Hey Doc,

On Friday morning, Moana sent me a photo of a puppy. My son fell in love on the spot. We decided to adopt her and drove 10 hours to bring her home. This morning, she woke up in her new home for the first time. What a feeling.

Writing about AI doctors this week, I kept wondering: would we ever accept an AI dog?

As always, happy Sunday evening!

Dr. David Luu, Founder, longevitydocs™

Meet Blue, our frenchie

The AI Doctor Gold Rush

Some of the best-known names in tech are betting that AI will take over much of what physicians do. The race to build AI doctors is on. Physicians should build AI that makes medicine better.

The prediction

In 2012, Vinod Khosla predicted machines would replace about 80% of what doctors do. In August, in JAMA, he and his son Neal Khosla, CEO of AI primary care company Curai Health, argued with bioethicist Zeke Emanuel that autonomous AI will likely outperform physicians, including physicians using AI, at core tasks from diagnosis to treatment, and could be ready for some, maybe many, workflows by 2030. In 2025, Elon Musk predicted robots would surpass the best human surgeons within five years.

We’ve heard this before. In 2016, Geoffrey Hinton said we should stop training radiologists. A decade later, demand for radiologists remains strong, and their average pay reached $571,000 in 2025. AI didn’t eliminate the need for radiologists.

Patients moved first

We went from Dr. Google to Dr. ChatGPT. Many patients now come in having already asked a chatbot about their symptoms. OpenAI says more than 200 million people ask ChatGPT a health question every week. The AI doctor companies didn’t create that habit. They’re building a business on it.

The rush

In January, I wrote that the AI doctor had been born. Nine months later, it’s raising Series B rounds.

Medvi was built in two months with $20,000 and more than a dozen AI tools. It reported $401 million in sales in 2025 and projects $1.8 billion in 2026, run by two people: founder Matthew Gallagher and his brother. Prescribing, pharmacy and shipping are outsourced to partners. Its support chatbot sometimes invented drug prices, and in February the FDA sent it a warning letter over how it markets compounded GLP-1s.

Nolla Health received regulatory relief under Utah’s AI sandbox to let its AI go from a face scan to a prescription for adult acne, choosing from eight topical drugs, with physician review stepping down to a weekly sample over time. Next on its roadmap: women’s health and cardiometabolic care.

Doctronic can renew prescriptions for 190 medications in a Utah pilot, with malpractice insurance that covers its AI.

General Medicine, from the PillPack founders, raised $120 million in October to build an online store for healthcare.

Function Health lets members connect their lab results to ChatGPT and Claude, has announced a connection to Meta’s Muse, and is building its own medical AI. I called this the biomarker gold rush last year.

These are different businesses. But they are moving in the same direction: more of medicine delivered through a platform, with less physician involvement.

We’ve seen this movie

I’ve watched this pattern four times in longevity medicine: clinics, testing, hormones, peptides. Each time there was real demand, fast capital, marketing ahead of the evidence, and standards that came later.

AI doctors are the next gold rush. The difference is scale. A bad clinic harms its own patients. A flawed algorithm can repeat the same error with every patient it sees, and in some cases it now writes the prescription.

The strongest argument for autonomous AI is access. Patients who cannot get care need better options. But access alone does not tell us whether a system is safe.

Keep reading on longevitydocs™ News: what the first real-patient study of an AI doctor showed, where I draw the line between an AI doctor and a doctor’s AI, and six moves I’d make in your practice now.

Read the full piece

GLP-1s and aging clocks: what Novo’s 10,000-patient data does and doesn’t mean

Illustration: longevitydocs™ News

Across five Novo outcome trials and 10,052 people, semaglutide users came out 2 to 4 years younger than placebo on a proteomic heart-age clock, with smaller drops on kidney, brain and other organ clocks. It is a preprint, Novo’s own analysis, and a surrogate, not proof of slower aging. Patients will quote the headline before the paper reaches a journal.

Read on longevitydocs™ News →

GIMAP6 loss caused fatal atherosclerosis in mice with normal cholesterol

Mice lacking the immune gene GIMAP6 developed leaky arteries, plaque and fatal heart attacks with normal LDL. In more than 700,000 biobank participants, damaging variants tracked with atherosclerosis, not cholesterol, and one variant, V65I, is more common in people of African ancestry (Cell). Mostly mouse data, but a mechanism for early disease in patients whose lipids never looked alarming.

Read on longevitydocs™ News →

Early p-tau217 results sharpened memory-clinic diagnoses in an RCT

In the PLASMAR trial (n=220, JAMA Neurology), memory-clinic patients who got plasma p-tau217 and NfL results at 3 months instead of 9 were far more likely to get a high-confidence diagnosis: 50.0% vs 4.6%. Fewer repeat neuropsychological tests, earlier treatment, no rise in anxiety. One center and process outcomes only, but the case for ordering the blood test at the first visit.

Read on longevitydocs™ News →

Certification

How Can I Use AI in My Practice?

Part of the Certified Longevity Doctor program.

AI can reduce your administrative burden, sharpen clinical reasoning, and expand patient capacity, provided you keep your own judgment at the center.

Where AI fits in a practice

1. Documentation (highest immediate ROI)

• AI scribes such as Nabla (real-time transcription and SOAP notes), Freed (strong EHR integration), and Abridge (patient-facing summaries) draft notes during the visit

• Workflow: the patient consents, AI drafts the note, and you review and edit afterward.

• In the course case scenario, documentation dropped from 20 to 8 minutes per patient

2. Clinical decision support

• AI integrates multi-omics, wearable data, and clinical records into a single picture

• It detects subtle aging signals, drafts personalized intervention plans, and can refine them against response data

• In the case scenario, complex cases were analyzed about 60% faster using Glass Health

3. Patient communication

• AI can draft async responses, patient education content, and meal plans. The case scenario showed responses generated about 50% faster

4. Deterministic AI for surveillance

• Rule-based AI suits automated monitoring and alerting, such as biomarker thresholds

5. Custom tools via APIs

• A RAG pattern lets an LLM answer from your own protocols: store them in a vector database, retrieve relevant sections, and generate a grounded response

• Use cases include an AI health coach, supplement interaction checks, and note summarization.

Guardrails

Never

• Accept AI treatment plans without verification.

• Use AI for urgent or emergent decisions.

• Rely on AI for nuanced judgment, since it cannot assess patient values or risk tolerance.

Always

• Verify against current evidence.

• Document your independent clinical reasoning.

• Personalize outputs to the patient.

• Remember that you, not the AI, are liable for care

HIPAA

• Use vendors that offer BAAs, de-identify data when possible, keep audit logs of AI interactions, and keep a human review layer

Learn more about our certification

Lexicon

AMPK

AMP-activated protein kinase (AMPK) plays a major role in regulating cellular energy balance,” activated “by an increase in AMP/ADP relative to ATP.”[1] It is “an evolutionarily conserved serine/threonine kinase that was originally identified as the key player in maintaining cellular energy homeostasis.”[2] “Homologs of AMPK are found in all eukaryotic species and serve as an ancient sensor of conditions of low cellular energy.”[3]

Read more about AMPK

Buzz in the Chat

Estradiol patch frequency, formulation choices, and a complex early menopause case

A member asked whether there is a reason to prefer the weekly estradiol patch over twice-weekly dosing. A second member said she finds twice-weekly more consistent, with fewer breakthrough symptoms. A third agreed, explaining that the patch has systemic absorption drop-off from day one to day three or four, and she uses daily estrogen mist or gel as an anchor for day-to-day symptom control on top of the patch. A fourth noted that patients dislike weekly patches because they are large and do not stay on well.

The conversation deepened when the first member presented a 43-year-old patient with FSH of 65 and undetectable estradiol, plus Hashimoto’s thyroiditis, a mother with breast cancer at 42, and elevated Lp(a) on rosuvastatin and ezetimibe. He asked whether there were zebra diagnoses to consider. One physician said that over age 40 those labs are menopausal or perimenopausal and that estradiol therapy should improve her symptoms, noting she is already appropriately on progesterone to protect the uterine lining.

Another member suggested adding DUTCH or Hormone Zoomer testing to evaluate estrogen metabolites and assess cortisol, and raised what she called an increasing trend of ovarian failure in the early-to-mid 40s post-COVID. A second physician said she has observed the same pattern and noted that women with autoimmune and auto-inflammatory susceptibility appear especially vulnerable to post-infectious hypogonadal states.

Read More Cases

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Longevity Doctor of the Week

Dr. Charlotte Sadler - San Diego, USA

Charlotte Sadler, MD, is an Associate Professor of Emergency Medicine at UC San Diego, where she directs the Undersea and Hyperbaric Medicine Fellowship. She practices emergency, hyperbaric and critical care medicine, and has published widely on diving and hyperbaric medicine. Her interests extend to precision medicine and the science of longevity. We’re glad to have her in the longevitydocs™ network.

View her profile

Calendar

Longevitydocs Events

Oct 14 · Rooms with Dr. Kay Durairaj
Online, 12 to 12:30 pm ET. Join

Oct 24 · Skin, Bone & Muscle Mastermind
New York, Convene, 101 Park Avenue. One day, physicians only: the clinical triad, new diagnostics, the GLP-1 tax and advanced protocols. From $499. Get tickets

Nov 7 · Tables: West Palm Beach
Private dinner for physicians on starting and growing a concierge longevity practice. Apply

Nov 8 · Tables: Miami
Same conversation, Miami. Apply

Nov 18 · Rooms with Dr. Abid Husain
Online, 12 to 12:30 pm ET. Join

Dec 2 · Rooms with Dr. Hillary Lin
Online, 12 to 12:30 pm ET. Join

Dec 11 · Tables: Las Vegas
Private dinner. Apply

Feb 6, 2027 · Mastermind, New York
Program and venue to be announced.

Jun 9 to 11, 2027 · longevitydocs™ Summit, Cannes
Palais des Festivals. The flagship gathering of longevity medicine. From $450. Get tickets

Join us

Where else you’ll find our physicians

Oct 15 to 16 · Visualizing Longevity, Mount Sinai, New York. Whole-body imaging and inflammaging, directed by Bachir Taouli, Miriam Merad and Zahi Fayad. Register

Oct 17 to 18 · Roundtable of Longevity Clinics, Buck Institute, Novato, CA. Book

Nov 5 to 8 · Eudēmonia Summit, West Palm Beach. Tickets

Dec 11 to 13 · A4M Longevity Fest, The Venetian, Las Vegas. Details

Feb 19 to 21, 2027 · The Science of Skin Longevity Summit, Scottsdale. Register interest

Missed one? Replays of the Peptides, Hormones and AI & Tech Masterminds are on demand. Watch

Discover all Events

POLICY · REGULATION & ENFORCEMENT

Maryland now requires mammogram reports to flag arterial calcification

Illustration: longevitydocs™ News

Since October 1, every mammography center in Maryland must tell patients whether breast arterial calcification is on their mammogram. In 123,762 women, severe BAC carried 2 to 3 times the risk of serious cardiovascular events. No trial yet shows that notification changes outcomes. It is free risk data already on the image, so ask for it.

Read on longevitydocs™ News →

TECHNOLOGY · WEARABLES & REMOTE MONITORING

FDA clears Biolinq Shine glucose sensor for over-the-counter sale

Image: Biolinq

Biolinq Shine is now cleared without a prescription for adults 22 and older who do not use insulin. The forearm sensor sits just under the skin, goes on without an insertion needle, and shows a colored light for glucose range instead of a number. Accuracy data, wear time and price are not public yet.

Read on longevitydocs™ News →

TECHNOLOGY · WEARABLES & REMOTE MONITORING

FDA clears a smart ring for cuffless blood pressure

Image courtesy of Happy Health

Happy Health says its ring is FDA cleared to measure blood pressure day and night with no cuff and no calibration. The company reports a mean error under 1 mmHg against arterial lines in 85 patients, but every number so far is its own. Useful for trends; check against a validated cuff before changing treatment.

Read on longevitydocs™ News →

BUSINESS · DEALS & FUNDING

PillPack founder raises $120M to build a store for healthcare

Image: General Medicine

TJ Parker, who cofounded PillPack and built Amazon Pharmacy, is now CEO of General Medicine, which raised a $120 million Series B led by Andreessen Horowitz, with Eli Lilly and Mercy Health among the investors. The pitch: more than 2,900 priced products, from labs to a $6 statin to specialist e-consults, bought like anything else online.

Read on longevitydocs™ News →

RESEARCH · RESEARCH TRANSLATION

Isomorphic Labs joins $1.8B push to build an AI virtual cell

Image courtesy of Isomorphic Labs

Isomorphic Labs is a founding member of the Virtual Biology Initiative, a $1.8 billion effort convened by Biohub with the Department of Energy, NIH, Google DeepMind and Meta to generate open data for an AI model of the cell. It is a funding commitment, not a result, but it shows where AI drug discovery is heading.

Read on longevitydocs™ News →

TECHNOLOGY · AI IN MEDICINE

Utah lets AI issue a first prescription, for acne

Image courtesy of Nolla Health

Under Utah’s AI regulatory sandbox, Nolla Health’s app can now diagnose acne and write a first prescription, not just a refill, for $4.99 a month. Guardrails: eight topical drugs only, adults only, physician messaging at any time. A first prescription is the core of what a physician is licensed to do, which makes this the regulatory story to watch.

Read on longevitydocs™ News →

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Editorial Disclaimer:

Published for licensed physicians and qualified healthcare professionals, for professional education and information only. It is not medical advice, clinical guidance, or treatment recommendation for any patient, and it is not intended for consumers, who should consult their own physician.

Physician discussions reproduced here are the personal clinical opinions of the individuals named. They are not the position of longevitydocs™ and have not been reviewed by any regulatory, medical, or professional body.

Therapies, compounds, devices, and protocols are referenced for educational context. Some are investigational, off-label, or not approved by the FDA, EMA, or your local authority. longevitydocs™ does not endorse or recommend any product, treatment, or company, and nothing here is a solicitation or an attempt to influence prescribing.

By reading, you confirm you are a licensed healthcare professional and will apply this information within your own clinical judgment, professional obligations, and applicable law.

If you are a patient or consumer, this content is not for making health decisions. Please consult your own physician.

Just back from ARDD in Boston, and glad to share what I learned for our fellow scientists about where medicine is going.

Meanwhile, we have been building a home for the voices of longevity medicine: the people working in the labs, treating patients, changing policy, building technology, and educating the field.

Today it goes live. longevitydocs™ News, every day at news.longevitydocs.org.

Who it’s for. Physicians practicing or moving into longevity medicine first. Researchers, health systems, founders and investors who need to know what is real are welcome too.

What you get.

• The day’s evidence, read for practice. Research, therapeutics, diagnostics, technology, business and policy, each with what it changes in clinic.

• The Buzz in the Chat. The best debates from our physician network, now in the open.

• Events. Not just ours. We now list the industry meetings worth your time, from Mount Sinai’s imaging course to the Buck Institute roundtable and Eudēmonia, alongside our Mastermind, Tables and Cannes 2027. One calendar for the field.

• Voices. We will invite leaders in longevity medicine to share commentary, opinions, articles and reviews. My ARDD notes open the section: Five Things That Will Change How We Practice Medicine by 2030.

The Sunday Newsletter stays right here. Now you have something to read the other six days.

As always, happy Sunday evening!

Dr. David Luu, Founder, longevitydocs™

Five Things That Will Change How We Practice Medicine by 2030

At ARDD in Boston, I asked eight of the people leading aging research what will change medicine in the next four years. Here’s what they told me, and what I think it means for your practice.

I just spent two days at ARDD in Boston, away from its traditional home in Copenhagen. I went with one question: how will aging research change the way we practice medicine?

The people in the room answered part of it. HHS, ARPA-H and the FDA. Lilly, Novartis, Moderna and Novo Nordisk. Mayo Clinic, Sheba, Atria and Human Longevity. Five years ago this was a basic science meeting. This year regulators, pharma and health systems sat in the same sessions and asked the same questions.

So I asked the leading researchers and leaders directly: what are you working on that will change how we practice medicine by 2030?

Eight of them answered: Jamie Justice, David Barzilai, Wei Wu, Steve Horvath, George Church, Alex Zhavoronkov, Evelyn Bischof, and Zahi Fayad. Their answers point to five shifts.

1. Multiomic mapping of each patient

Today most workups start with a lipid panel, an HbA1c and maybe a CAC score. By 2030, many patients will start with a full biological map: genome, proteome, metabolome, epigenetic age and imaging, read together instead of one test at a time.

The science isn’t new. The price is. Tests that were research tools five years ago are now commercial products, and they keep getting cheaper.

“The genome went from $3 billion down to $600 for your whole life. And all the other collections, like proteomics, are going to become cheaper and cheaper.”
Wei Wu, PhD, CEO, Human Longevity

My view: cost is no longer the barrier. Interpretation is. A patient who arrives with a genome, a proteomic panel and three epigenetic clocks needs a physician who can tell them which findings matter, which are noise and which change nothing. Most of us weren’t trained for that. That gap is the opportunity for physicians who learn this now.

2. AI that reads the data

A full multiomic profile isn’t something a person can read. It’s thousands of variables interacting. Nearly every guest came back to this point. AI isn’t a separate trend. It’s what makes the first shift usable.

