What Blood Tests Should I Get Every Year? A Family Doctor's Guide to Annual Bloodwork, Prevention and Healthy Aging
“What blood tests should I get every year?”
It sounds like a simple question.
It isn't.
I hear it regularly in my family medicine practice. Sometimes it comes from someone who feels completely well and wants to make sure everything is still on track. Other times, there is a reason behind the question.
They are exhausted. Their weight has changed. Their hair is thinning. Their periods are
different. They are sleeping poorly. They have been exercising and changing what they eat, yet their bodies don't seem to be responding the way they once did.
Or perhaps it has simply been years since they had bloodwork, and they are wondering, "Shouldn't somebody be checking something?”
There is no universal blood test panel that every person needs every year. Preventative
screening recommendations are based on evidence, and what makes sense depends on your age, sex, medical history, medications, family history and individual risk.
I follow those principles.
At the same time, my approach to medicine is proactive.
I would rather spend more time preventing disease than waiting for disease to announce itself.
For many of my patients, that means annual bloodwork. For others, selected tests every three to six months make more sense. If we're treating a deficiency, monitoring a chronic condition, or changing a medication, testing may need to happen sooner.
The goal isn't to order more tests.
The goal is to notice what is changing while we still have time to do something about it.
Why I Believe in Annual Blood Tests
A single blood test is a snapshot.
Several years of results can tell a much bigger story.
Imagine your HbA1c, which reflects your average blood sugar over the previous few months, is still technically within the normal range. If I look only at today's result, I have one number.
But what if I look back and see that it has gradually increased over four years?
Now I have a different question.
What's changing?
You may have become less active. Perhaps your sleep has deteriorated or your weight has increased around your abdomen. You may be going through perimenopause. Perhaps your work has become more demanding, and your eating pattern has changed as you rush from one responsibility to another.
Or nothing obvious has changed.
That is still useful information.
I am not looking at bloodwork simply to find numbers with an “H” or “L” beside them. I am interested in patterns and trends.
Those trends sometimes allow us to act before a problem becomes a diagnosis.
“Normal” Bloodwork Doesn't Always Mean Nothing Is Changing
Laboratory reference ranges are extremely useful. We need them.
But biology does not suddenly change the moment a result crosses a laboratory cutoff.
Someone's blood sugar, cholesterol or liver enzymes may gradually shift over several years while remaining within the reference range. That does not automatically mean disease is developing, and we should not turn every small change into a diagnosis.
It may be a reason to pay attention.
I may ask about changes in weight, exercise, sleep, alcohol use, medications, nutrition, or family history. Sometimes the trend tells us that something deserves a closer look.
It may simply be saying:
Pay attention.
And paying attention does not always mean prescribing medication.
Sometimes it means changing direction early.
Guidelines Matter, But So Does the Individual Patient
Preventive health guidelines provide an important evidence-based framework, and I use them.
But guidelines are developed for populations. Medicine happens one person at a time.
The person sitting in front of me has a particular family history, lifestyle, medication list,
nutritional habits, previous pregnancies, occupation, sleep pattern and health history.
Someone with a strong family history of diabetes may need a different screening approach from someone without those risk factors. A patient taking medication that can affect kidney function may require monitoring that another patient does not. Someone with heavy menstrual bleeding may need their blood count and iron stores assessed.
A person with prediabetes may benefit from HbA1c testing every few months rather than waiting another year.
That is not a rejection of evidence-based medicine.
It is individualizing it.
What Blood Tests Should You Get Every Year?
There is no single “annual bloodwork panel” that applies to everyone.
Depending on your age, symptoms, medical history and risk factors, your family doctor may consider several different tests.
1. Complete Blood Count (CBC)
A complete blood count, or CBC, provides information about your red blood cells, hemoglobin, white blood cells, and platelets. It can help identify anemia and provide clues about certain infections and blood disorders.
A CBC can be particularly useful when someone has:
● Persistent fatigue or weakness
● Heavy menstrual bleeding
● Unusual bruising or bleeding
● Recurrent infections
● Shortness of breath
● Reduced exercise tolerance
But there is an important limitation.
