Examination of male patients in general practice

Almost all Australian males visit a general practitioner if they think it’s necessary, probably after a period of monitoring their symptoms and trying to manage them independently, drawing on their past experiences of illness and healthcare.

Only half of Australian men consider an annual GP visit to be very important for their health, so unless illness necessitates a visit to the doctor it is reasonable to expect that some will have infrequent contact. This highlights the need to engage male patients in preventive care opportunistically.

This guide covers the content of a thorough examination of male patients in general practice.

History

Screening for adult males of all ages

RACGP recommendations:

Enquire about sedentary behaviour and frequency, duration and intensity of physical activity at least every 2 years
Ask about tobacco and cannabis smoking and nicotine vaping at every opportunity from 10 years of age
Screen for unhealthy alcohol use every 2 years from 18 years of age (e.g. use AUDIT-C tool)
The Australian STI management guidelines of use in primary care recommend opportunistic testing for HIV, syphilis and hepatitis B* for people who:

Request STI testing

Have a new sexual partner

Live or travel to areas of higher prevalence in Australia or in other countries

Have a known exposure to any STI or history of an STI within the past 12 months
Are a member or partner of special subpopulations, including:

Men who have sex with men

Sex workers

Aboriginal and Torres Strait Islander people

Trans and gender diverse people

*People who are 39 years old or younger in 2025 and who grew up in Australia can generally be assumed to have been vaccinated and do not need testing
Be alert to symptoms of depression (e.g. low mood, substance use, irritability, anger, anhedonia, stress) and anxiety (e.g. physical tension, feeling out of control, headache). If symptoms are present:

Consider using Sphere-12, the K10 anxiety and depression test, the Depression Anxiety Stress Scales (DASS)or the Depression self-report questionnaire (DMI-10 and DMI-18) for the assessment of depression

Consider asking about feelings of anxiety, and ability to stop or control the worry, using the Generalized Anxiety Disorder 2-item (GAD-2)
Enquire about problem gambling (especially in patients with mental illness, substance abuse, stress, relationship problems)

RACGP recommendations:

Screen for diabetes risk every 3 years from 40 years of age using The Australian type 2 diabetes risk assessment tool (AUSDRISK)

For Aboriginal and Torres Strait Islander people, opportunistic fasting blood glucose or HbA1C, or oral glucose tolerance test is recommended
Screen for colorectal cancer every 2 years from 45 (to 74) years of age using National Bowel Cancer Screening Program faecal occult blood testing
Screen for cardiovascular disease from 45 (to 74) years of age using the Australian CVD risk calculator, every 5 years unless risk factors worsen

For Aboriginal and Torres Strait Islander people, opportunistic screening should commence at 30 years of age
Use FRAX to estimate fracture risk from 50 years if risk factors (e.g. parent with hip fracture, health conditions) are present, every 2 years
Assess eligibility for the National Lung Cancer Screening Program for people aged between 50-70 years of age, asymptomatic, currently smoke or ceased smoking within 10 years and have a 30-pack year(or greater) history of cigarette smoking
Discuss prostate specific antigen (PSA) testing from 50 years of age, every 2 years

Discuss PSA testing from 45 years (40 years for Aboriginal and Torres Strait Islander males) of age in people with a sibling or parent diagnose with prostate cancer before 60 years of age

Discuss PSA testing from 40 years of age in people with 3 first-degree relatives diagnosed with prostate cancer

Historical concerns about PSA testing relate to harms caused by invasive diagnostic and treatment approaches that are now outdated. Contemporary diagnostic pathways, using multiparametric MRI, minimise overdiagnosis and overtreatment. Ensuring that all male patients (especially those at high risk, as above) understand the availability and implications of contemporary PSA testing should be a priority.

Examination and investigations for adult males of all ages

Genital examination is not recommended for asymptomatic adult males but it may be “crucial in deciding investigations and making the diagnosis” in patients with symptoms including:

Genital pain and discomfort
Symptoms or signs of androgen deficiency
Infertility

Small testis volume (<4 ml) in adulthood is a distinguishing characteristic of Klinefelter syndrome that should be investigated by genital examination of males with other signs of this common genetic condition.

For children and adolescents, a genital examination should be part of a physical examination to check for normal development, if there concerns about puberty progression, and for those with genital symptoms.

Health advice and counselling for adult males of all ages

Healthy Male recommends the provision of preconception care for males. This involves asking males of reproductive age about their reproductive intentions and providing services including suitable information, education, examination and laboratory tests.

Most Australian males hope to become fathers. Many causes or contributors to male infertility (e.g. Klinefelter syndrome, varicocele, cryptorchidism) are easily identified by physical examination. Early identification of such conditions (ideally before fertility concerns manifest) should be a goal of routine care.

Clinical review

Dr Filip Vukasin, General Practitioner

Prof Rob McLachlan AM, FRACP, PhD, Healthy Male Medical Director

Examination of male patients in general practice

History

Medical

Surgical

Medications

Allergies

Vaccinations

Family

Social

Exercise

Screening for adult males of all ages

Enquire about sedentary behaviour and frequency, duration and intensity of physical activity at least every 2 years

Ask about tobacco and cannabis smoking and nicotine vaping at every opportunity from 10 years of age

Screen for unhealthy alcohol use every 2 years from 18 years of age (e.g. use AUDIT-C tool)

The Australian STI management guidelines of use in primary care recommend opportunistic testing for HIV, syphilis and hepatitis B* for people who:

Are a member or partner of special subpopulations, including:

Be alert to symptoms of depression (e.g. low mood, substance use, irritability, anger, anhedonia, stress) and anxiety (e.g. physical tension, feeling out of control, headache). If symptoms are present:

Enquire about problem gambling (especially in patients with mental illness, substance abuse, stress, relationship problems)

Age-related and life-stage screening

Screen for diabetes risk every 3 years from 40 years of age using The Australian type 2 diabetes risk assessment tool (AUSDRISK)

Screen for colorectal cancer every 2 years from 45 (to 74) years of age using National Bowel Cancer Screening Program faecal occult blood testing

Screen for cardiovascular disease from 45 (to 74) years of age using the Australian CVD risk calculator, every 5 years unless risk factors worsen

Use FRAX to estimate fracture risk from 50 years if risk factors (e.g. parent with hip fracture, health conditions) are present, every 2 years

Assess eligibility for the National Lung Cancer Screening Program for people aged between 50-70 years of age, asymptomatic, currently smoke or ceased smoking within 10 years and have a 30-pack year(or greater) history of cigarette smoking

Discuss prostate specific antigen (PSA) testing from 50 years of age, every 2 years

Examination and investigations for adult males of all ages

Measure weight, height, abdominal circumference and calculate BMI opportunistically

Measure blood pressure opportunistically (no more than every 2 years) from 18 years of age

Health advice and counselling for adult males of all ages

Advise all patients that sunscreen should be applied every morning to the head, neck, arms and hands, and reapplied after heavy sweating, bathing or long sun exposure

Advise all patients to eat a variety of nutritious foods and reduce consumption of foods high in saturated fats, salt or sugar. Advise men to eat 5 serves of vegetables and 2 serves of fruit daily

Advise men to engage in 2-and-a-half to 5 hours of moderate-intensity activity weekly, and muscle strengthening activity 2 or more days per week

Advise men to limit their alcohol consumption to no more than 10 standard drinks weekly and no more than 4 on any one day, to limit the risk of alcohol-related disease or injury

Good oral hygiene and regular dental checks should be encouraged for all men

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