“Historically, to analyze 20 terabytes of data was almost impossible for a physician. But today, with AI, that is becoming easier and easier. All that knowledge is going to be at the fingertips of every human being on Earth.”
Wei Wu, PhD

AI is also changing how drugs are discovered. Alex Zhavoronkov runs systems that never stop working:

“We have long-running agentic frameworks that allow you to have always-on, 24/7 agents that will perform drug discovery tasks, aging research tasks and even clinical operations tasks. I think that will have massive impact in the short term.”
Alex Zhavoronkov, PhD, founder and CEO, Insilico Medicine

My view: AI won’t replace clinical judgment, but it will decide which signals reach the physician. In practice, that means AI will flag the three findings out of three thousand that deserve a conversation. Physicians who learn to question and check those outputs will see more and miss less. Those who don’t will be handed conclusions they can’t evaluate. Note Wu’s last line: the knowledge reaches the patient too. Your patients will arrive with AI-generated interpretations. Your job is to be the trusted second read.

3. Continuous monitoring with wearables and biomarkers

Medicine still runs on snapshots: a yearly physical, a lab draw, a scan. Biology changes every day. The next shift is from snapshots to a continuous view, through wearables, repeated molecular measurements and new aging clocks.

“By 2030, I expect wearables and molecular measurements to give us a much clearer picture of how each person’s health is changing.”
Zahi Fayad, PhD, director, BioMedical Engineering and Imaging Institute, Mount Sinai

Steve Horvath, who built the first epigenetic clocks, is working on the measurement layer:

“I’m very excited about new generations of aging clocks. My wheelhouse are methylation clocks. I’m very excited about proteomic measures, metabolomics, imaging. So there’s a real revolution, perhaps for diagnostics, and also to help find dosages.”
Steve Horvath, PhD, ScD, Altos Labs and UCLA

But one caveat came up in almost every conversation, and David Barzilai stated it most clearly:

“What most people aren’t thinking about for greatest innovation is biomarkers of aging. These are validated for populations, not yet for people. And when we have them with sufficiently high reliability for people, it’ll be a game changer for individuals and also for shorter-term trials.”
David Barzilai, MD, PhD, co-editor, Frontiers of Longevity Science

My view: this is the most important point in the piece. Continuous monitoring is only as good as the biomarkers behind it. A clock that is accurate across 10,000 people can still be wrong for the one patient in front of you. Until aging biomarkers are validated for individuals, use them to follow a trend in the same patient over time, on the same test, not as a verdict on a single draw. Tell your patients this directly. It builds trust, and it protects you when the next clock disagrees with the last one.

Barzilai’s second point matters for the whole field. Reliable biomarkers would shorten clinical trials, because researchers could see whether a drug slows biological aging without waiting a decade for hard outcomes. Every other shift depends on this one.

4. Prevention and earlier intervention

Once you can map a patient and track how that map changes, you stop waiting for disease to show up. You act when the trajectory bends, not when the diagnosis arrives.

“The goal is to intervene earlier and help people maintain their strength, cognition and independence.”
Zahi Fayad, PhD

Evelyn Bischof describes the clinical model that follows:

“To make longevity medicine a truly actionable medical discipline by 2030, we need to upscale its evidence base now. The next generation of medicine must be adaptive: continuously measuring biological change, intervening, learning from individual responses, and recalibrating therapy in real time.”
Evelyn Bischof, MD, PhD, MPH

The research world is measuring the same outcomes. XPRIZE Healthspan is testing whether therapies can preserve function in older adults:

“We have teams right now running their final trials. They’re going to see if their therapeutic can change muscle, cognitive and immune function through clinical trials in older adults. Those are all going to wrap up in 2030, and we’ll be announcing our global winner.”
Jamie Justice, PhD, XPRIZE Healthspan

My view: prevention has always been medicine’s promise and rarely its practice, because we had no tools to see risk early or a care model to act on it. That is changing. Look at the outcomes everyone named: strength, cognition, independence. Not lab values. Function. Define success with your patients in those terms. Measure grip strength, gait speed, VO2 max and cognition the way you measure LDL. That’s prevention patients can feel.

5. Precision therapies that target aging and disease

The last shift is in what we prescribe. The first aging therapies probably won’t be called aging drugs. They’ll be drugs we already know, or are developing for disease, that turn out to act on aging biology too.

“Everyone talks about GLP-1. I think we will have the answer within a year or two. But the big question is, are these [anti-inflammatories] also geroprotectors?”
Steve Horvath, PhD, ScD

Zhavoronkov is building his pipeline around the same idea:

“In the long term, we have many different therapeutic programs in different stages that have the potential to address aging and disease at the same time. Currently we’re developing them for diseases, but then we want to repurpose them for aging.”
Alex Zhavoronkov, PhD

George Church is working on combinations:

“There are a lot of genes that independently look very promising for age-related diseases. But what if you put them all together? Are they going to add up, or are they going to synergize? A lot of that is going to happen in the next four years at a research level.”
George Church, PhD, Harvard Medical School

My view: this is where hype is most likely, so be careful. Church was candid that approved drugs take longer than four years. In the near term, precision means matching existing drugs to the right patient at the right dose, guided by the measurements in shift 3. The GLP-1 geroprotection data and the NLRP3 trials are the two to follow. They’ll reach your prescribing decisions before most of what was presented at ARDD.

What I’m taking back to my colleagues

For physicians

• Map first, then monitor. A baseline is only useful if you repeat it on the same test.

• Treat clocks as trend tools, not verdicts, and tell your patients why.

• Personalize lifestyle freely, but prescribe only on evidence.

• Measure function: strength, cognition and independence, alongside your labs.

• Learn to read AI output, because your patients already are.

For industry

• Validated biomarkers are the shared bottleneck. Whoever helps validate them shortens every trial that follows.

• Develop for disease first and aging second. That’s the regulatory path the field is taking.

• Build for continuous data, not annual snapshots.

• Bring physicians in early. Nothing changes practice until clinicians trust it.

Read the full interviews →

THERAPEUTICS · HORMONES & MIDLIFE CARE

Menopause hormone therapy and healthy aging: what the evidence supports and what remains uncertain

A Science review maps hormone receptors across 15 organs and treats the fall in estradiol as a whole-body aging signal. Its strongest claim, about brain protection, rests mostly on observational data, and randomized trials haven’t shown that hormone therapy prevents dementia. The established indications haven’t changed, but patients will ask about timing.

Read on longevitydocs™ News →

RESEARCH · BIOLOGY OF AGING

Cardiolipin loss drives the muscle shift of aging in mice

Cardiolipin, a mitochondrial lipid, declines with age, and that loss turns fast muscle fibers slow. Fast fibers are the ones that catch a fall. Restoring the lipid in mice reversed atrophy and prevented premature death. One surprise: the antioxidant NAC made things worse, which is worth telling patients who take many antioxidants.

Read on longevitydocs™ News →

RESEARCH · CLINICAL TRIALS

Senolytics improved liver fibrosis in a small randomized trial

Dasatinib plus quercetin, given intermittently, improved fibrosis by at least one stage in 47% of patients with fibrotic MASH, compared with 7% on placebo. It’s the strongest human senolytic result this year, and it uses a hard endpoint: paired liver biopsies, not a biomarker. Only 31 patients were enrolled, so watch for the phase 3 rather than prescribing.

Read on longevitydocs™ News →

Lexicon

Epigenetic Clocks

Biomarkers of aging based on DNA methylation data enable accurate age estimates for any tissue across the entire life course, and these epigenetic clocks link developmental and maintenance processes to biological aging. Classic epigenetic clocks include Horvath's clock, Hannum's clock, DNA PhenoAge, and DNA GrimAge, and they are employed as a practical tool to evaluate the efficacy of age-reversing interventions. Epigenetic clocks comprise a set of CpG sites whose DNA methylation levels measure subject age and are being explored to quantify biological aging rates and test longevity or rejuvenating interventions.

Because DNA methylation and other epigenetic marks are reversible, manipulating them is central to the effectiveness of rejuvenating interventions such as partial reprogramming that aim to delay aging.

An expert consensus on biomarkers of aging identified DNA methylation and epigenetic clocks as an epigenetic-domain biomarker suitable for use as an outcome measure in intervention studies.

Read the full entry

Certification Highlight

Master the hallmarks of aging and their clinical relevance

Hippo built the checklist around the CLD framework (primary, antagonistic and integrative categories, the 2023 expansion to twelve, and interconnection), then added steps that link the hallmarks to clinical practice.

Explore the CLD Program

Mastermind Agenda

Skin, Bone and Muscle: The Mastermind Course

We designed the Mastermind as a physician-only course in three modules: The Science, The Clinic, and The Protocols. Faculty will examine the evidence, patient selection, safety, and practical decisions across skin, bone, and muscle aging.

Join us October 24 at Convene, 101 Park Avenue, New York City + Virtual; the welcome reception is October 23. Seating is limited.

View the full faculty, learning objectives, and schedule

Module 1: The Science

9:00 AM · Skin Regeneration: Stem Cells, Secretomes and Exosomes
Saranya Wyles, MD, PhD

9:20 AM · Gerotherapeutics for Skin, Muscle and Bone: The Pipeline
James Peyer, PhD

9:50 AM · Cellular Therapies: How Cell Products Are Actually Made
Robert Hariri, MD, PhD

10:10 AM · Topical Rapamycin and Rapalogs in Skin Longevity
Doris Day, MD

Module 2: The Clinic

10:50 AM · The Aging Face, Biomarkers and Protocol
Amanda Hill, MD

2:00 PM · The GLP-1 Tax: Muscle and Bone on Incretin Therapy
Elizabeth Yurth, MD

2:30 PM · Bone Loss: Screening, Markers and Sequencing
Catherine Johnson, MD

2:50 PM · Hormonal Transition and Collagen Loss
Neely Khan, MD, MS, FAAD

Module 3: The Protocols

3:30 PM · Energy-Based Devices: The Latest Protocols
Dan Belkin, MD

3:50 PM · Procedure Parameters and Pigment Risk Across Skin Types
Naana Boakye, MD, CLD, MPH, FAAD

4:10 PM · Biostimulators, Polynucleotides and Growth Factors
Kay Durairaj, MD, FACS

Mastermind includes Welcome Reception (10/23), breakfast at 8:00 AM, coffee breaks, Mastermind Lunch at 12:00 PM, and the Mastermind Dinner at 6:00 PM (tickets available).

Attend the Mastermind

Buzz in the chat

Miami law firm targeting physician websites for cookie consent violations

T. shared that a colleague had been served in a lawsuit alleging the physician’s website used cookies before visitors clicked an accept button, with a Miami-based law firm targeting medical practices over this privacy issue and pressuring them to settle. S. confirmed he had heard of the same tactic the previous week and suggested GoDaddy’s built-in cookie settings as a quick mitigation.

R. recommended Termly as a rigorous cookie consent management platform for physician websites. The consensus was that website developers should be contacted promptly to ensure compliant cookie consent flows are in place before a visitor can be tracked.

Key points

• A Miami law firm is systematically targeting physician websites that activate cookies before visitor consent and using lawsuit pressure to extract settlements

• GoDaddy offers a cookie management setting that can help bring sites into compliance quickly

• Termly is a rigorous cookie consent tool suitable for physician websites

Read More Cases

Apply for membership (physicians only)

Member profile

Ryan Greene, DO

Meet Dr. Greene

Calendar

Members’ Events

Co-run your practice with AI agents - Dr. Regina Druz
Rooms, Oct 7, 12:00 to 12:30 pm ET

Skin Longevity Blueprint - Dr. Kay Durairaj
Rooms, Oct 14, 12:00 to 12:30 pm ET

Skin, Bone and Muscle Mastermind
New York and virtual, Oct 24

Join us

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THERAPEUTICS · METABOLIC HEALTH

The next wave of obesity drugs, from EASD

Amylin is now paired with incretins. At EASD, CagriSema showed 22.4% weight loss at one year, and Lilly’s eloralintide plus tirzepatide reached 23%. Lilly’s oral orforglipron matched insulin glargine on heart safety in ACHIEVE-4. Weight loss in the low 20s is now a class effect, so the next question is how much of that loss is lean mass.

Read on longevitydocs™ News →

BUSINESS · PHARMA & BIOTECH

FDA approves AbbVie’s Juvmo (tavapadon) for Parkinson’s

Juvmo is the first selective D1/D5 dopamine agonist, taken once daily on its own or with levodopa. In TEMPO-3 it added 1.7 hours of good “on” time, compared with 0.6 hours on placebo. In early disease, 94% of patients had not started levodopa by week 85. Patients will ask about it, so know the name.

Read on longevitydocs™ News →

DIAGNOSTICS · SCREENING & PREVENTION

One in eight cancers worldwide starts with an infection

Infections caused 2.3 million new cancers in 2024, 12% of all cases. Most of them come from four pathogens: H. pylori, HPV, hepatitis B and Epstein-Barr virus. These are some of the most preventable cancers in medicine, and the tests are cheap. A longevity workup that includes a full-body MRI but skips an H. pylori test has its priorities backward.

Read on longevitydocs™ News →

TECHNOLOGY · DIGITAL HEALTH INFRASTRUCTURE

Epic pauses product work after an AI finds MyChart security bugs

Epic has paused most product development for about six weeks to fix vulnerabilities found by an AI security model. Some MyChart configurations could let outsiders read patient records without leaving a trace in the logs. Your patient portal is part of your clinical risk. Ask your vendor which fixes apply to your setup.

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BUSINESS · DEALS & FUNDING

Viome buys Sōlaria Biō to move from testing to treating

Viome acquired Sōlaria Biō and its AI-screened biobank of more than 5,700 plant-derived microbes. Its first product, Bōndia, is a probiotic for bone health aimed at women approaching menopause. Microbiome companies are building test-to-treat businesses, where the test sells the product. Before you recommend one, ask for the trial, the endpoint and the population studied, as you would for a drug.

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Editorial Disclaimer:

Published for licensed physicians and qualified healthcare professionals, for professional education and information only. It is not medical advice, clinical guidance, or treatment recommendation for any patient, and it is not intended for consumers, who should consult their own physician.

Physician discussions reproduced here are the personal clinical opinions of the individuals named. They are not the position of longevitydocs™ and have not been reviewed by any regulatory, medical, or professional body.

Therapies, compounds, devices, and protocols are referenced for educational context. Some are investigational, off-label, or not approved by the FDA, EMA, or your local authority. longevitydocs™ does not endorse or recommend any product, treatment, or company, and nothing here is a solicitation or an attempt to influence prescribing.

By reading, you confirm you are a licensed healthcare professional and will apply this information within your own clinical judgment, professional obligations, and applicable law.

If you are a patient or consumer, this content is not for making health decisions. Please consult your own physician.

Hey Doc,

In 2020, I put everything I could on a dashboard: biomarkers, imaging, sleep, activity, recovery. Measuring gave me understanding. It guided interventions and helped me build better habits. Whether it changes outcomes or mortality, I can't say yet. But it made me fall in love with longevity medicine, and with the complexity of human systems biology.

Now patients arrive with dashboards of their own, often explained first by the companies that sell the tests. Our role is not to take the data away. It is to ask what it means, what it changes, and whether acting on it helps.

That is why I created the Longevity Data Efficacy Pyramid: six questions to help physicians and patients decide what to act on, what to watch, and what to set aside.

As always, Happy Sunday.

Dr. David Luu, Founder, longevitydocs.™

The Longevity Data Efficacy Pyramid

For years, we said we didn’t have enough data for precision medicine. Now we have more than we can interpret.

A patient arrives with a biological-age score, a glucose trace, a full-body MRI report, sleep data, and an AI summary connecting it all. She has invested time, money, and attention. Now she wants to know which number to fix first.

Apps and AI are already interpreting these numbers for her. What a dashboard can’t offer is clinical context, accountability, and a plan. That’s our part.

Give all data a job

Before you order, read, or repeat a result, finish this sentence with the patient:

“We are measuring this so we can decide whether to…”

The decision might be to diagnose a condition, estimate risk, monitor treatment, support a habit, or stop testing.

Accuracy and value are separate questions. Fryback and Thornbury separated a test's technical performance from its effect on decisions and outcomes. The CDC's ACCE model does the same for genetic tests.

The pyramid

We adapted that logic for longevity care: one measure, one patient, one purpose. For each measure, ask how far the evidence supports using it for this particular purpose. The pyramid evaluates a use, and it works the same way for a lipid panel and an epigenetic clock.

Measure → Signal → Insight → Decision → Benefit → Value

1. Fit-for-purpose measurement. Can we obtain and interpret it consistently here? How was it collected, is it complete and repeatable, and what could distort it? Patient-reported fatigue counts as data. Elicit it carefully and record its context.

2. Valid signal. Does it reflect what we claim it reflects? A reliable measurement can still be a poor indicator of the condition, risk, or physiological state we want to understand. A wearable graph shows that something changed. It takes clinical reasoning to explain why.

3. Clinical insight. Does it add to what we already know? A recovery score may capture variation, but does it tell you more than asking about sleep, illness, training, alcohol, or travel?

4. Decision impact. Does it change a justified plan? Decide in advance what follows a positive, negative, or changing result, and who will review it. A clinical indication needs more than "interesting to know."

5. Patient benefit. Does care guided by this measure improve what matters to the patient? The goal is a patient who feels better, functions better, or lives longer. A biological-age score or HRV reading is a way to get there.

6. Net value. Is using this measure worth its total burden? Consider false alarms, false reassurance, incidental findings, downstream tests, money, privacy, and attention. Then consider what another dashboard might displace: sleep, movement, work, or time with people.

Each question builds on the one before it, and each needs its own answer. A measure can be accurate and still fail to change care.

Then agree on a plan

Reaching a tier does not trigger an intervention. Finish with one of three decisions:

• Act. Name the clinical step, the rationale, and the responsible clinician.

• Watch. Set a review date, an action threshold, and a reason to continue or stop monitoring.

• Set aside. Explain why the result doesn’t change care now and what would justify revisiting it.

The Longevity Data Efficacy Pyramid accompanies this issue. Try it this week in clinic: one measure, one patient, one purpose, and a decision at the end.