You can have a normal hemoglobin level and still have depleted iron stores. That is where ferritin and other iron studies may become important.
2. Ferritin and Iron Studies
“Should I get my iron checked?”
For many patients, particularly those who menstruate, this is worth discussing.
Ferritin gives us information about stored iron. Iron deficiency can contribute to:
● Fatigue
● Headaches
● Dizziness
● Restless legs
● Reduced exercise tolerance
● Weakness
● Feeling unusually cold
● Hair shedding
Heavy menstrual bleeding is a common cause. Pregnancy increases iron requirements, while dietary factors, gastrointestinal conditions and blood loss can also contribute.
And when someone's iron is low, I do not want the conversation to end with, “Take an iron supplement.”
I also want to ask:
Why is the iron low?
Replacing the iron may be necessary, but understanding the cause of the deficiency matters, too.
3. Blood Sugar and HbA1c
Metabolic health deserves attention long before someone develops diabetes.
HbA1c provides an estimate of average blood sugar over the previous 2 to 3 months and can help identify prediabetes or diabetes when used appropriately.
Risk factors can include:
● Family history of type 2 diabetes
● Previous gestational diabetes
● PCOS
● Increasing age
● High blood pressure
● Excess weight
● Other metabolic risk factors
Again, I pay attention to trends.
If someone's HbA1c is gradually increasing, I would rather have a conversation about metabolic health before diabetes develops.
Why wait?
Nutrition matters.
Movement matters.
Sleep matters.
Muscle mass matters.
Weight can matter.
Stress can influence our behaviour and daily choices.
There may be an opportunity to change the trajectory years before medication becomes necessary.
That is preventative medicine.
4. Cholesterol and Cardiovascular Risk
A lipid profile provides information about cholesterol and triglycerides, but cardiovascular risk cannot be reduced to a single number.
We also consider:
● Age
● Blood pressure
● Diabetes
● Smoking
● Kidney disease
● Family history of premature cardiovascular disease
● Physical activity
● Weight and metabolic health
Cholesterol can change with weight gain and menopause. Genetics can play a major role. Someone who looks extremely fit can still have significant cardiovascular risk.
That is why I do not look at a cholesterol result in isolation.
I look at the person.
5. Thyroid Blood Tests
Thyroid testing is another area where symptoms and context matter.
An underactive thyroid can cause symptoms such as:
● Fatigue
● Constipation
● Feeling unusually cold
● Dry skin
● Hair changes
● Menstrual changes
● Weight changes
● Difficulty concentrating
An overactive thyroid can look very different. Some people experience palpitations, tremors, sweating, heat intolerance, anxiety, or unexplained weight loss.
Thyroid bloodwork can be useful when symptoms or risk factors suggest thyroid disease. It can also be important when someone is already taking thyroid medication and needs monitoring.
But I want to make one point very clear: if your thyroid test is normal, that does not mean your symptoms are imaginary.
It means we may need to look somewhere else.
Fatigue, hair loss, weight changes, poor sleep, and difficulty concentrating have many possible causes. Good medicine does not stop at the first normal result.
6. Kidney Function and Electrolytes
Your kidneys do far more than produce urine.
They help regulate fluid balance, blood pressure, electrolytes, and the removal of waste products from the body.
Kidney function testing commonly includes measures of kidney filtration, as well as electrolytes such as sodium and potassium.
These tests become particularly important if you have conditions such as:
● Diabetes
● High blood pressure
● Kidney disease
● Cardiovascular disease
They are also important for people taking certain medications that can affect kidney function or electrolyte levels.
This is one reason I do not believe there is one bloodwork schedule that works for everyone.
A healthy person with no major risk factors may need very different monitoring from someone taking medications that require close follow-up.
7. Liver Enzymes
Your liver is involved in metabolism, medication processing, digestion, and many other
important functions.
Liver enzymes can sometimes provide an early clue that something needs further attention.
