks - Increased Risk.
  • Age 40-59 if increased risk (10% or greater 10-year CVD risk)
  • Grade C (USPSTF, 2022)
  • But recommend against those age 60+ 
  • Grade D (USPSTF, 2022)

 

Reference

Vaccine (18y-60y): Pneumococcal - Increased Risk.
  • Age 19-64: 1 or 2 doses depending on vaccine and only if risk factors or another indication. 
  • Age 65+: if unsure if previously vaccinated or previous infection 

 

Reference

Penile Disorders (phimosis, Peyronie's Disease, etc.) - Normal Risk.
  • Examination of the penis for foreskin issues is important, as well as questions about penile changes/curvature with erections (Peyronie’s Disease). 
  • Expert opinion.
Screening: Erectile Dysfunction - Normal Risk
  • Ask if any issues getting or maintaining an erection. 
  • If so, then can proceed with IIEF-5 questionnaire. 
  • Can be early marker for cardiovascular disease. 
  • Expert Opinion (Rhoden et al., 2002)

 

Reference

Vaccine: Influenza - Normal Risk.

One does annually (CDC, 2023)

 

Reference

Counseling: Activity for CVD Prevention - Normal Risk.
  • 150 minutes/week of moderate intensity and muscle strengthening 2x/week per Dept of HHS. 
  • Note: USPSTF says is grade C unless increased risk with CVD risk factors, then is Grade B.36 

 

Reference

Screening (35y/40y): Abnormal Glucose/Diabetes - If identified under obesity screening (BMI >30) or clinically indicated, consider screening - Increased Risk
  • Per USPSTF, age 35-70 if overweight or obesity (Grade B - USPSTF, 2021)
  • American Diabetes Association recommends screening at age 45 for all. Subsequent testing as clinically indicated. 
  • If identified under obesity screening, consider screening 

 

Reference

Screening: Unhealthy Drug Use - Normal Risk
  • Ask patients questions about unhealthy drug use (use of substances, not including alcohol and tobacco) that are illegally obtained or the nonmedical use of prescription psychoactive medications. 
  • Does not mean testing biologic specimens. 
  • Grade B, USPSTF (2020)

 

Reference

Screening: Depression, Anxiety & Suicide - Normal Risk

Depression

  • Patient Health Questionnaire– Depression (PHQ-9), 2-item version is also available. 
  • Grade B, USPSTF (2023)

 

Anxiety

  • Generalized Anxiety Disorder scale (GAD), 2- and 7-item versions. 
  • Adults <64: Grade B, USPSTF (2023)
  • Adults >64: Grade I, USPSTF (2023)

 

Suicide

  • PHQ-9 suicide item. 
  • Grade B, USPSTF (2023)
  • 988 is the National Suicide and Crisis Hotline.

 

References

Screening (50y+): Osteoporosis - Increased Risk

Age 50 with increased risk:

  • Bone density testing for increased risk (androgen deprivation, BMI < 20-25 kg per meters squared
  • Cigarette smoking
  • History of fragility fractures
  • Low dietary calcium intake
  • Oral corticosteroid use
  • Physical inactivity
  • Spinal cord injury
  • Weight loss > 10%

 

Per American College of Physicians (ACP, 2008) Guidelines

  • Strong Recommendation
  • Moderate Quality Evidence 

 

Reference

Counseling: Contraceptive Counselling - Normal Risk.
  • Periodic abstinence, withdrawal method, vasectomy. 
  • Expert Opinion
Transgender Women (prostate cancer screening) (40y) - Increased Risk.
  • if prostate present, needs screening as per AUA guideline
Counseling: Sleep Health - Normal Risk.
  • 7+ hours per night per American Academy of Sleep Medicine (2015).