The Longevity Data Efficacy Pyramid

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The Longevity Data Efficacy Pyramid is a proposed educational framework for longevity care, adapted from Fryback and Thornbury’s diagnostic-efficacy hierarchy. It is not a validated grading scale, clinical guideline, or substitute for individualized clinical judgment.

Menopause leaves a molecular signature linked to brain aging

Wood Alexander, Casaletto et al. | Nature Medicine | Sep 22, 2026

Blood proteomics identified a 16-protein inflammatory, synaptic and Alzheimer’s-related signature (including CCL2, BACE1 and p-tau231). It tracked FSH more closely than chronological age and was stronger in women with hot flashes and night sweats. Across UK Biobank and four cohorts of older women (about 11,900 people), higher scores were linked to worse cognition and a modest increase in Alzheimer’s risk (HR 1.15).

For longevitydocs: this proteomic signature may help researchers investigate links between the menopause transition and brain health. It is a discovery finding, not a clinical assay or evidence that hormone therapy changes dementia risk.

Multi-cancer blood test performance in 35,900 adults (PATHFINDER 2)

Karthik V. Giridhar | Nature Medicine | Sep 22, 2026

PATHFINDER 2 evaluated the Galleri multicancer detection test in adults aged 50 and older. Its reported test-performance results include a 60.3% positive predictive value and 39.3% sensitivity for cancers diagnosed within 12 months. An FDA advisory panel voted in favor of the test, but that is not FDA approval.

For longevitydocs: the 60% PPV and the 70% sensitivity for the deadliest cancers, the next milestone is mortality data, which would determine whether multi-cancer detection earns a place alongside guideline screening.

Caloric restriction improves a composite aging-biomarker index

Guida, Hsu, Neiberg et al. | GeroScience | Sep 12, 2026

Across 7 pooled RCTs (829 older adults), caloric restriction improved a six-marker index modeled on the TAME trial (CRP, IL-6, cystatin C, insulin, GDF-15 and TNF-R1). About half the effect came from weight loss, and some signal remained independent of weight.

For longevitydocs: that gives geroscience a practical, repeatable readout of aging biology, and a way to compare interventions head to head in clinic and in trials. The next step is linking the index to function and clinical events.

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Fasting Insulin

Fasting insulin is the circulating insulin concentration measured after an overnight fast, commonly reported alongside fasting glucose and the homeostatic model assessment for insulin resistance (HOMA-IR). Fasting insulin is one of the markers of glycaemic control reported in trials of dietary and metabolic interventions, distinct from post-load or stimulated insulin measures.

Fasting insulin serves as a proxy for insulin resistance: when tissue response to insulin falls, fasting insulin tends to rise, and it is combined with fasting glucose in the HOMA-IR index. Increased fasting insulin and a higher HOMA-IR index are observed in states of metabolic and psychiatric dysregulation, including acute depression.

How it is measured?

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Hormone Optimization Protocols in Aging Patients

Explore a structured learning pathway for evaluating hormone-related symptoms, evidence, safety, and treatment decisions in aging patients.

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Mastermind Agenda

Skin, Bone and Muscle: The Mastermind Course

We designed the Mastermind as a physician-only course in three modules: The Science, The Clinic, and The Protocols. Faculty will examine the evidence, patient selection, safety, and practical decisions across skin, bone, and muscle aging.

Join us October 24 at Convene, 101 Park Avenue, New York City + Virtual; the welcome reception is October 23. Seating is limited.

View the full faculty, learning objectives, and schedule

Module 1: The Science

9:00 AM · Skin Regeneration: Stem Cells, Secretomes and Exosomes
Saranya Wyles, MD, PhD

9:20 AM · Gerotherapeutics for Skin, Muscle and Bone: The Pipeline
James Peyer, PhD

9:50 AM · Cellular Therapies: How Cell Products Are Actually Made
Robert Hariri, MD, PhD

10:10 AM · Topical Rapamycin and Rapalogs in Skin Longevity
Doris Day, MD

Module 2: The Clinic

10:50 AM · The Aging Face, Biomarkers and Protocol
Amanda Hill, MD

2:00 PM · The GLP-1 Tax: Muscle and Bone on Incretin Therapy
Elizabeth Yurth, MD

2:30 PM · Bone Loss: Screening, Markers and Sequencing
Catherine Johnson, MD

2:50 PM · Hormonal Transition and Collagen Loss
Neely Khan, MD, MS, FAAD

Module 3: The Protocols

3:30 PM · Energy-Based Devices: The Latest Protocols
Dan Belkin, MD

3:50 PM · Procedure Parameters and Pigment Risk Across Skin Types
Naana Boakye, MD, CLD, MPH, FAAD

4:10 PM · Biostimulators, Polynucleotides and Growth Factors
Kay Durairaj, MD, FACS

Mastermind includes Welcome Reception (10/23), breakfast at 8:00 AM, coffee breaks, Mastermind Lunch at 12:00 PM, and the Mastermind Dinner at 6:00 PM (tickets available).

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Empower Sleep catches sleep apnea missed by consumer wearables in fit physicians

A case discussion on what a consumer sleep signal can miss, and when a clinical assessment changes the picture.

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Jonathan Bastian, MD, CLD

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Wearable

Your ring now carries your chart

Ultrahuman's new HealthEx add-on lets US ring users pull their medical records through TEFCA, the national health-data exchange. Their conditions, medications and procedures (532 mapped categories) sit beside resting heart rate, HRV, temperature and sleep. It costs $4.99 a month, builds a visit summary and flags missed follow-ups. Patients may soon arrive with their medical records and wearable trends together on one screen. That may make a visit more informed, but aggregation alone does not establish diagnostic accuracy or clinical benefit. Hitconsultant

Global Health

$16.4 trillion: the economic case for prevention

A McKinsey Health Institute and Abu Dhabi Future Health whitepaper models an upper-bound scenario in which eliminating modifiable behavioral, metabolic, and environmental risks could add $16.4 trillion to annual global GDP in 2050. The model also estimates a 12-year increase in healthy life expectancy at birth under that scenario. McKinsey

Diagnostics

Alzheimer’s blood tests are for symptomatic patients, not screening

Four Alzheimer's blood tests now have FDA clearance, including PrecivityAD2 and Roche's Elecsys pTau217. As Time reported, experts agree they belong in the workup of patients with cognitive symptoms, not in screening healthy people, because false positives rise in low-risk groups. Have a clear policy for when to order one and what to do if a patient brings you a result obtained outside that pathway. Time

Lab-grade breath testing goes self-serve

PNOĒ's new mask runs an 8-minute breath test that claims to measure 23 metabolic markers, including a VO2-style fitness reading. It's aimed at gyms and spas, with Equinox, Restore and Mount Sinai listed as sites. It is not FDA-cleared, and the CEO calls it wellness rather than a diagnostic. Expect patients to bring in results. TechCrunch

Policy

FDA puts a major GLP-1 compounder on notice

In a September 18 warning letter, FDA said Empower Pharmacy appeared to compound semaglutide and tirzepatide products that were essentially copies of approved drugs in substantial quantities. The agency also cited deficiencies in sterile-production practices that could put patients at risk. If your practice prescribes compounded GLP-1s, review your supplier and the patient-specific rationale for prescribing; do not assume that adding another ingredient resolves the agency’s concerns. FDA

Culture

Longevity fixation syndrome

The article examines how health tracking can become an obsession with measurements and interventions, even among otherwise healthy people. It raises a question central to the Longevity Data Efficacy Pyramid: does monitoring improve patients’ lives enough to justify the anxiety, cost, follow-up care, and attention it demands? RobbReport

Every doctor should be a longevity doctor

longevitydocs.™ is the intelligence network for longevity medicine. 1,000+ physicians, 68 countries

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Editorial Disclaimer:

Published for licensed physicians and qualified healthcare professionals, for professional education and information only. It is not medical advice, clinical guidance, or treatment recommendation for any patient, and it is not intended for consumers, who should consult their own physician.

Physician discussions reproduced here are the personal clinical opinions of the individuals named. They are not the position of longevitydocs and have not been reviewed by any regulatory, medical, or professional body.

Therapies, compounds, devices, and protocols are referenced for educational context. Some are investigational, off-label, or not approved by the FDA, EMA, or your local authority. longevitydocs does not endorse or recommend any product, treatment, or company, and nothing here is a solicitation or an attempt to influence prescribing.

By reading, you confirm you are a licensed healthcare professional and will apply this information within your own clinical judgment, professional obligations, and applicable law.

If you are a patient or consumer, this content is not for making health decisions. Please consult your own physician.

Issue 107. The question I get more than any other: where can I find a longevity doctor? For my family. For my company. For my board. Today we launch the longevitydocs Directory, a global network of vetted, license-verified longevity doctors practicing evidence-informed medicine.

Also inside: a speedometer for aging, a federal bill that would reach most med spas and deepfakes doctors selling drugs online.

Thank you to the 10,000+ readers across 119 countries.

As always, Happy Sunday.

Dr. David Luu, Founder, longevitydocs.™

Where can I find a longevity doctor?

We hear this question more every week. From patients: “Who is the best in New York?” From colleagues: “Do you know someone who works on hormones and longevity?” From a friend: “I need a cardiologist who goes deeper than the guideline.”

Five years ago, “longevity doctor” was not a category. Obesity medicine had no board certification before 2012. Cardiology had none before 1941. Specialties often begin as questions patients are already asking.

The patients asking today are different. They want answers before disease arrives, and they look online first: Instagram, TikTok, Google, Reddit, ChatGPT. None of those platforms can check a license, a training, or a claim. In a market where much of the longevity conversation is led by people who are not physicians, that gap matters.

So we built the place we wished existed.

The LongevityDocs Directory. A global directory of licensed physicians practicing evidence-informed longevity medicine. Every profile says where the physician stands: certified, teaching the certification, completing it, or a member of the network. The status is on the card, in plain words.

Search by name, specialty, city or country. Read the profile, the specialties, and what the practice offers. Then contact the practice directly. The directory does not rank, recommend or endorse. It gives people a verified starting point and lets the physician take it from there.

Live now in New York, London, Miami, Dubai, Bengaluru, Melbourne, and virtual care worldwide.

Find a Longevity Doctor

If you are a physician practicing longevity medicine and not yet listed, reply to this email. We would like to hear from you.

Aging Rate Indicators (ARI) measure pace, not accumulated age

Austad et al, Frontiers in Science, Sept 17, 2026.

A biological-age clock is an odometer: how far you have aged. An aging rate indicator, or ARI, would be a speedometer: how fast you are aging now. Austad, Kaeberlein and Miller went looking for one in the mice that live longest in the NIA’s Interventions Testing Program (ITP), where eight drugs, including rapamycin, acarbose and canagliflozin, extend lifespan by 12 percent or more. Twelve shifts kept showing up across those mice, from lower mTORC1 activity to higher UCP1 in fat. If the same shifts can be read from one midlife blood draw, a drug’s effect on aging could be judged in months. A clock needs two timepoints to say the same thing.

For longevitydocs: Useful language for the next patient with an Apple Health Age. That number is an odometer, not a speedometer, and we prescribe against neither. ARIs are mouse data with no human panel yet. The real argument in the paper is that these drugs work when started in midlife, which supports late-start trials, not off-label rapamycin.

REM sleep tracks lower risk across 83 diseases in 95,559 UK Biobank adults

Luo et al., PLOS Medicine, Sept 17, 2026

Nearly 96,000 UK adults wore a wrist tracker for a week, and researchers followed their health records for about nine years, checking against more than a thousand diagnoses. People who got more REM sleep were less likely to develop 83 conditions, including heart failure (26 percent lower risk), atrial fibrillation (17 percent lower) and dementia (46 percent lower). More deep sleep went with less type 2 diabetes and depression. Broken and irregular sleep went with more anxiety, depression and substance dependence. Total sleep followed a U-curve: 6 to 8 hours was the low-risk zone for most conditions, and sleeping under 5 hours accounted for 37 of the 41 links to higher risk.

For longevitydocs: We already knew sleep cuts morbidity. We now know how to measure it at scale, and this study shows the pieces that matter: more REM, more deep sleep, less time awake after falling asleep. The open question is how do you get more REM and deep sleep, and less WASO? The honest answer is that we have very little trial evidence for moving any of the three on purpose, and a tracker cannot measure them well enough to know if you did. What holds up is simpler. Duration and regularity are the levers we can pull, and both moved the rest in this cohort.

Regular exercise rewires immune cells at the chromatin level

Song et al., Science Advances, Sept 18, 2026.

We know exercise protects against metabolic disease and infection. This paper asks what it does to the blood. A team at BGI Research in Shenzhen compared 40 adults exercising at the WHO threshold with 46 sedentary controls, all in their late twenties, and read their plasma and 1.3 million immune cells down to the chromatin. Exercisers had the familiar labs, lower glucose and triglycerides, higher HDL, and underneath, a plasma signature of fat burning and antioxidant defense. Their monocytes and B cells had antigen-presentation genes more open and more active. Killer T and NK cells were primed, with the inflammatory switches AP-1 and NF-κB turned down. Cell-to-cell signaling shifted from resistin and IL-6 toward antigen presentation and interferon-γ.

For longevitydocs: The mechanism under the advice we already give: exercise sharpens immune surveillance and quiets inflammation, and each effect now has an address in the genome. A snapshot of young, self-reported exercisers, so it explains rather than proves. The finding to watch is resistin, a monocyte signal that acts on the vascular wall. Exercise turned it down.

Lexicon

Interleukin-6 (IL-6)

Interleukin-6 (IL-6) is a cytokine that is elevated in chronic low-grade systemic inflammation, which is associated with cardiovascular disease and type 2 diabetes. IL-6 was the first cytokine described as a myokine, produced and released by contracting skeletal muscle fibers during exercise and exerting effects in other organs. Robust epidemiologic evidence, together with human genetic studies and mechanistic experiments, supports IL-6 as a central mediator of cardiovascular risk.

How it's measured

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Every week we turn the best conversations in the network into a Case you can read in five minutes. Each one gives you the summary, the key points with the physicians who made them, and the full thread underneath. Read it, add your comment, or jump straight into the conversation.

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Guidelines

Ferritin below 30 is the new line

The 2026 American Society of Hematology guidelines in Blood Advances keep ferritin as the best first test. They move the adult low cutoff from below 15 to below 30. Below 50 may guide treatment around surgery, blood loss or pregnancy planning. With inflammation, the guidelines add a full iron panel, where TSAT below 20 percent is significant.

For longevitydocs: Women's health and midlife panels will feel this first. A fair number of ferritin results filed as normal last year would now read differently. It seems worth a look back through recent results.

Pharma

FDA opens the file on testosterone for menopause

On Sept 17, FDA’s Office of Women’s Health and Center for Drug Evaluation and Research (CDER) held a public workshop on testosterone use in menopausal women: benefits, dosing, lab interpretation and long-term safety, with the stated aim of informing research and drug development. There is still no FDA-approved testosterone indication or formulation for menopausal women, so prescribing runs on off-label male products or compounding. The evidence is strongest for hypoactive sexual desire disorder (HSDD); energy, mood and cognition are what patients ask about, without a guideline-backed indication behind them. Long-term cardiovascular and breast cancer data remain the regulatory bottleneck.

For longevitydocs: This is the first time FDA has put the question on its own agenda, and a female-dose NDA path is now imaginable. For practices already prescribing off-label, the documented indication (usually HSDD), consent, assay choice and monitoring are what will read well if the regulatory picture sharpens.

Policy

Bill Targets Corporate Control of Doctors

The Stop Corporate Takeovers of Physicians Act, introduced Sept 16 by Senators Warren, Wyden and Merkley, would bar private equity, insurers and other non-physician-controlled businesses from owning or directing medical practices. It closes the two standard workarounds: the friendly physician who owns the practice on paper, and the management services organization that runs hiring, schedules, pay, billing and pricing behind it. Hospitals and nonprofits are exempt. Med spas and telehealth platforms built on a medical director plus MSO are not. The bill is modeled on Oregon's 2025 law, and its sponsors cite more than 80 percent of U.S. doctors now employed by corporate entities, up from 62 percent in 2019.

For longevitydocs: PE-owned and VC-backed MSOs, and the med spas and telehealth platforms built on them, would be inside the bill's definition. Federal passage is unlikely this session, but the Oregon template is spreading state by state. A good moment to reread your own agreement and ask who actually controls hiring, schedules and billing.

Media

Deepfake doctors are selling pills

CBC reports that AI-generated ads using the faces and voices of prominent Canadian physicians are circulating on Facebook and TikTok, selling prostate treatments, joint pills and “$1 million satisfaction guarantees.” Dr. Bonnie Henry, British Columbia’s provincial health officer, and Dr. François Marquis, chief of intensive care at Maisonneuve-Rosemont in Montreal, have both been cloned repeatedly; one victim came to Marquis’s ICU asking for a refund on pills that never arrived. Cease-and-desist letters, platform reports, the medical college and the police have all led nowhere. A 2024 BMJ report describes the same pattern in the UK, and the US NO FAKES Act is still a bill.

For longevitydocs: If you have a public face, assume it is already in a training set. The practical steps are small: a verified profile patients can check, a line on your site saying you sell nothing through social ads, and a saved search on your own name once a month. The larger point is the one behind this week’s cover. Patients cannot tell a physician from a rendering of one, and the platforms will not do it for them.

Every doctor should be a longevity doctor

longevitydocs.™ is the intelligence network for longevity medicine. 1,000+ physicians, 68 countries

Apply to Join

Editorial Disclaimer:

Published for licensed physicians and qualified healthcare professionals, for continuing medical education and professional information only. It is not medical advice, clinical guidance, or treatment recommendation for any patient, and it is not intended for consumers, who should consult their own physician.