Abnormal results can have many explanations, including metabolic dysfunction-associated fatty liver disease, alcohol use, medications, supplements, infections, or other liver conditions.
One mildly abnormal result does not automatically mean something serious is happening.
What matters is the context and the trend.
If a liver enzyme has changed from one year to the next, I want to know why. Sometimes the answer is simple. Sometimes it requires further investigation.
Again, we are not just looking at a number. We are trying to understand the person behind the number.
8. Vitamin B12
Vitamin B12 is important for healthy red blood cells and normal nerve function.
A deficiency can sometimes cause:
● Fatigue or weakness
● Numbness or tingling
● Balance problems
● Changes in concentration or thinking
● Anemia
Certain gastrointestinal conditions, dietary patterns, and medications can increase the risk of B12 deficiency.
But this is another example where more testing does not automatically mean better medicine.
Not everyone needs a B12 level checked every year. If there is a reason to suspect a
deficiency, however, it may be an important test.
9. Vitamin D
Vitamin D comes up frequently in Canadian conversations, and for good reason. We have long winters, limited sunlight at times, and many people spend much of their time indoors.
Vitamin D plays an important role in bone health and normal body function.
However, there is a difference between making sure you are getting adequate vitamin D and automatically checking your vitamin D level every year.
Routine testing is not necessary for everyone.
Your medical history, bone health, risk factors, symptoms, diet, medications, and other
circumstances can help determine whether testing makes sense.
The goal is not to collect the biggest possible bloodwork report.
The goal is to answer useful questions.
What About Annual Blood Tests for Women?
Women often have additional factors that can affect how we look at things.
Your menstrual history matters.
Pregnancy history matters.
Your reproductive stage matters.
So does whether you are experiencing heavy periods, symptoms of PCOS/PMOS, or changes associated with perimenopause.
For example, a woman who has heavy menstrual bleeding may slowly lose iron for years.
She may feel exhausted and assume she is simply overworked.
Her hemoglobin may eventually become low, but iron stores can become depleted before significant anemia develops.
That is why sometimes I want to look beyond the CBC and check ferritin and iron studies.
PCOS/PMOS can also change the conversation because it may be associated with metabolic concerns, including blood sugar and cardiovascular risk factors.
Pregnancy and the postpartum period bring their own considerations as well.
As women move through perimenopause and menopause, the focus may shift again toward cardiovascular, metabolic, and bone health, menstrual changes, sleep, and symptoms.
This is why I do not like the idea of an identical annual bloodwork package for every woman.
Your body is not the same at 25 as it is at 45.
And your bloodwork should reflect that.
Do You Need Hormone Testing Every Year?
Probably not.
This is an area where social media has created a lot of confusion.
Patients often ask, “Can you check all my hormones?”
My first question is:
Which hormones, and why?
Hormone levels fluctuate. Menstrual-cycle timing matters. Age, pregnancy, medications and symptoms all matter.
Hormonal testing can be useful when we are investigating concerns such as irregular periods, fertility difficulties, signs of androgen excess, suspected PCOS or specific endocrine conditions.
But randomly measuring every hormone we can measure is not necessarily preventative medicine.
Testing should have a purpose.
What Blood Tests Should You Get During Perimenopause?
Perimenopause is another area where people often expect a blood test to provide a simple answer.
But perimenopause is frequently diagnosed based on a person's symptoms, age and menstrual changes rather than one definitive laboratory result.
Periods may become unpredictable. Hot flashes and night sweats can appear. Sleep can deteriorate. Mood and concentration can change. Vaginal symptoms may develop, and body composition can shift.
Hormones such as FSH can fluctuate substantially during the menopausal transition.
One “normal” result, therefore, does not necessarily mean:
"You're not in perimenopause.”
Sometimes the patient's story tells us more than one laboratory value.
What About Cortisol Testing?
Cortisol has become one of the internet's favorite explanations for almost everything.
Can't lose weight? Cortisol.
Tired? Cortisol.
Stressed? Cortisol.
