We hear some version of the same story regularly.
A patient comes in — maybe for a membership consultation, maybe just because something feels off and they haven’t been able to get a satisfying answer. They tell us they’ve had their annual physical. They tell us their doctor said everything looked fine. And then they describe a year — sometimes several years — of fatigue, brain fog, weight changes, mood shifts, poor sleep, or just a persistent sense that they’re not operating at the level they should be.
We pull their labs. And what we find, almost every time, is not that their previous provider missed something obvious. It’s that the standard annual physical panel simply doesn’t ask the right questions.
This post is about what those questions are, why most physicals don’t ask them, and what a more complete picture of your health actually looks like.
The typical annual physical lab panel — what most insurance-based practices order — is designed around a narrow goal: screening for acute disease. It’s built to catch things that are already significantly wrong. Anemia. Kidney failure. Uncontrolled diabetes. Dramatically elevated cholesterol.
What it isn’t built to do is optimize. It doesn’t tell you how well your thyroid is actually functioning. It doesn’t look at your hormone levels. It doesn’t assess inflammation, insulin resistance in its early stages, micronutrient deficiencies, or cardiovascular risk beyond a basic lipid panel. It tells you whether you’re sick today — not whether you’re heading somewhere you don’t want to go, or whether there’s a reason you’ve been feeling the way you’ve been feeling.
The standard panel is a floor, not a ceiling. And for most of our patients, the floor isn’t nearly enough.
What’s typically ordered:
These are useful. We order them too. But they leave significant gaps.
TSH is a pituitary hormone that signals the thyroid to produce more or less hormone. It’s a useful screening marker, but it tells you almost nothing about what the thyroid is actually doing.
A complete thyroid assessment includes free T3, free T4, and in many cases reverse T3 and thyroid antibodies. A patient can have a perfectly normal TSH and still have low free T3 — the active form of thyroid hormone that actually drives metabolism, energy, mood, and cognitive function. We see this pattern regularly in patients who have been told their thyroid is fine while they continue to experience every classic hypothyroid symptom.
For women: estradiol, progesterone, testosterone (total and free), DHEA-S, and FSH/LH. These tell us whether a woman is in perimenopause, how her hormone levels compare to where she should be for her age and symptoms, and whether hormone optimization is appropriate.
For men: total testosterone, free testosterone, SHBG, estradiol, LH, FSH. As Gregory wrote in our recent post on low T, a man can have a testosterone level that’s technically “in range” and still feel terrible. The full picture tells us whether treatment is indicated and what form it should take.
Most annual physicals order none of these for adults who aren’t actively trying to conceive. The assumption seems to be that hormones only matter for reproduction. They don’t. They matter for everything.
The standard lipid panel — total cholesterol, LDL, HDL, triglycerides — is a starting point, not a complete picture. What we also look at:
ApoB — a more accurate measure of cardiovascular risk than LDL alone. ApoB measures the number of atherogenic particles directly. Two patients can have identical LDL numbers and very different cardiovascular risk depending on their ApoB.
Lp(a) — lipoprotein(a) is a genetically determined cardiovascular risk factor that is not modified by diet or most medications. It needs to be measured once in every adult — and most never have it checked.
hsCRP (high-sensitivity C-reactive protein) — a marker of systemic inflammation. Chronic low-grade inflammation is a major driver of cardiovascular disease, metabolic dysfunction, and accelerated aging. A normal cholesterol panel alongside an elevated hsCRP is still a significant concern.
Homocysteine — elevated levels are associated with increased cardiovascular risk and can indicate B vitamin deficiencies that are directly addressable.
Fasting glucose can be normal for years while insulin resistance quietly develops underneath. By the time glucose becomes abnormal, the underlying metabolic dysfunction has often been present for a decade.
Fasting insulin, and the HOMA-IR calculation that derives from it, gives us a much earlier window into metabolic health. We can identify insulin resistance — and address it — long before it becomes prediabetes or type 2 diabetes. This is exactly the kind of preventive insight the standard panel misses.
Beyond hsCRP, we often look at ferritin (which can indicate inflammation when elevated, independent of iron status), uric acid, and other markers depending on the clinical picture. Chronic inflammation is one of the most modifiable contributors to long-term disease risk, and it often goes completely undetected on a standard panel.
Vitamin D deficiency is extraordinarily common and associated with immune dysfunction, mood disorders, bone loss, cardiovascular risk, and fatigue. Most people have never had their level checked. When they have, they’ve often been told a level of 25 ng/mL is “normal” — when optimal is generally considered to be above 50.
Magnesium, B12, folate, zinc, and iron studies (beyond the hemoglobin in the CBC) round out a meaningful micronutrient picture. Deficiencies in these are frequently the underlying explanation for symptoms that have been attributed to stress or aging.
The adrenal hormones are almost never assessed in a standard physical. DHEA-S declines with age and is associated with energy, immune function, and mood. Cortisol dysregulation — whether from chronic stress, poor sleep, or HPA axis dysfunction — has widespread downstream effects and can suppress thyroid function, sex hormones, and metabolic health simultaneously.
When a provider tells you your results look normal, they’re telling you something true and something incomplete at the same time.
True: your results fall within the reference range for that test.
Incomplete: the reference range was established from a population that includes a lot of unwell people. “Normal” in that context means statistically average, not healthy or optimal. A TSH of 3.8 is within most labs’ normal range. It’s also associated with symptoms in many patients that resolve when the level is brought lower. A free testosterone of 8 pg/mL is “normal” for an 80-year-old. It’s not normal — or acceptable — for a 42-year-old man who feels like he’s running on empty.
We don’t treat lab values. We treat people. The number exists to inform a conversation about how you’re feeling and what might be driving it — not to close that conversation down.
When a new member joins, we don’t start with the minimum. We start with a comprehensive baseline that gives us an actual picture of where you are — hormonally, metabolically, cardiovascularly, and nutritionally. From there, we build a plan that’s specific to you, monitor it properly, and adjust as your body responds.
That’s what we mean when we say we practice medicine differently. It’s not about running more tests for the sake of it. It’s about asking the right questions so we can give you real answers — and real help.
Dr. Bethany Recker, MD is the Medical Director and co-founder of Retro Health & Aesthetics in Worthington, Ohio. She practices concierge primary care, functional medicine, and hormone optimization.
Gregory LaFontaine, PA-C is the co-founder and Director of Men’s Health & Wellness at Retro Health & Aesthetics. He specializes in hormone optimization, men’s health, and concierge primary care.