Physician discussions reproduced here are the personal clinical opinions of the individuals named. They are not the position of longevitydocs and have not been reviewed by any regulatory, medical, or professional body.

Therapies, compounds, devices, and protocols are referenced for educational context. Some are investigational, off-label, or not approved by the FDA, EMA, or your local authority. longevitydocs does not endorse or recommend any product, treatment, or company, and nothing here is a solicitation or an attempt to influence prescribing.

By reading, you confirm you are a licensed healthcare professional and will apply this information within your own clinical judgment, professional obligations, and applicable law.

If you are a patient or consumer, this content is not for making health decisions. Please consult your own physician.

Hey Doc,

Apple put the word longevity on a billion phones this week. Health Age, a Quest panel ordered from the app, coaching, the whole loop. Many of you have been running that loop by hand for years. This issue is about what changes now that the patient side is a consumer product, and how to build the doctor side from your own phone, in four levels.

Also inside: an AI-designed drug that moved six aging clocks in an IPF trial, why two questions about a patient’s parents beat a polygenic score, and caloric restriction data showing half the benefit is not the weight. Plus a poll. Tell me what you want more of.

As always, Happy Sunday.

Dr. David Luu, Founder, longevitydocs.™

How to run a longevity clinic from your phone

Apple put the word Longevity in the Health app.

iOS 27 ships tomorrow. A Longevity tab, a Health Age built from VO2 max, resting heart rate, HRV, sleep and blood work, and a Quest panel of 50+ biomarkers ordered inside the app for $119. Daily data, habits, monitoring, coaching, labs. The whole loop, in a pocket.

I am thinking out loud here. If Apple can hand a patient blood work from the phone, what comes next? Can you run a full virtual clinic from a phone? On the patient side, probably yes. Add a pharmacy and a consultation and Apple becomes the largest healthcare system in the world. Not a hospital. A phone.

Apple’s own footnote says the Health app is for wellness, not medical use. Read that carefully. The doctor is the part they left out. On purpose.

That is where I see the real opportunity. Not Apple running a clinic. Each doctor running a practice from a phone.

Four levels of the longevity clinic on a phone:

Level 1: patient communication

HIPAA-compliant messaging, and the patient’s data in front of both of you, visualized. Wearables, labs, trends. Most physicians can be here in a week.

Level 2: patient coordination

Scheduling, all tests in the app: labs, imaging, continuous data, reminders, your team in the loop. The admin layer, without the front desk.

Level 3: the full clinic

Prescriptions and pharmacy, a written plan, lifestyle detail, and direct access to the physician including telemedicine. Everything a visit does, from the phone.

Level 4: physician intelligence

A fully customizable platform where a patient asks any question and gets an immediate answer, built on their own data and the knowledge and expertise of their specific doctor. Your brain, your protocols, your judgment, available at 2 a.m. It knows when to say “this one goes to the doctor.”

Levels 1 to 3 put your clinic on the phone. Level 4 puts you on the phone.

Apple built the patient side and branded it. The doctor side is still yours to build. Every Health Age and every lab number is a question, and the question lands on a doctor. Pick your level this week. The patient with a $119 panel and a Health Age of 52 is already looking for someone to call.

Download the building guide

How To Run A Longevity Clinic From Your Phone

32.2KB ∙ PDF file

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An AI-designed drug moved six aging clocks. In IPF patients. For 12 weeks.

Zhavoronkov et al., Nature Biotechnology, Sep 7, 2026

Proteomic substudy of the Phase 2a IPF trial of rentosertib, Insilico’s TNIK inhibitor (n=42). Six proteomic aging clocks, Insilico’s and independent, all shifted younger versus placebo, clearest at 30 mg BID around week 4. Clock change and FVC gain only partially tracked each other. The authors say it themselves: clocks cannot separate an anti-fibrotic effect from a geroprotective one.

For longevitydocs: credit to the team for putting the clocks inside the trial. That took foresight, and a positive readout like this one is good news for all of us. It shows what aging endpoints can look like in a real disease trial, and it opens the door for others to do the same. The design is the template: aging-first target, disease indication, multi-clock readout.

Ask about the parents. It beats the polygenic score.

Seidu et al., GeroScience, Sep 11, 2026

1,126 Swedish 70-year-olds, followed six years. Having two parents who lived past 85 tracked with less hypertension, higher MMSE, lower BMI, lower homocysteine, lower IL-6 and CRP, less smoking, and a slower rise in plasma pTau217. A GWAS-derived polygenic longevity score only tracked with socioeconomic factors and fewer heart attacks. The two measures did not correlate. Inflammation and pTau217 findings did not survive multiple-comparison correction. White cohort, self-reported parental ages.

For longevitydocs: the cheapest longevity biomarker in your intake is two questions about the patient’s parents. Add parental age at death to your history if it is not there.

Caloric restriction improves an aging-biomarker index. Half of it is not the weight.

Cassidy A. Guida, et al. 2026 - Geroscience

Pooled individual data from seven caloric restriction RCTs (n=829, mean age 67, mostly overweight or obese). A composite of CRP, IL-6, cystatin C, insulin, GDF-15 and TNF-R1 improved with CR. Weight loss explained about half the effect. The other half held after adjustment.

For longevitydocs: good news for anyone running a lifestyle or obesity program, and a nice piece of work from the authors for pooling seven trials at the individual level. Two things to take into the clinic. Measure response on a multi-marker panel, not on a single biological age score. And tell your patients the benefit goes beyond the number on the scale. Surrogate endpoints, not hard outcomes yet, but the direction is encouraging.

Lexicon

Oxytocin

Oxytocin is a nonapeptide hormone that has a central role in the regulation of parturition and lactation. It is a peptide hormone secreted from the pituitary that is also released in the brain, where it acts as a neuromodulator to shape several aspects of social behavior.

It regulates the salience of social cues through its interaction with the dopaminergic system, and its effects depend on context and on individual differences such as gender, personality traits, and degree of psychopathology, so it can induce antisocial effects including aggression and envy

As women transition into menopause, oxytocin levels decrease while their susceptibility to mood disorders, poor sleep, osteoporosis, and cardiovascular diseases increases, highlighting oxytocin as a potential influence on the health and mood of women across the reproductive life span.

For longevitydocs: oxytocin is showing up in menopause and bone conversations. Know the physiology before a patient asks about the nasal spray.

Open the Lexicon

Certification

What you should know when prescribing exercise

Hippo, the physician AI inside longevitydocs, now builds your learning checklist from the exercise module. Tick what you already know. Hippo tracks the rest and points you to the session that covers it.

Explore the CLD Program

Buzz in the chat

TRT training resources for physicians: guidelines versus AI-generated curricula

A member asked if colleagues could recommend a TRT course. Another member responded that formal TRT certification courses aimed at physicians are largely commercialized products geared toward non-physician prescribers and amount to a money grab; his recommendation was to start with the AUA guidelines and the Endocrine Society guidelines, noting the latter are solid but on the conservative side.

A third member suggested an alternative: using an LLM such as Claude with a detailed structured prompt to generate a custom physician-level curriculum. He shared a comprehensive prompt covering diagnostic workup, primary versus secondary hypogonadism differentiation, treatment modalities with dosing, monitoring, side effect management, contraindications, fertility-preserving alternatives, and informed consent, with instructions to cite current guideline positions and flag areas of ongoing controversy.

Two other members offered an important caveat: LLMs default back to standard medical society guidelines even when prompted otherwise, and the longevity practice mindset does not fit neatly into conventional guidelines. One added that prescribers need to understand both the guideline baseline and how to frame off-label or outside-standard-of-care options for patients exercising the right to try, within a medically supervised integrative framework.

Key points

• Formal TRT certification courses for physicians are largely commercialized and aimed at non-physician prescribers; the AUA and Endocrine Society guidelines are a more reliable starting foundation.

• The Endocrine Society guidelines provide a solid baseline but are conservative relative to longevity practice standards.

• An LLM can generate a structured physician-level TRT curriculum when given a detailed prompt, but the output must be reviewed carefully and customized.

• LLMs default to standard guidelines even when prompted with longevity framing, so the output is a starting scaffold, not a finished curriculum.

• Physicians practicing outside standard guidelines should be able to document and explain off-label decisions and frame them clearly within medically supervised integrative care.

Evidence: Member discussion; not clinical or regulatory guidance

Read More Cases

Member profile

Jila Senemar, MD, CLD

Board-certified OB/GYN in Miami, 20 years in practice, certified menopause specialist, mother of three. Jila spent two decades treating perimenopause and menopause the conventional way. Then she moved the practice toward women’s longevity: metabolic health, hormones, sleep, mood and sexual health managed as one plan rather than five referrals.

She built a community around it. Women across Miami and Coral Gables now come to her for midlife care that starts earlier and looks further ahead. Physicians in the network come to her for the same reason.

She graduates this year as a Certified Longevity Doctor. Women’s longevity is one of the fastest-growing rooms in longevitydocs, and Jila is one of the reasons.

Visit Dr. Jila Senemar

In the app

Cases of the week is live

Every week we turn the best conversations in the network into a Case you can read in five minutes. Each one gives you the summary, the key points with the physicians who made them, and the full thread underneath. Read it, add your comment, or jump straight into the conversation.

Open in the app (members)

Apply for membership (physicians only)

Calendar

Upcoming Events

ROOMS with Dr. Tamsin Lewis
Online, Sept 16, 11 pm ET. Autonomous Nervous System

Table, New York City
Sept 22. Twelve physicians, one dinner. Reply to this email to request a seat.

ROOMS with Dr. Haleem Mohammed
Online, Sept 30, 12 pm ET. Confessions of a Chief Medical Officer

ROOMS with Dr. Regina Druz
Online, Oct 7, 12 pm ET. Co-run your practice with AI agents

Mastermind Skin, Bone and Muscle
New York and virtual, Oct 24

Join us

Visualizing Longevity: Whole-Body Imaging and the Science of InflammAging
Mount Sinai, New York, October 15 to 16. A CME course from our friends and partners at Icahn, directed by Zahi Fayad, PhD and Miriam Merad, MD on what whole-body imaging can and cannot tell you about aging.

Attend

Tech

Apple puts longevity inside the phone

Covered in full above.

For longevitydocs: two things the essay skipped. Health Age needs an Apple Watch. A third-party clinician signs off on every Quest order, which means a doctor is already in Apple's loop. It just isn't you yet.

Consumer

System raises $20M to own the peptide supply chain

System raised $20M to run the full chain: patient, US-licensed clinician, certified compounding pharmacy, front door. Glutathione, NAD+, sermorelin and MIC+B12 on the menu, all 50 states, with API manufacturing on the roadmap.

For longevitydocs: peptides are becoming what supplements were ten years ago, and venture money is building the layer between the gray market and your exam room. Members will keep being asked for mail-order stacks. Set your formulary, your 503A/503B sourcing standard and your consent language before a platform sets them for you. A raise is not evidence. No peptide on that list is a longevity drug.

Bryan Johnson’s Immortals Concierge: from $75k to $1M

Fully managed care from Johnson's medical team. Dedicated physician, coach, coordinator, full-body MRI, coronary CT, multi-cancer early detection, DEXA, 200+ biomarkers, epigenetic workups, Whoop and Oura, Blueprint supplements. US only, cash pay, capped roster.

For longevitydocs: Read the service list again. Dedicated physician, full diagnostics, wearables, a protocol. Most of you have been doing this for years, solo or in a clinic. What Johnson adds is the brand, and the brand is what the premium customer pays for. At $75k to $1M, brand appears to matter as much as clinical expertise. No peer-reviewed evidence that the membership extends lifespan or healthspan. Your evidence bar is higher. Your brand should be too.

Every doctor should be a longevity doctor

longevitydocs.™ is the intelligence network for longevity medicine. 1,000+ physicians, 68 countries

Apply to Join

Forward this to a colleague. Questions and corrections: reply to this email.

Editorial Disclaimer:

Published for licensed physicians and qualified healthcare professionals, for continuing medical education and professional information only. It is not medical advice, clinical guidance, or treatment recommendation for any patient, and it is not intended for consumers, who should consult their own physician.

Physician discussions reproduced here are the personal clinical opinions of the individuals named. They are not the position of longevitydocs and have not been reviewed by any regulatory, medical, or professional body.

Therapies, compounds, devices, and protocols are referenced for educational context. Some are investigational, off-label, or not approved by the FDA, EMA, or your local authority. longevitydocs does not endorse or recommend any product, treatment, or company, and nothing here is a solicitation or an attempt to influence prescribing.

By reading, you confirm you are a licensed healthcare professional and will apply this information within your own clinical judgment, professional obligations, and applicable law.

If you are a patient or consumer, this content is not for making health decisions. Please consult your own physician.

Hey Doc,

In this issue 105, the last of the series: the Longevity Patient Journey Canvas.

My prediction: more physicians will leave the corporate clinic and the health system over the next few years to own their practice. Most of them want to do medicine, not run a business. They will need to be equipped anyway, because a patient who walks into a longevity clinic is trusting a physician with the rest of their life. That is the job. Not the newest biomarker, peptide, or ring, however much we enjoy those. Patient outcomes first, and a standard of care we set ourselves before someone else sets it for us. The Canvas is a start.

The rest of the issue is a lesson in reading headlines. Semaglutide gave old mice 12% more life. Pelacarsen lowered Lp(a) and did not lower events. A biomarker moving is not a patient doing better. Longevity medicine is a complex system, and the only way to practise it is with humility, with standards, and in the service of the patient.

As always, Happy Sunday.

Dr. David Luu, Founder, longevitydocs.™

Story · Part 4 of 4

The 7-Part Canvas to Standardize Longevity Care

Three weeks ago this series started with why doctors are making the move. Then 26 physicians said what not to do. Last week, the systems. This week, the patient’s year, on one page.

The physician who leaves the health system to open a longevity practice becomes two people at once: the doctor and the operator. Ownership is the reward. It is also the problem, because there is no department to hand the year to. Every touchpoint, every price, every promise to the patient is now a decision the physician makes, or fails to make, alone.

Hospitals solved this with standards. Longevity medicine has not written its own yet, so most practices run on the founder’s memory. That holds at 40 patients and breaks at 200.

The Canvas is the standard on one page. Seven questions every patient is already asking, and for each one, a document the patient leaves with. Fill it in with what the practice actually does. The empty boxes are the work.

The 7 parts

1. Calendar When will care happen?
The rhythm of the year: baseline, results, coaching, retesting, the annual reset, and what happens in between.
The patient leaves with: a 12-month Care Calendar.

2. Team Who is looking after me?
Who owns the plan, who interprets results, who prescribes, who coaches, and who to contact first.
The patient leaves with: a Team Roster, with names.

3. Care What should I expect?
The rationale, evidence, and limits of every test and intervention, with expectations that do not promise what biology cannot deliver.
The patient leaves with: a Care Guide.

4. Outcomes How will we see progress?
The few measures that matter, baseline to trend, including the one the patient chose.
The patient leaves with: an Outcomes Scorecard.

5. Experience How does this work in practice?
How blood draws, imaging, the app, and messaging fit a life with travel and a job, and what the practice does when something goes wrong.
The patient leaves with: an Experience Guide.

6. Pricing What will I invest, and where does the practice earn money?
The fee, the inclusions, the likely extras, and where the practice earns revenue, including on supplements, testing, and referrals.
The patient leaves with: a Pricing and Financial Disclosure.

7. Trust What commitments can I hold the practice to?
How the practice handles evidence, uncertainty, consent, privacy, safety escalation, and conflicts of interest, in writing.
The patient leaves with: Our Commitment to You.

Download it, fill it in, share it with your team.

Longevity Patient Journey Canvas

201KB ∙ PDF file

Download

Download

Missed last week? The Longevity Clinic Readiness Checklist is on the website.

Semaglutide, started late, extended life in mice

Chen et al. · Nature · Sep 2, 2026

Female mice started daily semaglutide at 20 months, roughly a human mid-60s, and stayed on it for life. Median lifespan rose from 742 to 834 days, about 12%. A shorter course improved movement, muscle function, glucose tolerance, and hippocampal neurogenesis, and the gene-expression profile looked like calorie restriction. Head to head against 24% calorie restriction, semaglutide matched most of the benefit and did better on memory and glucose, without the hunger.

For longevitydocs: the Monday question is "is Ozempic a longevity drug," and this is the best citation yet for "in mice, started late, probably." Female mice only, no human aging endpoint, and Evoke already showed the biomarkers can move while the patient does not. A real signal, and a reason to keep the human outcome study in view before the word longevity goes on the prescription.

Evidence: Company-reported Phase III topline result; full data pending

Aging-related disease is now the largest burden a newborn will face

Ashwin, Bloom, Scott et al. · Nature Aging · September 2, 2026

Using Global Burden of Disease data, the authors sort every disease into four life-stage clusters: infant, early adult, later adult, and ageing-related. Ageing-related disease is already the largest burden worldwide and the largest expected lifetime burden for a newborn in every income group. It is also the only cluster with increasing returns: each gain in mortality makes the next gain in morbidity worth more, and the reverse.

For longevitydocs: this is the answer to why longevity medicine is needed. The paper is the evidence that aging-related disease is the largest burden for individuals, nations, health systems, payers, and employers.

Evidence: Preclinical / female mice

Lexicon

TMAO

Trimethylamine N-oxide (TMAO) is the main diet-induced metabolite produced by the gut microbiota and is mainly eliminated through renal excretion. It is a low-molecular-weight amine oxide, formed by oxidation of trimethylamine (TMA) by hepatic flavin-containing monooxygenases. TMAO has been widely tested as a prognostic marker across patient populations, and the studies so far support its use as a prognostic marker in cardiovascular disease.