Abdominal weight gain? Cortisol again.
Real disorders involving too much or too little cortisol absolutely exist, and they require
appropriate medical investigation.
But randomly measuring cortisol is not a universal screening test for stress.
If someone's history and examination suggest an adrenal or endocrine disorder, targeted testing can be arranged.
Being stressed and having an adrenal disorder are not the same thing.
What About Insulin Testing and Functional Medicine Bloodwork?
There are valuable lessons in lifestyle medicine and in some aspects of functional medicine.
One of the biggest is the importance of looking at the whole person.
Nutrition, sleep, physical activity, stress, metabolic health, medications, supplements,
environment, relationships and daily health behaviours can all influence health. They do not exist in separate boxes.
Where I remain cautious is the assumption that more testing automatically means better or more comprehensive healthcare.
It doesn't.
Some specialized tests have clear clinical value. Others have limited evidence or may yield results that are difficult to interpret meaningfully.
My approach is to remain curious and proactive while still asking a basic question:
What will this test tell me, and what will I do differently if the result is abnormal?
Preventive medicine should be thoughtful.
Not performative.
Why Some of My Patients Have Bloodwork Every Three Months
Some patients need much more frequent monitoring than once a year.
If we are actively treating something, waiting twelve months to see whether the treatment worked makes little sense.
For example, I may repeat bloodwork every few months when:
● We are treating iron deficiency
● We are monitoring prediabetes after lifestyle changes
● We are managing diabetes
● We are treating high cholesterol
● We are adjusting thyroid medication
● We are following abnormal liver tests
Imagine we identify a problem in January and make a meaningful change.
Why would I automatically wait until the following January to see whether anything improved?
Sometimes, three months gives us useful information. We can look at the trend, assess whether the intervention is working, and decide whether anything needs to change.
This is one of the advantages of longitudinal family medicine.
I get to see what happens over time.
When Bloodwork Needs to Be Repeated Even Sooner
Some medication changes or medical conditions require laboratory monitoring within days or weeks.
Certain medications can affect kidney function, potassium, sodium, liver enzymes, blood counts, blood sugar, thyroid function or other markers.
In those situations, repeating bloodwork is not unnecessary testing.
It is appropriate monitoring.
The timing should match the clinical question and the treatment.
“My Bloodwork Is Normal, But I Still Feel Terrible”
This sentence deserves attention.
You had your bloodwork done. Everything came back within range.
But you are exhausted.
Your weight has changed. Your brain feels foggy. You are sleeping badly. Something simply does not feel right.
Normal bloodwork is reassuring, but it does not rule out every possible explanation.
Sleep apnea does not necessarily appear on routine bloodwork. Depression is not diagnosed through a CBC. Medication side effects can occur even when laboratory results appear completely normal. Perimenopause cannot always be ruled in or out by one hormone level.
And stress does not appear on your laboratory report with a giant warning that says:
HIGH STRESS. PLEASE TAKE A VACATION.
Medicine still requires listening.
Bloodwork should complement the clinical story, not replace it.
Preventative Healthcare Is Bigger Than Bloodwork
This may be the most important point in the entire article.
I believe in regular bloodwork.
But preventative medicine is not drawing blood once a year and declaring the job finished.
What happens during the other 364 days matters.
Preventative healthcare means paying attention to how you eat, how you move, how well you sleep, how much strength and cardiovascular fitness you maintain, how you manage stress, whether you smoke or vape, how much alcohol you consume and how your mental health is doing. It also includes relationships and social connections, vaccinations, reproductive and sexual health, cancer screening, blood pressure, bone health and metabolic health.
You cannot out-test your lifestyle.
The laboratory gives us information.
What we do with that information matters more.
Why Wait Until Someone Is Sick?
This is where my philosophy of medicine becomes very simple.
I do not believe healthcare should be primarily reactive.
Modern medicine is remarkably good at treating disease. We can manage diabetes, treat heart attacks, support failing kidneys, perform complex surgeries and treat cancers that would have been considered untreatable in previous generations.
