A routine annual blood panel is built to catch disease, not dysfunction. It will tell you whether you have diabetes. It will not tell you that you have been insulin resistant for six years. These eight markers close most of that gap.
1. Fasting insulin
The most underordered useful test in medicine. Insulin rises years before glucose does, which means it flags metabolic dysfunction long before an A1c looks abnormal. If you order one thing off this list, order this.
2. HbA1c
Your average blood glucose over roughly three months. Standard, but read it alongside fasting insulin rather than alone, a normal A1c with high insulin is a very different picture from a normal A1c with normal insulin.
3. ApoB
A direct count of atherogenic particles, and a better predictor of cardiovascular risk than LDL cholesterol. Rarely ordered in routine practice. Should be.
4. hs-CRP
High-sensitivity C-reactive protein, a marker of systemic inflammation, linked to cardiovascular and metabolic disease. Elevated readings warrant investigation rather than a shrug.
5. Full thyroid panel
TSH alone is not enough. Free T3, free T4 and thyroid antibodies catch dysfunction that a TSH-only screen misses entirely, a common cause of fatigue, weight gain and low mood that goes undiagnosed for years.
6. Free and total testosterone
For men and women. Total testosterone without free testosterone and SHBG is an incomplete picture, because how much is bioavailable matters more than how much exists.
7. Vitamin D
Deficiency is extremely common, affects immune function, mood and bone health, and is trivially cheap to correct once identified.
8. Ferritin
Iron stores. Low ferritin causes fatigue and hair loss well before anaemia appears on a standard blood count, a pattern that is especially common in menstruating women and frequently missed.
How often
Baseline now. Repeat at six months if you are actively changing something. Annually once stable. Retest the markers you set out to move rather than repeating the entire panel every time.
Results vary. Clinical trial results apply only to the FDA-approved branded medication specifically identified and do not apply to compounded medications. All medications must be prescribed by a licensed provider based on medical necessity.