How it is made, how it is thought to drive atherosclerosis and thrombosis, and what it does in chronic kidney disease, with the six references, in the full entry.

Read TMAO in the Lexicon

Certification

Biomarker Interpretation Learning Checklist, by Hippo

Hippo, the physician AI inside longevitydocs, now builds your learning checklist from the CLD biomarker module: the markers to be able to read, what each one does and does not tell you, and where the reference range is not the target. Tick what you already know. Hippo tracks the rest and points you to the session that covers it.

Ask Hippo

Explore the CLD program

Buzz in the chat

What cash-pay clinics are doing about compounded GLP-1s

One member raised the question of what cash-pay practices are doing about tirzepatide and semaglutide compounding given the FDA crackdown.

• Branded manufacturer programs (Lilly Direct, Novo Direct) are viable alternatives to compounding but become expensive at higher doses; compounded tirzepatide can still be cost-competitive for many patients.

• Oral semaglutide produces weaker weight loss than injectable, requires daily dosing, and still causes nausea; it has utility for blood sugar regulation and some inflammatory and anxiety benefits.

• The Lilly Direct Qwikpen has a one-year beyond-use date, allowing patients to stock up; ordering must occur at least every 45 days to maintain discounted pricing.

• Expanded access to branded Retatrutide at no cost to patients is available through Eli Lilly for qualifying patients, though it involves significant paperwork.

• Compounders have adjusted pricing upward to compensate for branded competition, reducing the cost gap at higher doses.

Evidence: Member discussion; not clinical or regulatory guidance

Discover more

Non-member physician → Explore memberships

Member profile

Ken Winnard, MD, CLD

Ken graduated from the CLD this year and did not wait. OneLife Health & Performance is now open: 6,500 square feet in Palm Beach Gardens with diagnostics, recovery, and performance in one building, and an internist at the head of it. Most physicians in the network talk about building this. Ken did it.

Visit OneLife

In the app

Daily Digest is live

Six cards, one minute, every morning. Four news items from the last 24 hours, tagged clinical, business, or regulatory. One Lexicon concept. And one card of emerging topics: what is accelerating across the network’s reading over seven days, and what is fading. This week wearable diagnostics and growth hormone are new, GLP-1 longevity is up a third, immune aging is down a third.

Open in the app (members)

Apply for membership (physicians only)

Calendar

Upcoming Events

September 9 · Rooms · Dr. Elizabeth Poynor · Women's Longevity Protocols · 12pm ET · 30 min, audio, open floor
September 22 · Table · New York City · Dinner, limited to 20 physicians
October 24 · Mastermind · Skin, Bone & Muscle · New York City and virtual
June 9-11, 2027 · Summit · Cannes

See the full calendar

AI

ChatGPT is now reading your Epic chart

ChatGPT for Healthcare integrates with Epic. Authorized physicians can pull labs, medications, notes, and specialist documentation into ChatGPT, or use it embedded in Epic, with UCSF Health as the named pilot. Read-only, physician-rated 99.1% safe across thousands of evaluations, and linked to PubMed, ClinicalTrials.gov, and CMS Coverage.
For longevitydocs: AI is arriving in the chart from every direction, and read-only is the sensible first step. The part it cannot do yet is what longevity doctors do every day: weigh a thin evidence base against the one patient in front of you. That job just became more visible, not less.

Pharma

The Lp(a) drug moved the number, not the outcome

Novartis and Ionis reported topline Phase III results from Lp(a)HORIZON on September 4: 8,323 patients with elevated Lp(a) and established cardiovascular disease on guideline-directed therapy. Pelacarsen lowered Lp(a) as expected. It did not reduce the composite of CV death, MI, stroke, or urgent revascularization versus placebo, in either the 70 mg/dL or the 90 mg/dL population.

For longevitydocs: one trial, one population, one dose. The Lp(a) hypothesis is still alive, and the deeper-lowering programs will tell us more. For now, measuring Lp(a) still changes how you counsel residual risk, and that was always the reason to measure it.

Tirzepatide earns its first outcomes label

FDA approved tirzepatide to reduce MACE in adults with type 2 diabetes at cardiovascular risk. The claim rests on SURPASS-CVOT against dulaglutide, an active comparator, with an 8% relative reduction. First label expansion for Mounjaro.

For longevitydocs: good news for a large group of patients, and the first incretin label written on hard cardiovascular outcomes. The non-diabetic trials are the ones to watch next; if they land, the conversation in longevity clinics changes.

Wearables

Oura is going public with 3.6 million people's worth of data

Oura filed for a US listing with roughly $1.21B in revenue over nine months and more than 3.6M rings sold in the past year. The pitch to investors is the pitch to patients: continuous sleep, recovery, cycle data, and now lab panels through the app.

For longevitydocs: that is 3.6 million people already collecting what you would have asked for at intake. Physicians who bring it into the visit are finding it a useful starting point, especially on sleep.

A hormone panel from behind the ear, n=12

Phira unveiled a behind-ear wearable that models estrogen, LH, and progesterone dynamics from skin temperature at 0.03°C resolution, not from blood or urine. The pilot: 12 women, 31 cycles, compared with daily urine. A larger study including PCOS and perimenopause is underway, launch targeted for 2027.

For longevitydocs: a temperature model that tracks cycle pattern is a real step, and the perimenopause data will be interesting. Twelve women for now, so it sits alongside the lab, not in place of it.

Evidence: Pilot validation study; n=12

Every doctor should be a longevity doctor

longevitydocs.™ is the research and education network for longevity medicine. 1,000+ physicians, 68 countries

Apply to Join

Forward this to a colleague. Questions and corrections: reply to this email.

Editorial Disclaimer:

Published for licensed physicians and qualified healthcare professionals, for continuing medical education and professional information only. It is not medical advice, clinical guidance, or treatment recommendation for any patient, and it is not intended for consumers, who should consult their own physician.

Physician discussions reproduced here are the personal clinical opinions of the individuals named. They are not the position of longevitydocs and have not been reviewed by any regulatory, medical, or professional body.

Therapies, compounds, devices, and protocols are referenced for educational context. Some are investigational, off-label, or not approved by the FDA, EMA, or your local authority. longevitydocs does not endorse or recommend any product, treatment, or company, and nothing here is a solicitation or an attempt to influence prescribing.

By reading, you confirm you are a licensed healthcare professional and will apply this information within your own clinical judgment, professional obligations, and applicable law.

If you are a patient or consumer, this content is not for making health decisions. Please consult your own physician.

Hey Doc,

In this issue 104, I mapped the systems a physician founder needs to build, launch, and scale a longevity clinic. It became the Longevity Clinic Readiness Checklist - the practical guide I wish I had when I started.

As always, Happy Sunday.

Dr. David Luu, Founder, longevitydocs.™

One story a week for physicians moving into longevity medicine (part 3).

Longevity Clinic Readiness Checklist

Why we created this

Longevity medicine should be more than a menu of tests and therapies. It should be physician-led, grounded in evidence, transparent about uncertainty, measured by outcomes, and supported by systems that protect patients and clinical judgment. We created this checklist to help physicians and practice leaders identify what must be documented, implemented, and reviewed before launching or scaling a longevity medicine practice.

How to use it

Review the checklist with your leadership team. Tick an item only when it is documented, assigned to an owner, implemented in practice, and reviewed on a defined cadence. Keep evidence for each completed item, prioritize safety-critical gaps first, and turn the remainder into a dated action plan. Revisit it at launch, before adding services, after major changes, and at least annually.

Download the Longevity Clinic Readiness Checklist

Longevitydocs Clinic Readiness Checklist

1.04MB ∙ PDF file

Download

Download

Introducing the Longevity Medicine Lexicon

Longevity medicine is moving faster than anyone can build standards for it.

That is mostly good. More people care about their health. More physicians are moving into prevention. More researchers are studying aging. More companies are shipping products.

But the vocabulary has not kept up. The same term means three things depending on who is using it, and patients arrive with definitions they got from a social media post.

We need words everyone agrees on.

The Lexicon is our answer. A standardized definition for each concept, with the publications behind it, so you can check the evidence without a PhD and without fact-checking an influencer.

How the Lexicon works

1. Pick a concept and learn it with references.

Take DEXA Scan. Definition, how it works, how it is measured, what the levels mean, with a T-score table and a citation on every claim. Key takeaways at the bottom if you need it in thirty seconds.

2. Explore connected concepts.

Every concept sits in a map. DEXA connects to bone density, muscle mass, sarcopenia, visceral fat, osteoporosis. Follow the links or open the graph and see the whole field at once.

3. See what the LongevityDocs community says about it.

This is the part no textbook has. Under Community knowledge, you get what physicians in our network actually do with the concept in practice.

A Mastermind faculty debate on whether an AI read of a plain spine image can substitute for DEXA, and why FDA approval says no. A Hormones Mastermind participant asking why we wait until 65 to scan bone, by which point the damage is done.

Members can jump straight to the timestamp and watch it.

Open to everyone

The definitions and references are free. Anyone can read them. The community layer, the sessions, the timestamps, the full recordings, is for physicians members of longevitydocs.

Some concepts are already written. Others are referenced constantly and not yet covered. Those are on the frontier list, and they get written next.

If you are building a clinic, explore the Lexicon to standardize how your team uses clinical language.

Explore the Lexicon

ROOMS

The Heart-Gut-Brain Connection

September 2, 2026, 12.00pm ET• longevitydocs.ai

Dr. Sarah Cammarata, board-certified psychiatrist, will discuss The Heart-Gut-Brain Connection: Preventing Comorbidities and Boosting Mental Health.

Women’s Longevity Protocols

September 9, 2026, 12.00pm ET• longevitydocs.ai

Dr. Elizabeth Poynor, gynecologic oncologist and Chair of Women’s Health & Gynecology at Atria, will discuss the latest women’s longevity protocols.

MASTERMIND

Skin, Bone & Muscle

October 24, 2026 • New York City

Faculty:

Saranya Wyles, MD, PhD
Amanda Hill, MD
Naana Boakye, MD
Doris Day, MD
James Peyer, PhD
Dan Belkin, MD
Neely Kahn, MD
Catherine Johnson, MD
Kay Durairaj, MD
Elizabeth Yurth, MD

Secure your ticket

SUMMIT & AWARDS

CANNES 2027

June 9-11, 2027 • Cannes, France

Buy Digital Replay - Summit 2026

DIGITAL

MEDICAL EDUCATION

Browse Programs

Keto Outperforms Mediterranean and Low-Fat on Liver Fat: RCT

WashU randomized 42 patients with obesity, prediabetes, and fatty liver to keto, Mediterranean, or low-fat, fed them everything, and matched all three arms to roughly 10% weight loss. Keto cut liver fat 67% versus 45%, with no rise in lipids despite 73% of calories from fat. Prediabetes resolved in half the keto group, 29% Mediterranean, 7% low-fat. Cell Metabolism

For longevitydocs: same weight loss, different metabolic outcome. In a patient with steatosis and prediabetes, the carbohydrate restriction is doing work independent of the pounds. Worth holding onto as GLP-1s make the pounds the easy part.

Silent Atherosclerosis across Adult Life

Atherosclerosis may begin in early adulthood and remain clinically silent for decades before cardiovascular disease manifests. Although silent atherosclerosis is associated with cardiovascular events and death independent of traditional cardiovascular disease risk factors, its age- and sex-specific prevalence, vascular territory distribution, and plaque volume across adult life remain incompletely defined. NEJM

For longevitydocs: this is the evidence gap underneath every imaging decision you make in a 40-year-old. Risk calculators are built on events, not on the twenty silent years before them. Until the prevalence data exists, you are making a judgment call each time, and the honest version of that conversation says so.

Longevity Medicine Certification for Dermatologists

Our CLD learners told us they wanted to study alongside their own specialty. So we built one, starting with dermatology.

Dermatologists see skin aging every day. Patients come in for the surface and want the inside treated too. They ask about biomarkers, hormones, GLP-1s. This cohort teaches how to apply longevity medicine in a dermatology clinic, on the patients already in front of you.

Limited to physicians in dermatology, plastic surgery, and aesthetic medicine.. Applications close September 25.

Do You Qualify?

Every week, I track funding, FDA approvals, product launches, and breakthrough announcements shaping longevity medicine.

PHARMA

Mounjaro Approved for Cardiovascular Diseases

FDA approved tirzepatide on August 28 to reduce MACE in adults with type 2 diabetes at high risk. SURPASS-CVOT ran 13,299 patients across 30 countries for a median 210 weeks, head to head against dulaglutide rather than placebo. Result: non-inferior, 8% lower rate of CV death, heart attack or stroke, superiority not established.

POLICIES

“Intrinsic Capacity” in the NYT

The WHO's composite of what a person can actually do, scored across locomotion, cognition, sensory, psychological, and vitality. Grip strength and gait speed. It landed in ICD-11 in 2022, and ARPA-H is now funding work to test whether it tracks function and whether exercise or GLP-1s can move it.

WEARABLE

Abbott Adds Ketones to the Sensor

FDA authorized Libre Duo 10 Day on August 25, the first sensor tracking glucose and ketones together. Built for insulin users and patients on SGLT2s, where DKA develops with normal glucose and admissions are up 55% in a decade. The biowearable just picked up a second analyte, and it will not be the last.

MANUFACTURING

Celularity Manufactures Muse Cells

Robert Hariri built Celularity on placental-derived cell therapy. This week it started manufacturing someone else's platform: Dezawa MuseCells, MuseExosomes, and MuseSecretome, at its Florham Park site. The science is not the bottleneck anymore, cGMP capacity is. If you use exosome or secretome products, ask which facility made the vial and from what starting material.

Every doctor should be a longevity doctor

longevitydocs.™ is the research and education network for longevity medicine - 1,000+ physicians, 68 countries

Apply to Join

Editorial Disclaimer:

This newsletter is published exclusively for licensed physicians and qualified healthcare professionals. It is not intended for consumers or patients.

All content is for continuing medical education and professional information purposes only. It reflects emerging research, science, and technology that may have implications for the practice of medicine. It does not constitute medical advice, clinical recommendations, or treatment guidance for any individual patient.

Peer-to-peer discussions reproduced in this newsletter represent the personal clinical opinions of individual physicians. They do not reflect the official position of longevitydocs and have not been reviewed or endorsed by any regulatory, medical, or professional body.

References to specific therapies, compounds, devices, or protocols are provided for educational context only. Some may be investigational, off-label, or not approved by the FDA, EMA, or equivalent regulatory authorities in your jurisdiction. Physicians are responsible for independently evaluating all information in accordance with current evidence, applicable law, and the standards of their licensing board.

longevitydocs does not promote, endorse, or recommend any specific product, treatment, or commercial entity. Nothing in this newsletter should be construed as a solicitation or as influencing prescribing behavior.

By reading this newsletter, you confirm that you are a licensed healthcare professional and that you will apply the information contained herein within the bounds of your clinical judgment, professional obligations, and applicable regulations.

If you are a patient or consumer reading this newsletter, please note that this content should not be used to make any health or medical decisions. Please consult your personal physician or a qualified healthcare provider for guidance specific to your situation.

Hey Doc,

Ten mistakes in the report below. I made most of them.

New tech and new protocols get the attention. There are a thousand posts a week on them. The hard work happening on the ground is less clickable. The sweat, the tears, the wins nobody sees. Foundations, reputation, team.

Part of why it stays quiet is that the conversation is hard. It takes humility, self-awareness, and a willingness to say what you got wrong with your name attached.

So I asked. Twenty-six doctors answered, in the open. I compiled it into a field report below. It is a work in progress, and that is the point. If we want a standard for longevity medicine, we have to put this out and let others build on it.

Our certification learners also told us they wanted to study alongside their own specialty. So we are opening the first CLD cohort for dermatologists. Just reply to this email if that is you.

As always, Happy Sunday.

Dr. David Luu, Founder, longevitydocs.™

PS. Built the technology. Built a complex product. Built a multi-offering. Built a place. Maybe I should not have. I learned from all of them. We were building something that did not exist yet. Happy to give back now. These are the photos from that time.

One story a week for physicians moving into longevity medicine (part 2).

Mistakes to Avoid When Building a Longevity Practice

A field report from 26 physicians.

What 26 physicians would do differently

Longevity medicine has a growing clinical literature and no operational one. Physicians opening practices have no published standards, no pricing benchmarks, no model comparisons, no software evaluations, and no account of what the first eighteen months actually cost.

So we collected one. Over the course of a week we put a series of questions to physicians in the member chat on longevitydocs.ai and let them answer each other in the open. Twenty-six responded on the record, from two months in practice to twenty-three years.

Ten mistakes came back often enough to treat as the operating reality of the field rather than one person’s bad luck. Insurance does not pay for this work. Most physicians underprice at launch. The payment model decides how you practice, not just how you get paid. Capital gets spent before demand exists. Service lines get added before any of them are good. Paid marketing loses to the physician’s own voice. Income tied to time caps the practice. Access given without terms is the most common boundary failure. No software does the job, so everyone runs workarounds. And systems get built only after something breaks.

One condition sits under all ten. Longevity medicine is an emerging field. Cardiology has had since 1949, when the American College of Cardiology was founded, to build its benchmarks and its guidelines. We are starting to build it for longevity medicine.

We know the medicine. We are still learning the business.

Published work in longevity medicine covers what to measure and what to prescribe. It says nothing about the conditions the medicine gets delivered in.

So every physician entering the field solves the same problems from scratch. What to charge. Whether to take insurance. Membership or fee for service. Which software. When to hire. Each one solves it alone, pays for the errors alone, and never finds out what anyone else learned.