Those advances are extraordinary.
But I keep coming back to another question:
What happened during the 10, 20 or 30 years before the disease developed?
Could we have done something earlier?
Not always.
Genetics, environment, social circumstances and plain bad luck all matter. Disease cannot always be prevented.
But sometimes there is an earlier opportunity.
And I do not want us to miss it.
What If We Invested More in the Earlier Years of Life?
We devote enormous healthcare resources to treating complex diseases, much of which develops later in life.
We should.
People deserve excellent care at every age.
But I would also like us to become much more passionate about investing in health decades earlier.
Imagine recognizing deteriorating metabolic health at 35 rather than diagnosing diabetes at 55.
Imagine talking about resistance training and muscle preservation in your 40s, rather than waiting until frailty becomes a problem decades later.
Imagine addressing high blood pressure before the stroke, smoking before COPD, poor sleep before years of untreated sleep apnea take their toll, or declining iron stores before someone becomes profoundly anemic.
Imagine talking about bone health before the fracture.
That is where prevention becomes powerful.
The goal is not to predict every disease. We cannot.
The goal is to improve the odds.
I Would Rather Have the Conversation at 40 Than at 70
No blood test guarantees longevity.
No lifestyle guarantees you will never get sick.
And no physician can promise that early monitoring will catch everything.
That is not what prevention means.
Prevention means recognizing the factors we can influence and acting while we still have time to influence them.
I would rather talk about metabolic health before diabetes develops, cardiovascular health before a heart attack, muscle health before frailty, bone health before a fracture, and sleep before years of exhaustion have passed.
I would rather have those conversations while a person still has choices.
Because once the disease has taken hold, the conversation often becomes harder.
The opportunity may still exist, but the cost of changing direction can be much higher.
The Bonsai Approach to Preventive Medicine
There is a reason behind the name Bonsai.
A bonsai tree does not thrive because someone suddenly pays attention to it after decades of neglect.
It requires observation.
Consistency.
The right environment.
Adjustment.
Pruning.
Patience.
Human health is obviously far more complicated than caring for a tree, but the philosophy resonates with me.
You pay attention over time.
You notice changes.
You make adjustments.
You do not wait until something is falling apart before you decide it deserves care.
That is how I think about preventative medicine.
I want to know what your blood pressure is doing over time. I want to understand your
laboratory trends. I want to know how you are sleeping, eating, moving, and managing stress. I want to consider your strengths, mental health, relationships, family history, medications, and everyday habits.
Annual bloodwork can be part of that picture.
For some people, once a year may be appropriate.
For others, testing every three or six months makes more sense.
Sometimes we need to repeat a test much sooner.
The goal is not to order the maximum number of tests.
The goal is to pay attention before we are forced to.
Guidelines matter. Evidence matters. But so does knowing the individual patient sitting in front of me.
That is one of the reasons I value family medicine.
I do not want to see a laboratory result in isolation. I want to see the pattern. I want to
understand the person. I want to notice when something is gradually changing, even before it crosses a laboratory reference range.
Because health is not a single number.
It is a story that unfolds over time.
And if we are willing to pay attention early, we may have more opportunities to influence how that story continues.
I don't simply want my patients to have more years of life.
I want them to have more healthy years within those years.
That is the difference between lifespan and healthspan.
And we should start investing in healthspan long before the final chapters of someone's life.
Because the best time to care about your future health is not when your body finally forces you to.
It is now.
Ready to Be More Proactive About Your Health?
If it has been a while since you had your health reviewed, or you are noticing changes that you do not want to ignore, book a consultation with me at Bonsai Medical & Aesthetics. We can review your health history, risk factors, symptoms, and whether bloodwork or other preventive care makes sense for you.
Your future health is worth paying attention to today.
Disclaimer
This article is for informational purposes only and does not constitute medical advice. It is not intended to diagnose, treat, or cure any condition. Always seek guidance from a qualified healthcare provider about your health.
View our privacy policy here.
Comments