 

Reference

Thyroid Function (35y+) - Increased Risk.
  • If increased risk, consider with increased risk factors/symptoms (ED, fatigue, obesity, cold intolerance, hair loss)
Counseling: Skin Cancer Prevention - Normal Risk.
  • American Academy of Dermatology recommends all persons to limit UV exposure, use protective clothing and sunscreen with SPF 30 or higher (ADD, 2025).
  • Note: USPSTF gives grade C for behavior counselling to persons with fair skin (USPSTF, 2018).

 

Reference

Vaccine: COVID - Normal Risk.
  • 2- or 3- dose primary series and booster.

 

Reference

Screening: Tobacco Use & Cessation - Normal Risk
  • Tobacco use and cessation
  • USPSTF, Grade A (2021)

 

Reference

Vaccine: Hepatitis A (If not done in childhood) - Normal Risk.
  • 2, 3, or 4 doses depending on vaccine 

 

Reference

Vaccine: Monkeypox - Increase Risk.

Reference

Vaccine (18y-45y): HPV- Normal Risk.
  • Catch-up HPV vaccination is now recommended for all persons through age 26 years. 
  • For adults aged 27 through 45 years, public health benefit of HPV vaccination in this age range is minimal.
  • Shared clinical decision-making is recommended (Meites et al., 2019).

 

Reference

Male Hygiene - Normal Risk.
  • Foreskin care is important to prevent infection and scarring which can lead to phimosis. 
  • Foreskin should be retracted to void, and then replaced to down position to avoid paraphimosis, a medical emergency. 
  • Expert Opinion. 
Screening: Penile Cancer - Normal Risk
  • Men should pay close attention and report any changes, and an exam is recommended to be conducted by providers. 
  • Expert Opinion
Counseling (65y+): Fall Prevention - Normal Risk.

American Geriatric Society recommends 800 IU per day of Vit D for persons at increased risk of falls: 

  • History of falls, 
  • History of mobility problems, and poor performance on the timed Get-Up and-Go test. 
  • Expert Opinion. 
  • Note: USPSTF (2024) gives a grade D

 

References

Preventative Medications (40y+): Statin For CVD Prevention - Increased Risk.
  • Ages 40-75 with increased risk
  • 1 or more CVD risk factors and estimated 10-year CVD risk of 10% or greater
  • Grade B (USPSTF, 2022)
  • If between 7.5% 10% CVD risk, may consider statin
  • Grade C (USPSTF, 2022)

 

Reference

Screening: Voiding Health - Normal Risk

Three important questions to ask each patient: 

  1. Are you bothered with voiding?
  2. How many times do you wake up at night to void?
  3. Do you have leakage/accidents? 

 

  • If bothered by voiding, or if 2 or more night voids occur, or if urine leakage, can use further screening tools for BPH (AUA Symptom Score), and Overactive Bladder Symptom Score (OABSS). 
  • Expert Opinion 
Screening: Obesity - Normal Risk
  • Weight, BMI, waist circumference annually and at every visit, all ages (BMI Calculator).
  • If BMI over 30, refer for interventions
  • Grade B, USPSTF (2018)

 

References

Vaccine (65y+): Pneumococcal - Normal Risk.
  • Age 19-64: 1 or 2 doses depending on vaccine and only if risk factors or another indication. 
  • Age 65+: if unsure if previously vaccinated or previous infection 

 

Reference

Counseling: Accidental Injury - Normal Risk.
  • There is a wide range of potential injury focus areas in the reference including preventing violence and preventing injuries related to transportation, falls, traumatic brain injury and concussion (CDC, 2025).

 

References

Screening: Tuberculosis (TB) - Increased Risk
  • Increased prevalence of active disease and increased risk of exposure include persons who were born in, or are former residents of, countries with high tuberculosis prevalence and persons who live in, or have lived in, high-risk congregate settings (e.g., homeless shelters or correctional facilities) 
  • Grade B (USPSTF, 2023)

 

Reference

Screening: Testicular Cancer - Normal Risk
  • Given the more updated studies referenced, performing and teaching boys and men a testicular self-exam is recommended. 
  • Expert Opinion. 
  • Note, this is in contrast to the Grade D recommendation by USPSTF (Fadich et al., 2018).