Nobody has asked the people who know.

Community-sourced field report

Questions were posted in the member chat on longevitydocs.ai over the course of a week. Physicians answered in an open thread, visible to each other, and were told their answers would be quoted by name, with the option to stay unnamed.

Questions covered early mistakes, what they would build differently from zero, technology, and operations.

Twenty-six physicians contributed. Experience ranged from two months to twenty-three years. Settings included solo boutique, concierge, membership, hybrid fee for service, and pre-launch. Quotes are verbatim, trimmed only for length.

Ten mistakes, in the order they cost you money

Ten mistakes recurred across respondents.

1. Expecting insurance to pay for longevity testing

2. Underpricing at launch

3. Letting your payment model decide your medicine

4. Spending on space and equipment too early

5. Building every service line at once

6. Spending on paid marketing instead of your own voice

7. Tying your income to your time

8. Giving away your access without boundaries

9. Waiting for the perfect EMR

10. Waiting to build systems until you need them

1. Expecting insurance to pay for longevity testing

Steven Murphy named it as his first error in exactly those words. Every respondent who addressed insurance had made the same one.

Murphy rebuilt his around three moves: explain why the patient should pay for it, identify where insurance legitimately covers something based on a medical diagnosis, and make clear you will be a good steward of their spend. “That built a trusting Sherpa relationship where I could then navigate the ship for best labs at best prices.”

His constraint: “Don’t expect to be able to spend this much time with a patient and have insurance pay for your time.”

Jijoe Joseph found the more dangerous version, which is partial coverage.

“I got insurance wrong by assuming that ‘usually covered’ was good enough. About 1 in 8 patients could still get a surprise $4,000 to $5,000 bill.”

He negotiated pricing at roughly 80% off retail, then built his own panel and folded the cost into his plans so pricing was predictable upfront. Partial coverage is worse than none. It moves unpredictable risk onto the patient, and the surprise lands on your relationship.

Melissa Loseke has been cash pay since 2012 and is the only respondent looking the other way. She sees parts of this work drifting toward coverage and says the open question is “determining when to start utilizing insurance again.” She already uses insurance for prescriptions where she can.

2. Underpricing at launch

Near-universal. The regret is not the number. It is that the number is hard to change later.

Melissa Loseke: “I should have started pricing higher. Most of my colleagues would chastise me for how little I charge. And that’s harder to walk back now.”

Shah Ahmed, one year in, correcting it now: “I know I will lose people but I undervalued myself for a year.”

Jijoe Joseph, past it: “You’ll be surprised how many stay after the price increase.”

Steven Murphy offers the bridge for anyone who cannot wait on revenue. Price the practice where you intend to sustain it and fund the ramp elsewhere. He points to Medicare work in short term rehabs and SNFs, “where there is zero overhead.”

3. Letting your payment model decide your medicine

The most consequential finding came from a physician who changed her model to fix her medicine.

KeriLyn Bollmann spent twenty-three years with the underserved and underinsured before moving into longevity practice. On fee for service she says

“I was nervous to ask people to come back (and pay money), so instead I would see them, do some testing, give them some supplements, and then they would feel lost for next steps.” She moved to concierge to ensure “consistent follow up, so people felt like we were moving the needle.”

Fee for service made her reluctant to ask patients to return. That reluctance removed follow-up. Without follow-up, testing produces confusion instead of care. She changed the payment structure to restore the clinical loop.

Julie Doyle reports the same from the other side. Unlimited portal messaging, same-day replies.

“I would not have been able to offer this outside a membership structure... I’m never feeling like answering messages or responding to patient questions is uncompensated time.”

Jijoe Joseph gives the timeline. He ran both.

“Membership was slow for almost two years. Fee for service kept the lights on.” New patients are now membership only.

His planning note: “Whatever overhead you estimate, double it.”

4. Spending on space and equipment too early

Shah Ahmed lists renting space and buying equipment “thinking I would do so many things” among his first-year errors.

Steven Murphy on sequencing: “Make money first, assess patient needs and then buy one thing at a time.” He also names the pressure that produces bad capital decisions. A patient told him she loved him but got more at another practice. “That stung, but good business is not reacting to every sting with bad economic decisions.”

Shoma Datta-Thomas bought devices she did not need and says she should have hired admin help earlier. The equipment was the wrong purchase. The person was the right one.

Ahmed’s counterfactual is the cleanest alternative on record:

“If I could go back I would literally just open a PLLC, rent a desk somewhere, and do some light organic marketing and social content.”

5. Building every service line at once

Jijoe Joseph named this as his number one:

“Every vertical adds equipment, staff, training, marketing, and management complexities before demand is proven.”

Mark Dukshtein gives the number:

“Trying to add too many services at once instead of being really good at 2-3.”

Shoma Datta-Thomas found demand somewhere she had not planned for. She expected more GYN minor procedures. “Patients were begging for good hormone therapy.” Her rule is to iterate the menu on observed demand, fast.

Daniel Kessler applies the same logic to case selection:

“Start with something solvable that gets the patient results quickly. Do not start with the complex cases.”

Jonathan Stegall puts the boundary around who rather than what:

“Don’t try to be everything to everybody. Define your ideal patient avatar and go after them.”

6. Spending on paid marketing instead of your own voice

Melissa Loseke would cut all of it:

“Word of mouth and just doing a great job with patients is all you need.”

Shah Ahmed ran the comparison inside his own practice without intending to. He spent $20,000 on local ads. His social account reached 17,000 followers “despite zero formal strategy and completely erratic posts.” His conclusion:

“Now imagine if I took the 20k in local ads and put that into a real social team instead.”

Twenty thousand dollars of advertising underperformed inconsistent posting by the physician himself.

Jonathan Stegall states the principle:

“You don’t need perfect videos or perfect social media posts. The public wants your authenticity, not your perfection.”

7. Tying your income to your time

Jonathan Stegall: “Don’t tie your income to your time. Put systems in place early so that other people in your practice are doing the heavy lifting.”

Jijoe Joseph states the target:

“a business that can keep working even when the founder takes a step back.”

Shah Ahmed is inside the problem and says so. Compensation directly tied to time with patients. He is announcing memberships and building workflows an APP or nurse can run.

What he wishes he had: “a ‘business’ partner... someone to look over my shoulder and help me avoid silly mistakes.”

Ladi Ilkhani reduces it to three instructions: “Ask for help and take it. Delegate instead of trying to do it all myself. Billing consistently.”

Katie Rybak on the spending decision underneath:

“I wouldn’t be so afraid to spend the money on quality staff. They are everything to a successful practice.”

Haleem Mohammed:

“I wouldn’t do it alone. Easy way to burn out. I’d find a group of like minded killers with no ego who live and breathe medicine.”

8. Giving away your access without boundaries

Shah Ahmed identifies the asset: “People are paying to sit down and talk to me. The value is the physician.” Which makes the rest harder to explain. Ladi Ilkhani:

“I also would protect my ‘time,’ something I never thought we could put more value on. Shouldn’t have given out my cell so easily.”

Melissa Loseke changed her number over it.

“I changed numbers because of this. Most had little respect for my time or awareness.”

Sarah Lacarrubba would define roles, ownership, and accountability from day one:

“Set clearer boundaries and trust more slowly. In the beginning, I blurred the lines between being a boss, mentor, friend, and business partner, and I was too generous with trust, titles, and credit.”

9. Waiting for the perfect EMR

Lisa Menuet, opening a practice soon, asked the simplest question in the thread: does anyone have an EMR they love?

The answers describe a category that has not been built.

Haleem Mohammed says his most used app is not his EMR.

“Doximity Ask is probably the most used app in my entire phone... helps me organize my thoughts, create notes, my social post captions are fact checked on there and I use the dialer to do telehealth video visits.”

Tatiana Zeballos gave the most complete account. Solo boutique practice on SimplePractice, valued for one thing: app-based messaging that feels like texting, with “no emails directing patients to a portal, repeated logins, password resets, or other EPIC-like friction.” As she adds services she needs lab integrations, e-prescribing, wearables and high-risk merchant processing without losing that.

“Essentially, I’m looking for the unicorn: SimplePractice ease plus a more robust longevity-medicine EMR.”

She has tried Charm, Practice Better, OptiMantra and Elation. She is evaluating Ultralight Health and SigmaMD, with Ultralight the current front-runner.

Bismarck Cadet on Ultralight: “awesome and continues to improve.” Mohan Muvvala runs Hint Health core and clinical, and rates the marketplace integrations and the responsiveness of the team.

Steven Murphy names the system hardest to change later. “It’s really hard to switch EMRs.” Choose for patient communication and documentation from day one. Retention runs through it.

Salomé Masghati answered the question the way the market should find most interesting. Does she have an EMR she loves? “Yes, the one we created ourselves.”

Maloes Zadeh diagnoses why none of it resolves. What is missing is “a truly integrated longevity platform that brings together labs, imaging, wearables, lifestyle data and longitudinal trends and translates them into clinically meaningful, evidence based actions.” Measurement is solved.

“The real challenge is turning all that data into better clinical decisions rather than simply generating more dashboards.”

10. Waiting to build systems until you need them

Jijoe Joseph put it first on his list.

“Businesses last when they have repeatable processes, and revenue that doesn’t depend on the founder doing everything. The goal is building a business that can keep working even when the founder takes a step back.”

Jonathan Stegall on timing: put systems in place early

“so that other people in your practice are doing the heavy lifting.”

Shah Ahmed is building his now, retroactively: firmer systems for simple workflows “that an APP or nurse can follow for me.” What he wishes he had had is a business partner. “Someone to look over my shoulder and help me avoid silly mistakes.”

Shoma Datta-Thomas disagrees, and specifically. Her first lesson from running a boutique practice:

“NO consultants! They could never value every hard earned dollar I brought in myself the same way.”

Both are right about different people. A partner with skin in the game is not a consultant billing hours.

Janaan Arfeen, new to the field, asked the room the question this section exists to answer:

“I would appreciate if the leaders and pioneers in this field can share their wisdom and guide newbies in establishing systems.”

Ten mistakes, one cause

Most of the conversation in this field is about protocols. Which peptide, which panel, which AI tool, which automation. Useful, but small. None of it decides whether a practice survives.

The decisions that do are the ones in this report. What you charge. Whether you take insurance. Membership or fee for service. What you buy and when. Who you hire. What you delegate. A physician can have every protocol right and still close, because the strategic decisions were made blind.

And they are made blind. There are no benchmarks, so most price low and learn years later. There are no guidelines, so each physician invents the scope, the panel, the follow-up cadence. There is no infrastructure, so one wrote her own software and the rest run workarounds.

Some of that is writable and should be written. Fee ranges by model and market. What an EMR has to do. How long membership actually takes to gain traction.

The rest is not. Judgment, taste, and strategy do not compress into a benchmark. Knowing when to raise your price, when to say no to a patient, when to hire, when to stop adding services. That comes from experience, and from watching other physicians make the same calls and say out loud how they went.

Which is why a thread beat a study here. Shah Ahmed is correcting his pricing in public while Jijoe Joseph, who has already done it, tells him more patients stay than he expects. That exchange is not data. It is judgment being transferred, and it is the only way this kind of knowledge moves.

“Money is the least of it. I just want to be BETTER. More efficient. More high value for my patients.” Shah Ahmed

Limitations

Respondents were self-selected members of a single professional community and are not a random sample of physicians practicing longevity medicine. The sample skews toward United States practice mainly and toward solo and small-group settings. Responses were given in an open thread where participants could read each other, introducing possible convergence. All figures are self-reported and unverified.

This is not survey data and should not be cited as such. It is the collected operational experience of practicing physicians, which is a different thing and, for a physician about to open, a more useful one.

What this field still has to build

This field is early. Nobody in this report had a map when they opened, and it shows in what they got wrong.

What closes the gap is not more protocol content. It is benchmarks, so a physician knows what to charge without guessing for two years. It is systems, so the first eighteen months are inherited instead of reconstructed. It is technology built for this work rather than borrowed from another specialty. And it is continuous learning between physicians, because judgment and strategy do not come from a document. They come from watching a colleague make the call and say how it went.

That last part is the one we can do immediately, and it is what this report is. Twenty-six physicians answered a question in the open so the next physician does not pay for the same lesson alone.

Next week: The Ecosystem Checklist

Thank you to the longevitydocs members who answered in the app

Shah Ahmed, Janaan Arfeen, Katy Bernstein, KeriLyn Bollmann, Bismarck Cadet, Shoma Datta-Thomas, Brenda Dintiman, Julie Doyle, Mark Dukshtein, Ladi Ilkhani, Jijoe Joseph, Daniel Kessler, Sarah Lacarrubba, Melissa Loseke, Salomé Masghati, Lisa Menuet, Haleem Mohammed, Steven Murphy, Mohan Muvvala, Jontel Pierce, Laura Preece, Katie Rybak, Jonathan Stegall, Christine Watson, Maloes Zadeh, Tatiana Zeballos.

This conversation happened inside the network. The next one will too. Physicians only, applications reviewed.

Join the Network

This report describes the experience of individual physicians. It is not legal, financial, or medical advice, and nothing here should be taken as guidance on billing, coding, or corporate structure in your jurisdiction.

Go deeper on one concept every week from the LongevityDocs Lexicon. Longevitydocs Lexicon

Red Light Therapy

Definition

Red light therapy, more formally photobiomodulation (PBM) and previously known as low-level laser therapy, is a noninvasive form of phototherapy that uses wavelengths in the red light (620-700 nm) portion of the visible spectrum and the near-infrared (700-1440 nm) spectrum. ^[1] It is often administered through low-level lasers or light-emitting diodes and is applied to a range of dermatologic and nondermatologic conditions. ^[1] The field, sometimes known as photobiomodulation, has broadened over time to include light-emitting diodes and other light sources beyond lasers, spanning many wavelengths in the red and near infrared. ^[2]

How it works

Photons from red and near-infrared light are absorbed by endogenous photoreceptors including mitochondrial cytochrome c oxidase, whose activation modulates ATP production, generates reactive oxygen species, and alters intracellular calcium levels. ^[1] Red to near-infrared light can stimulate complex IV of the mitochondrial respiratory chain (cytochrome c oxidase) and increase ATP synthesis, with light absorption by ion channels releasing calcium and activating transcription factors and gene expression. ^[3] It is hypothesized that inhibitory nitric oxide can be dissociated from cytochrome c oxidase, thereby restoring electron transport and increasing mitochondrial membrane potential. ^[4] The modulation of ATP, reactive oxygen species, and calcium promotes activation of signaling pathways that contribute to downstream effects on cellular proliferation, migration, and differentiation. ^[1]

Evidence & status

An evidence-based consensus of an international multidisciplinary panel concluded that photobiomodulation is a safe treatment modality for adult patients and that red light PBM does not induce DNA damage. ^[5] The same consensus judged PBM an effective treatment option for peripheral neuropathy, androgenic alopecia, wound ulcers of multiple etiologies, decubitus ulcers, pain from diabetic foot ulcers, and acute radiation dermatitis. ^[5] A systematic review and meta-analysis of 22 randomized placebo-controlled trials with 1063 participants found that low-level laser therapy significantly reduced pain and disability in knee osteoarthritis, with no adverse events reported. ^[6] A separate systematic review and meta-analysis of randomized controlled trials found that low-level laser therapy significantly reduces pain and disability in lower-extremity tendinopathy and plantar fasciitis in the short and medium term, though long-term data were not available. ^[7] There is a considerable body of evidence supporting the efficacy of PBM for preventing oral mucositis in patients undergoing radiation therapy for head and neck cancer, chemotherapy, or hematopoietic stem cell transplantation. ^[8] In a meta-meta-analysis of myopia control strategies, repeated low-level red-light therapy demonstrated clinically significant effects on slowing both axial length elongation and spherical equivalent refraction progression. ^[9]

Why it matters

PBM is generally well-tolerated and safe, with erythema being the most common and self-limiting adverse cutaneous effect. ^[1] More than 50 years after its discovery there is still no agreement on the parameters and protocols for clinical application, and the wide range of applicable parameters has in some cases led to contradictory results. ^[10] Effective therapy depends on treatment parameters such as fluence, treatment duration, and output power, and cells or tissues with higher numbers of mitochondria tend to respond to lower doses of light than those with fewer mitochondria. ^{[1] [10]}

Community knowledge

Brain Applications

Dr. Neil Paulvin includes red light in his brain-optimization stacks, favoring red light helmets while noting that the more effective devices are costly and typically require at least a three-day-a-week commitment, whether used at home or in-office, and pairing them with more portable options such as mini red lights for travel ^A.

Skin And Hair Applications

Dr. Amanda Hill has found red light caps such as Revian to be a helpful adjunct in androgenic alopecia, explaining that they increase nitric oxide, which locally reduces the conversion of testosterone to DHT through reduced 5-alpha reductase activity without side effects, and likely also help via their anti-inflammatory effect ^B.

Dr. Saranya Wyles acknowledged some utility for at-home red light, microcurrent, and RF devices but stressed that consistency of use, daily versus twice weekly, drives the difference in results, and that sunscreen remains the single strongest skin-longevity intervention on the market ^C. At the Cannes Summit 2025, the Skin, the Next Longevity Frontier talk introduced Cell Bioprint, a five-minute proteomic diagnostic that estimates skin biological age and predicts future skin concerns, offering a complementary way to track outcomes from interventions such as red light therapy ^H.

Mechanism

Dr. Giovanni Campanile described photobiomodulation, that is, red light therapy, as affecting mitochondria throughout the body even when applied peripherally, and recommends pairing a red light panel with regular sauna use ^D.

References

Rooms

A. My Brain Longevity Stack to Type A Patients: Dr. Neil Paulvin

B. ROOMS: Dr. Amanda Hill : The hair loss protocol, how to prevent and reserve hair loss

Summit

E. Peptides from Research to Practice — Dr. Craig Koniver

F. Gene Therapy Demystified — Dr. Patrick Sewell

G. Cellular Optimization: Is It the Future of Medicine? — Dr Elizabeth Yurth

H. Skin, the Next Longevity Frontier — Vania LaCascade

Mastermind

C. The SkinSpan Stack — Dr. Saranya Wyles

Faculty Lectures

D. Unlocking Secrets of Heart Health — Dr. Giovanni Campanile

1. 1.Maghfour J, Ozog DM, Mineroff J, Jagdeo J, Kohli I, Lim HW. Photobiomodulation CME part I: Overview and mechanism of action. J Am Acad Dermatol · 2024

2. 2.Chung H, Dai T, Sharma SK, Huang YY, Carroll JD, Hamblin MR. The nuts and bolts of low-level laser (light) therapy. Ann Biomed Eng · 2012

3. 3.Salehpour F, Mahmoudi J, Kamari F, Sadigh-Eteghad S, Rasta SH, Hamblin MR. Brain Photobiomodulation Therapy: a Narrative Review. Mol Neurobiol · 2018

4. 4.Hamblin MR. Mechanisms and Mitochondrial Redox Signaling in Photobiomodulation. Photochem Photobiol · 2018

5. 5.Maghfour J, Mineroff J, Ozog DM, Jagdeo J, Lim HW, Kohli I, Anderson R, Kelly KM. Evidence-based consensus on the clinical application of photobiomodulation. J Am Acad Dermatol · 2025

6. 6.Stausholm MB, Naterstad IF, Joensen J, Lopes-Martins RÁB, Sæbø H, Lund H, Fersum KV, Bjordal JM. Efficacy of low-level laser therapy on pain and disability in knee osteoarthritis: systematic review and meta-analysis of randomised placebo-controlled trials. BMJ Open · 2019

7. 7.Naterstad IF, Joensen J, Bjordal JM, Couppé C, Lopes-Martins RAB, Stausholm MB. Efficacy of low-level laser therapy in patients with lower extremity tendinopathy or plantar fasciitis: systematic review and meta-analysis of randomised controlled trials. BMJ Open · 2022

8. 8.Robijns J, Nair RG, Lodewijckx J, Arany P, Barasch A, Bjordal JM, Bossi P, Chilles A. Photobiomodulation therapy in management of cancer therapy-induced side effects: WALT position paper 2022. Front Oncol · 2022

9. 9.Zaabaar E, Asiamah R, Kyei S, Ankamah S. Myopia control strategies: A systematic review and meta-meta-analysis. Ophthalmic Physiol Opt · 2025

10. 10.Zein R, Selting W, Hamblin MR. Review of light parameters and photobiomodulation efficacy: dive into complexity. J Biomed Opt · 2018

Longevity Medicine Certification for Dermatologists

Our CLD learners told us they wanted to study alongside their own specialty. So we built one, starting with dermatology.

Dermatologists see skin aging every day. Patients come in for the surface and want the inside treated too. They ask about biomarkers, hormones, GLP-1s. This cohort teaches how to apply longevity medicine in a dermatology clinic, on the patients already in front of you.

Board-certified dermatologists only. Applications close September 15.

Do You Qualify?

Mastermind: Skin, Bone & Muscle

October 24, 2026 • New York City

Faculty: Amanda Hill, MD - James Peyer, PhD - Saranya Wyles, MD, PhD, - Elizabeth Yurth, MD and more.

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Biological clocks validated as trial endpoints, reshaping longevity drug development

A Nature Medicine study shows epigenetic aging clocks are sensitive enough to detect biological responses to longevity interventions in living humans within trial-feasible timeframes, not just stratify risk in observational cohorts. That distinction matters for regulators and trial designers who’ve debated whether biological age metrics can substitute for hard endpoints like mortality or disease incidence, this closes the evidence gap needed for accelerated approval pathways in aging medicine. Nature Medicine

Semaglutide’s cardiovascular benefit may run partly through inflammation, SELECT sub-study finds

A pre-specified secondary analysis of the SELECT trial found semaglutide cut hsCRP by 37.8% over 104 weeks versus placebo in patients with cardiovascular disease and obesity but not diabetes. Patients with baseline hsCRP ≥10 mg/L had 2 to 4 times the risk of major cardiovascular events, cardiovascular death and all-cause death versus those under 2 mg/L. The hsCRP drop showed up within 4 to 8 weeks, before major weight loss and even in patients who lost none, and modeling suggests reduced inflammation accounts for roughly a third of semaglutide’s cardiovascular event reduction. Circulation

Every week, I track funding, FDA approvals, product launches, and breakthrough announcements shaping longevity medicine.

PHARMA

A Cancer Vaccine Worked For Melanoma

Merck and Moderna’s mRNA vaccine hit in Phase 3. Intismeran plus Keytruda kept melanoma from returning and delayed spread to other sites. No numbers yet, it came out as a press release. The magnitude we do have is from June: a smaller five-year study where the combination cut recurrence or metastasis by 49% against Keytruda alone.

The vaccine encodes up to 34 mutations from the patient’s own tumor. Melanoma is the easy case, loaded with mutations, so the immune system finds it. Lung, bladder and kidney trials are running. That is where we learn whether this is a melanoma result or a cancer result.

TECH

Whoop Expands Labs to Non-Members

Whoop announced it is making Advanced Labs available without a membership for the first time, and adding Grail’s Galleri multi-cancer early detection test to the offering. Whoop will hold your daily biometrics and your bloodwork under one app. They already do video visits and pull your records. Prescriptions come next?

WEARABLE

Happy Sleep Raises $75m for Sleep Apnea

Happy Sleep raised a $75 million Series A led by ARCH Venture Partners and OpenLoop to build out its AI-powered home care platform. The company’s FDA-cleared Happy Ring is the first smart ring approved for multi-night sleep testing, diagnosing obstructive sleep apnea and insomnia in as few as three nights at 98% accuracy. Nearly 80% of Americans with sleep apnea remain undiagnosed.

HEALTHCARE

Bone Health Is The Next Big Category

Cardiovascular had its decade. Then metabolic. Then hormones and sleep. Bone is next, and prevalence has nothing to do with it. More than 60 million US adults over 50 have osteoporosis or osteopenia. Most are never diagnosed. What changed is that patients are starting to ask. Medcity

AI

Network Bio is Building a General Medical Intelligence

Network Bio is training AI models on biological data broad enough to work across diseases rather than one at a time. The pitch is a single model that can answer quantitative questions about any condition: detect it earlier, find the biomarkers, point at a more personalized therapy.

Every doctor should be a longevity doctor

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Editorial Disclaimer:

This newsletter is published exclusively for licensed physicians and qualified healthcare professionals. It is not intended for consumers or patients.

All content, including the Buzz in the Chat section, is for continuing medical education and professional information purposes only. It reflects emerging research, science, and technology that may have implications for the practice of medicine. It does not constitute medical advice, clinical recommendations, or treatment guidance for any individual patient.

Peer-to-peer discussions reproduced in this newsletter represent the personal clinical opinions of individual physicians. They do not reflect the official position of longevitydocs and have not been reviewed or endorsed by any regulatory, medical, or professional body.

References to specific therapies, compounds, devices, or protocols are provided for educational context only. Some may be investigational, off-label, or not approved by the FDA, EMA, or equivalent regulatory authorities in your jurisdiction. Physicians are responsible for independently evaluating all information in accordance with current evidence, applicable law, and the standards of their licensing board.

longevitydocs does not promote, endorse, or recommend any specific product, treatment, or commercial entity. Nothing in this newsletter should be construed as a solicitation or as influencing prescribing behavior.

By reading this newsletter, you confirm that you are a licensed healthcare professional and that you will apply the information contained herein within the bounds of your clinical judgment, professional obligations, and applicable regulations.

If you are a patient or consumer reading this newsletter, please note that this content should not be used to make any health or medical decisions. Please consult your personal physician or a qualified healthcare provider for guidance specific to your situation.

Hey Doc,

Issue 102. I started watching Best Medicine on Netflix yesterday - don’t judge please. A heart surgeon leaves Boston for a village practice. He was used to treating the organ, fixing the patient, next. Now he sees his impact on the community he just moved into, good and bad.

What I like about Dr. Best is the relentlessness. The pursuit of the diagnosis, the appetite for investigation, the complete indifference to what anyone thinks of him, and the coldness with which he educates - he could be a bit warmer though. Watch his personality shift across the episodes. I recognized something. I did the same thing for years. Fix the heart, not the health.

That is what this week’s cover story is about. Why more doctors are moving into longevity medicine.

And no, this is not an invitation to binge Netflix!

As always, Happy Sunday.

Dr. David Luu, Founder, longevitydocs.™

Go deeper on one concept every week from the LongevityDocs Lexicon.

Lipoprotein(a)

Also known as Lp(a), Lpa, apo(a)

Definition

Lipoprotein(a) [Lp(a)] is an apoB100-containing lipoprotein whose two major protein components are apoB100 and apolipoprotein(a), and high levels are an independent and causal risk factor for atherosclerotic cardiovascular disease. ^[1] Lp(a) is predominantly a monogenic (genetically determined) cardiovascular risk determinant, with roughly 70% to 90% of the interindividual variation in levels being genetically determined. ^[1] High Lp(a) concentrations are present in about 10% to 20% of the population and, on a genetic basis, affect an estimated more than one billion individuals worldwide. ^[2]

How it works

High Lp(a) drives atherosclerotic cardiovascular disease through mechanisms associated with increased atherogenesis, inflammation, and thrombosis. ^[1] Epidemiologic and genetic studies involving hundreds of thousands of individuals strongly support a causal and continuous association between Lp(a) concentration and cardiovascular outcomes across different ethnicities, and elevated Lp(a) remains a risk factor even at very low levels of LDL cholesterol. ^[3] Lp(a) has pro-inflammatory and pro-atherosclerotic properties that may partly relate to the oxidized phospholipids it carries, and high Lp(a) is associated with both microcalcification and macrocalcification of the aortic valve. ^[3] Effect sizes are most pronounced for myocardial infarction, peripheral arterial disease, and aortic valve stenosis, where high Lp(a) concentrations predict roughly 2- to 3-fold increases in risk. ^[2]

Connected concepts

How it’s measured

Lp(a) measurement should be performed using well-validated assays with traceability to a recognized calibrator so that common cut-offs for high concentrations and risk assessment can be applied. ^[2] A recognized limitation is that the field still lacks full standardization and harmonization of assays and universal guidelines for diagnosis and risk assessment. ^[1] Multiple cardiovascular societies now recommend measuring Lp(a) concentration at least once in all adults, with cascade testing having potential value in familial hypercholesterolaemia or with a family or personal history of very high Lp(a) or premature ASCVD. ^{[3] [4]} European consensus recommendations note that Lipoprotein(a) cholesterol is contained within the LDL cholesterol reported on the standard Lipid Panel, and advise estimating it in all patients at risk of atherosclerotic cardiovascular disease ^[5]

What levels mean / management

In a participant-level meta-analysis of statin-treated individuals, those with an Lp(a) level above 50 mg/dL (about 125 nmol/L) had increased ASCVD risk across all quartiles of achieved LDL-C, confirming Lp(a) as a risk driver independent of LDL-C control. ^[6] Because no Lp(a)-specific lowering therapy is yet approved for outcome reduction, current guidance is early, intensive management of all other modifiable cardiovascular risk factors in people with elevated Lp(a). ^[3] Statins do not reduce Lipoprotein(a) and instead tend to increase its levels, an effect proposed to contribute to the residual cardiovascular risk observed in statin outcome trials and clinical practice ^[7] In primary prevention, elevated Lipoprotein(a) acts as a risk-enhancing factor that refines calculator-based cardiovascular risk estimates, complemented by subclinical atherosclerosis testing with Coronary Artery Calcium scoring to guide preventive therapy decisions ^[8]

Community knowledge

Lipoprotein(a), or Lp(a), is a genetically determined, LDL-like particle with pro-inflammatory and prothrombotic properties that carries substantial atherosclerotic, thrombotic, and aortic-stenosis risk.

Dr. Giovanni Campanile has described Lp(a) as a silent, largely genetically fixed risk factor for which no direct therapy is yet approved, recommending once-in-a-lifetime measurement and cascade testing of first-degree relatives, and noting that high-dose statins can paradoxically raise Lp(a) while PCSK9 inhibitors and apheresis lower it ^a; he has also emphasized the ApoB/ApoA1 ratio as a highly predictive treatment target ^d

Dr. Jessica Shepherd, Dr. Saranya Wyles, Dr. Giovanni Campanile, and Dr. Elizabeth Poynor jointly noted that Lp(a) is not perfectly constant and can rise with inflammatory states, remaining a several-fold stronger risk factor than LDL when elevated at any point in life ^c.

Dr. Simar Randhawa has echoed the guidance to consider trending Lp(a) over time and to lower ApoB and the ApoB/ApoA1 ratio when direct Lp(a) reduction is not yet available ^b.

The Longevitydocs community have noted that dedicated Lp(a)-lowering agents are anticipated and may become options for high-risk patients.

References

Rooms

a. How should we treat high Lp(a)? with Dr. Giovanni Campanile

b. Dr. Simar Randhawa

Summit

c. Women’s Longevity 360, Dr. Jessica Shepherd, Dr. Saranya Wyles, Dr. Giovanni Campanile, and Dr. Elizabeth Poynor

Faculty Lectures

d. Unlocking Secrets of Heart Health, Dr. Giovanni Campanile

Peer-Reviewed Publications

1.Reyes-Soffer G, Ginsberg HN, Berglund L, Duell PB, Heffron SP, Kamstrup PR, Lloyd-Jones DM, Marcovina SM. Lipoprotein(a): A Genetically Determined, Causal, and Prevalent Risk Factor for Atherosclerotic Cardiovascular Disease: A Scientific Statement From the American Heart Association. Arterioscler Thromb Vasc Biol · 2022

2.Kamstrup PR. Lipoprotein(a) and Cardiovascular Disease. Clin Chem · 2021

3.Kronenberg F, Mora S, Stroes ESG, Ference BA, Arsenault BJ, Berglund L, Dweck MR, Koschinsky M. Lipoprotein(a) in atherosclerotic cardiovascular disease and aortic stenosis: a European Atherosclerosis Society consensus statement. Eur Heart J · 2022

4.Anchouche K, Baass A, Thanassoulis G. Lp(a): A Clinical Review. Clin Biochem · 2025

5.Nordestgaard BG, Langlois MR, Langsted A, Chapman MJ, Aakre KM, Baum H, Borén J, Bruckert E, Catapano A, Cobbaert C, Collinson P, Descamps OS, Duff CJ, von Eckardstein A, Hammerer-Lercher A, Kamstrup PR, Kolovou G, Kronenberg F, Mora S, Pulkki K, Remaley AT, Rifai N, Ros E, Stankovic S, Stavljenic-Rukavina A, Sypniewska G, Watts GF, Wiklund O, Laitinen P. Quantifying atherogenic lipoproteins for lipid-lowering strategies: Consensus-based recommendations from EAS and EFLM. Atherosclerosis · 2020

6.Bhatia HS, Wandel S, Willeit P, Lesogor A, Bailey K, Ridker PM, Nestel P, Simes J. Independence of Lipoprotein(a) and Low-Density Lipoprotein Cholesterol-Mediated Cardiovascular Risk: A Participant-Level Meta-Analysis. Circulation · 2025

7.Tsimikas S. A Test in Context: Lipoprotein(a): Diagnosis, Prognosis, Controversies, and Emerging Therapies. J Am Coll Cardiol · 2017

8.Goldsborough E, Osuji N, Blaha MJ. Assessment of Cardiovascular Disease Risk: A 2022 Update. Endocrinol Metab Clin North Am · 2022

9.Boffa MB, Koschinsky ML. Lipoprotein(a) and cardiovascular disease. Biochem J · 2024

10.Xu R, Wang Z, Dong J, Yu M, Zhou Y. Lipoprotein(a) and panvascular disease. Lipids Health Dis · 2025

New feature: Audio courses are live in the CLD

You asked. We built it. Every unit now has an audio version.

Courses used to need a free weekend, or a cold conference room in a suburban hotel. Now all you need is headphones. Hit play and the lecture runs while you drive, train, cook, or pretend to listen to family reunion. Adjust the speed and get through it faster.

Open School in the app, try the audio, and tell us what you think of the voice we picked.

Each week, I try to explore one idea that could advance longevity medicine and hopefully support physicians in bringing it to life.

Why More Doctors Are Moving Into Longevity Medicine. Part 1/4

Over the next four weeks I am writing one story a week for the physicians thinking about this move. Why doctors are making it. How to actually start a practice. The ecosystem you have to build around it. And what the work looks like in practice. Then on September 13, something opens.

Imagine thirteen minutes to work out what is wrong with your patient, order the tests, interpret them, prescribe, educate, and feel like you practiced medicine. You cannot.

So the visit ends, the patient leaves with the prescription he came in for, and goes looking for the real answer somewhere else. Another doctor, a med spa, a chatbot.

Probably not what you signed up for after ten years of training. You know exactly what I am talking about.

Nearly half our Certified Longevitydocs, across 29 countries, come from primary care, emergency medicine and internal medicine. That surprises people who assume this is a boutique subspecialty for concierge doctors. It is not. The doctors building this field came from the frontline, and they left it wanting better care for their patients.