 

Reference

Counseling: Diet for CVD Prevention - Normal Risk.
  • Take nutritional history on annual basis, per Centers for Disease Control “Dietary Guidelines for Americans, 2020-2025”. 
  • Note: USPSTF says is grade C unless increased CVD risk factors, then is Grade B (USPSTF, 2022).

 

Reference

Screening (50y+): Kidney Cancer - Increased Risk
  • Age 50 if increased risk
  • Consider UA for high risk, smokers, family history. 

 

 

Screening: HIV Infection - Normal Risk
  • Recommended for initial screening, ages 18-65. 
  • Grade A, USPSTF (2019; 2024). 
  • Subsequent testing based on further risk exposure.

 

References

Screening (45y+): Abnormal Glucose/Diabetes - If identified under obesity screening (BMI >30) or clinically indicated, consider screening - Normal Risk
  • Per USPSTF, age 35-70 if overweight or obesity (Grade B - USPSTF, 2021)
  • American Diabetes Association recommends screening at age 45 for all. Subsequent testing as clinically indicated. 
  • If identified under obesity screening, consider screening 

 

Reference

Screening: Sexual Health - Normal Risk
  • Taking a sexual health history for all patients is important for their medical care and wellbeing, influencing physical health and mental health. 
  • Ask about the Five “P”s: 
    • Partners
    • Practices
    • Protection from STI
    • Past History of STI
    • Pregnancy Intention. 
  • Expert Opinion (CDC, 2024)

 

Reference

Counseling: Sexual Health - Normal Risk.
  • Sexual Health is integral to a person's Physical Health and Mental Health, including older persons. 
  • Expert Opinion (Bach et al., 2013)

 

Reference

Transgender Men (Annual STI/Cancer Screening if Cervix Present) - Normal Risk.
  • If cervix present, needs annual screening 
Screening: Hepatitis C Virus Infection - Normal Risk
  • Recommended for initial screening, ages 18-79. 
  • Grade B, USPSTF (2020). 
  • Subsequent testing based on further risk exposure.

 

Reference

Vaccine (50y+): Shingles- Normal Risk.
  • 2 doses. age 19-49 if immunocompromised, age 50+ for all 

 

Reference

Counseling: Sexually Transmitted Infection Prevention - Normal Risk.
  • All sexually active adults have increased risk of STI and behavioral counselling is recommended. 
  • Grade B (USPSTF, 2020)

 

Reference

Screening: Skin Cancer Screening - Normal Risk
  • Regular skin self-exam recommended by American Academy of Dermatology (AAD, 2023).

 

Reference

Screening (35y-69y): BRCA Gene screening - Increased Risk

Consider for 

  • Men with personal or family history of male breast cancer.
  • Personal or family history of at least two men with aggressive prostate cancer (Gleason score of 7 or greater).
  • Family history of ovarian cancer
  • Female relative with breast cancer before age 50 or multiple primary breast cancers, or 3+ female relatives with breast cancer at any age
  • Men of Ashkenazi Jewish descent and personal or family history of breast, ovarian, pancreatic, aggressive prostate cancers, or melanoma 
  • Those with known family history of BRCA1 or BRCA2 mutation. 

 

Screening

  • Age 35 is the first age where breast screening would be initiated (breast self-exam training and clinical exam starting at age 35)
  • Consider annual mammogram starting at age 50 or 10 years before earliest known male breast cancer in the family, whichever is first
  • Age 40 to initiate prostate cancer screening. See NCCN Guideline. 
  • Consider referral to genetic counselor for other specific recommendations. See NCCN Guideline.

 

References

  • NCCN Guidelines for Breast Cancer Risk Reduction. 
  • NCCN Guideline for Early-Stage Prostate Cancer. 
  • See NCCN.org for further details.

Citation

  • American Society for Men's Health (ASMH)
  • Sexual Medicine Society of North America (SMSNA)

Literature

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