Ten reasons they give

1. Prevent disease instead of managing its complications
Treat the atherosclerosis, not the heart attack.

2. Spend time on medicine
Ninety minutes with a patient instead of ninety minutes on prior authorization.

3. Get paid for outcomes, not volume
Right now, seeing thirty patients badly pays more than seeing ten well.

4. Write protocols for the patient in front of you
Not wait for a committee, not inherit a pathway built for a population that is not yours.

5. Follow patients long enough to know the protocol worked
Watch the biomarkers improve instead of referring the patient and never finding out.

6. Answer what patients are already asking
When they ask about peptides, be the one who answers instead of the influencer.

7. Own the reputation
Patients come to you, not to the logo on the building.

8. Own the business
A panel of 150 at $5,000 instead of 2,000 patients you never really see.

9. Live what you prescribe
Stop advising people on sleep while running on five hours yourself.

10. Freedom.
Which is what the other nine add up to.

What nobody tells you

The first year is hard. You are building a business you were never trained to build. Pricing used to be done by the insurer. Now it is yours. So are the protocols, finding your first patients, choosing the technology, hiring the team. Nobody does this alone. That is what opens on September 13.

Next Sunday: Part 2/4 - How to actually start a longevity practice, including what the first year costs and earns.

Each week, I give you a sneak peek on topics discussed in our community.

The Retatrutide risks

Lilly sued six companies for selling unapproved retatrutide. Med spas, compounding pharmacies and online sellers, most shipping “research use only” product for human use. More than 200 additional entities were referred to FDA, DOJ, state attorneys general, law enforcement and professional licensing boards. Read that last one twice. Retatrutide is still Phase 3 with no approval anywhere, filing now expected in Q1 2027, and FDA said in June that it cannot lawfully be compounded. Lilly also asked payment processors and credit card companies to cut sellers off, so check your merchant terms this week. If retatrutide is in your practice, you are at risk.

Build your own lab panel

Cash-pay lab access came up hard this week, mostly out of New York where client billing is not permitted. Some physicians route patients through indigent pricing at Quest or Labcorp, up to 80 percent off. Know what that program is. It is reserved for patients with genuine financial hardship, the requisition has to say so, and it is not a pricing strategy for a cash-pay practice. The better answer came from members who stopped working around the big labs and built their own. A custom panel designed with a lab partner, roughly $400 all in, scheduled pickups, and the exact markers you actually need.

Join the Network

Sneak peek: the Skin, Bone and Muscle Mastermind

October 24, 2026 • New York City

Secure your ticket

Why skin, bone and muscle

It is the front door of longevity care. It is what the patient sees first, what brings them in, and what they use to judge whether any of this is working.

And it is a triad, not three separate problems. Bone and muscle fail together. Skin reports on what is happening in both. Manage them in isolation and you get exactly the results the field has been getting.

The medical community still underrates it. Cardiometabolic gets the seriousness, skin and musculoskeletal get filed under aesthetics, and the patient goes looking for answers somewhere other than a physician’s office.

That is the gap we are closing in one day.

Physician-led sessions. Every one sends you home with a protocol or a framework. Full program drops next week. Here is a sneak peek:

• Skin, Bone and Muscle. The clinical triad of healthy longevity.

• The Evidence. Where the science stands today, and where it is going.

• New Diagnostics. The biomarkers, AI and devices you can use in practice now.

• The GLP-1 Tax. Protecting skin, bone and muscle in patients already on the drug.

• The Regenerative Menu. Stem cells, peptides and photons, with a risk-tiered framework for each.

• Advanced Protocols. What to implement, and in whom.

• The Debate. Where the money is versus where the data is. Choosing a service line you can defend in five years.

Front-row access to the physicians pioneering skin, bone and muscle longevity. One day in New York City. Breakfast, lunch and a VIP dinner. Clinical protocols and scientific breakthroughs you can put to work Monday.

For physicians only. Limited to 150.

CLD Zoom in: one section of the Certified Longevitydocs program(CLD)

Beyond Statins

For patients requiring greater LDL reduction than statin monotherapy achieves — or in patients with statin intolerance — combination therapy with non-statin agents provides additive benefit:

Ezetimibe:

• Mechanism: Inhibits intestinal NPC1L1 cholesterol transporter; reduces dietary and biliary cholesterol absorption

• LDL-C reduction: Additional 15–20% when added to statin

• Cardiovascular outcome evidence: IMPROVE-IT trial demonstrated significant incremental MACE reduction when ezetimibe was added to statin in post-ACS patients — establishing the principle that LDL lowering beyond statin monotherapy provides additional cardiovascular benefit

PCSK9 Inhibitors (evolocumab, alirocumab):

• Mechanism: Monoclonal antibodies inhibiting PCSK9-mediated LDL receptor degradation; increase hepatic LDL receptor recycling

• LDL-C reduction: 50–60% reduction when added to maximally tolerated statin

• Cardiovascular outcome evidence: FOURIER (evolocumab) and ODYSSEY OUTCOMES (alirocumab) trials demonstrated significant MACE reduction; FOURIER notably showed progressive benefit with greater LDL lowering, supporting the “lower is better” principle down to very low LDL-C levels

• Vascular biology benefit: PCSK9 inhibitors may have direct anti-inflammatory and plaque-stabilizing effects beyond LDL reduction, currently an area of active investigation.

Unit 16 - Cardiovascular Longevity Medicine. Sections are reviewed and updated continuously as the evidence moves.

Become Longevity Fluent

The only longevity medicine curriculum built for physicians, by physicians.

Join the Certification Next Cohort

Histological aging signatures for monitoring tissue-specific aging and disease

Aging is the primary risk factor for chronic disease and is characterized by profound structural and architectural remodeling of human tissues. Here, we present a comprehensive assessment of these changes using 25,712 whole-slide histopathological images from 40 tissue types across 983 individuals in the Genotype-Tissue Expression cohort. By leveraging deep learning, we quantified nuanced morphological alterations to develop ‘tissue clocks’, predictors of biological age that reflect tissue structural integrity and physiological fitness. These clocks correlate with established aging markers, such as telomere attrition, subclinical pathologies and comorbidities. Nature

Exercise intensity modulates interorgan communication and is associated with cardiometabolic health outcomes in humans

We found that exercise intensity distinctly influenced the plasma proteome and metabolome in untrained and trained participants. By integrating multi-organ gene and protein expression datasets with in vitro and in vivo tissue sampling, we mapped regulated proteins to their predicted tissues of origin and destination. Muscle fibers and adipocytes were particularly sensitive to exercise intensity and observed to undergo broad secretory and transcriptomic changes. Cell Reports Medicine

Every week, I track funding, FDA approvals, product launches, and breakthrough announcements shaping longevity medicine.

CARE

Hims & Hers planning to sell compounded peptides

Hims & Hers Health is planning to sell compounded peptides, the company said in a Monday earnings call. The company’s CEO, Andrew Dudum, said in the earnings call that it was “currently developing a best-in-class peptides experience, including U.S. manufactured products, clinical-led guidance, and ongoing blood testing.” A public company announcing a compounded peptide line in the same week Lilly sued six peptide sellers is worth watching. The Hill

AI

Want concierge medicine? AI can deliver it

About 1 in 3 American adults have turned to a chatbot for health advice in the past year. Bots can sound like a concierge doctor. What AI does best is the underlying work: reading a patient’s health history, weighing symptoms and suggesting a treatment plan. AI is already in almost every pocket. It can transform healthcare with the record, the proof and the payment. Build them, and the forward-looking concierge care some have today could become available to anyone with a phone. WSJ

TECH

Google puts insulin resistance on the wrist

Google announced Health Guardian for Pixel Watch and Fitbit Air on Aug 12. Four features: insulin resistance trends (trained over a trillion minutes of data from 5 million opted-in users), estimated from multi-week physiological data with no blood draw. Blood pressure trends come from pulse and motion patterns with no cuff and no calibration. Sleep breathing quality tracks overnight, and breathing emergency detection can call emergency services on a critical oxygen drop. Google

PHARMA

The brain may be about to have its Ozempic moment

The Economist makes the case that orexins are the next GLP-1. FDA approved oveporexton on Aug 5, the first orexin agonist for narcolepsy, after a trial where patients stayed awake 12.5 to 25 minutes longer on the Maintenance of Wakefulness test and had roughly a third as many cataplexy attacks. Lilly bought Centessa in June for up to $7.8bn to get into the class. Morgan Stanley projects $16bn a year by 2035 from sleep disorders alone. The Economist

RESEARCH

XPRIZE Healthspan names 20 finalists

XPRIZE Healthspan named 20 finalists for the clinical phase of its $101 million competition, with ten teams taking $1 million each. Between 2026 and 2029 they run trials of up to one year in adults aged 50 to 90, aiming to restore muscle, cognitive and immune function lost to at least ten years of age-related decline, with 20 years as the stretch target. LongevityTechnology

The ten $1 million awardees:

• AgelessRx (US)

• Goda Lab, NanoTitan with University of Tokyo and Tokyo RELIFE Clinic (Japan)

• Johns Hopkins-Suninflam, Suninflam Inc with Johns Hopkins University (US)

• Longeveron, Inc (US)

• Minicircle Inc (US)

• Mitochondrial All Stars, Mighty Therapeutics with University of Washington (US)

• NYC-Vita, Mount Sinai Health System (US)

• RETRO-EPIGERNA, Macau University of Science and Technology (Macao SAR, China)

• RPRGAON-Progeria, PRG S&Tech (South Korea)

• TIME TRAVELER Plant-EVs (Japan)

SOCIETY

The $250,000 blood concierge

A non-physician concierge charging up to $250,000 a year to arrange unapproved therapies for wealthy clients. Peptides, stem cells, exosomes, infusions, delivered by private nurse with no baseline screening, no regulatory oversight and nobody accountable for outcomes. This is what fills the space when the field has no standard. Longevity medicine needs standardization and it needs to be judged on health outcomes, not on what a client can be sold. Vanity Fair

Every doctor should be a longevity doctor

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Editorial Disclaimer:

This newsletter is published exclusively for licensed physicians and qualified healthcare professionals. It is not intended for consumers or patients.

All content, including the Buzz in the Chat section, is for continuing medical education and professional information purposes only. It reflects emerging research, science, and technology that may have implications for the practice of medicine. It does not constitute medical advice, clinical recommendations, or treatment guidance for any individual patient.

Peer-to-peer discussions reproduced in this newsletter represent the personal clinical opinions of individual physicians. They do not reflect the official position of longevitydocs and have not been reviewed or endorsed by any regulatory, medical, or professional body.

References to specific therapies, compounds, devices, or protocols are provided for educational context only. Some may be investigational, off-label, or not approved by the FDA, EMA, or equivalent regulatory authorities in your jurisdiction. Physicians are responsible for independently evaluating all information in accordance with current evidence, applicable law, and the standards of their licensing board.

longevitydocs does not promote, endorse, or recommend any specific product, treatment, or commercial entity. Nothing in this newsletter should be construed as a solicitation or as influencing prescribing behavior.

By reading this newsletter, you confirm that you are a licensed healthcare professional and that you will apply the information contained herein within the bounds of your clinical judgment, professional obligations, and applicable regulations.

If you are a patient or consumer reading this newsletter, please note that this content should not be used to make any health or medical decisions. Please consult your personal physician or a qualified healthcare provider for guidance specific to your situation.

Hey Doc,

Issue 101. I am starting the next hundred with what we get wrong about longevity medicine.

Not exactly a summer newsletter… no 120 tips.

What I heard. This year I met physicians, scientists, entrepreneurs and patients across the world. Everyone is talking about longevity. The enthusiasts and the skeptics, in the same room, using the same word to mean different things.

What I saw. An explosion of products, services and clinics, from Italy to Shanghai. Almost no way to tell which ones actually work. And a growing number of people who no longer trust the science at all.

What I feel. Longevity medicine is being led by platforms, influencers, and physicians are being left behind. We have the knowledge. We are losing the authority.

And I am optimistic because this is the beginning of a new era, driven by people who decided that they will be in charge of their longevity.

As always, Happy Sunday.

Dr. David Luu, Founder, longevitydocs.™

Each week, I try to explore one idea that could advance longevity medicine and hopefully support physicians in bringing it to life.

What People Get Wrong About Longevity Medicine

Written for your patients. Feel free to forward it to them.

I have spent this year in a lot of different countries, different cities, different rooms. Same questions every time.

What does longevity actually mean? Where do I find a good doctor? What do you think about GLP-1s, Brian Johnson, Huberman, Sinclair, BPC-157, peptides, NAD? Who is the best doctor, the best clinic, the best test?

Longevity has gone mainstream. It does not matter where you are in the world or what you earn. Everyone is interested. Everyone is talking about it. It is the new status, and it is here to stay.

People come in through whatever door is closest to them. Beauty. Sleep. Wearables. Weight loss. Diet. A full-body MRI they saw on a podcast.

Then they get lost.

Ten things people get wrong, from the believers to the skeptics

1. Longevity means living forever. It does not. It means more years where your body still works, and you are enjoying your life.

2. Longevity is a panel of tests. Bloodwork, genomics, microbiome, full-body scan. Testing is not care. A result you cannot act on is a number, not a plan.

3. Longevity is diet, sleep and exercise. These matter enormously. They are the floor, not the ceiling.

4. Longevity is biohacking. Biohacking is n-of-1 with no control group and nobody accountable for the outcome.

5. Longevity is intervention. Peptides, hyperbaric chambers, sauna. Interventions are tools. Tools are not a strategy.

6. Longevity drugs already exist. They do not, not in the way people mean.

7. Longevity is genetics. Your genome loads the gun. It is not the only thing pulling the trigger.

8. The right stack will do it. No supplement combination has ever been shown to extend human lifespan.

9. AI knows better than my doctor. So I will order my own labs and find my own drugs online.

10. We are all going to die anyway, so let me enjoy my life. My grandfather smoked until 95 and he was fine. Maybe. You are not your grandfather, and survivorship bias is not a health plan.

The problem is not the evidence. It is the interpretation.

There is more longevity research published now than any physician can read. That is not the bottleneck. The bottleneck is who translates it.

Right now that job falls to media articles, influencer content, and scientific papers most people cannot parse. Self-appointed gurus. Brands explaining the thing they are selling. A few excellent physicians, drowned out.

One diet study in mice becomes a viral claim that protein is bad for you. Nobody reads the paper. Everybody shares the reel.

Meanwhile the people who actually know are in clinic or in the lab. Physicians and scientists are not trained to communicate at the speed the internet demands. So the loudest voice wins, and the loudest voice is usually selling something.

Longevity medicine is network intelligence

There is a deeper problem than bad information. Longevity medicine does not work as a list of facts.

ApoB does not sit by itself. It connects to the lipid panel, to PCSK9 inhibitors, to oxidized LDL, to cardiovascular risk, to atherosclerosis, and out from there to inflammation, to hs-CRP, to IL-6.

Search any one of those terms and you get an article about that term. That is not how the biology works, and it is not how a good physician thinks. Your doctor is not looking up a definition. She is holding a map.

That map is what patients have never had access to. We believe longevity should be a human right. Which means the education has to reach everyone.

Introducing the Lexicon

Lexicon is a living map of longevity medicine, built on published research and the experience of physicians who see patients.

Two ways in. Search a term and read the entry. Or open the graph and see how that term connects to everything around it, which is the part that actually teaches you something.

Every entry gives you the science, the publications, the clinical experience, the strength of the evidence, and where consensus exists versus where it honestly does not.

Every entry carries a community note from a verified physician. Not an influencer. Not a brand. A doctor with a license and patients.

The Lexicon is open to everyone.

Anyone can join the waitlist

Hundreds of topics are live, and we are building toward the most comprehensive map of longevity medicine there is.

We are opening the beta to a limited number of non-physicians before the Lexicon goes public. This group gets first access, and gets to tell us which topics we write next.

Reply to this newsletter, or email us at contact@longevitydocs.org, and tell us why you want in. What brought you to longevity. What you are trying to figure out.

We read every one. Numbers are capped, small enough that we can answer every one of you.

Each week, I summarize conversations from our community.

Mitochondrial Testing: Measure vs. Interpret

Two tests came up this week, and the thread ended up somewhere more useful than where it started.

A Doc raised GDF-15 as the marker he builds mitochondrial protocols around. The practical answers came fast. There is only one clinical lab running it, it costs around $250. The same lab is currently declining pTau-217 under age 50 because of how their LDT indication is written.

“GDF-15 is like a red alert if you use traditional levels. I adjust them down based on health and age. But that’s an art, not a study of 100,000 people with a statin.”

Another Doc raised the concern regarding organic acid testing

“I also do OAT testing, however, a colleague at another institution told me that commercial OAT testing are not ACMG approved for mitochondrial function, only for inborn errors of metabolism.”

Why it matters

If you order GDF-15, know the reference ranges were not built for the patient in front of you. Document why you moved the threshold. If you order OAT, check the lab’s certification before it changes a protocol.

Right now we can measure more than we can interpret.

A $450M round, and what it taught us about pricing

A large growth financing in consumer diagnostics set off a debate.

First question in the room: what is actually proprietary here beyond a brand and a subscriber list. The answer from members with visibility was recurring revenue and growth, heavy customer acquisition spend, and churn nobody (outside the cap table) can see. One member called it a CAC financing rather than a normal equity round, closer to venture debt during the zero-rate years.

The useful part came from three physicians who had changed their own pricing in the last month.

One raised membership 50% across the board and gave existing patients a discounted rate for the first year.

“No one freaked out. Of course there will be some churn but one needs to trim old branches for fresh growth.”

A second raised fees for legacy patients and was surprised by how little happened.

A third took a different route. He closed his panel, built a waitlist, hired a PA, and placed 42 of 50 waitlisted patients within two months.

Pricing, branding and positioning matter in longevity medicine

That company raised $450M on pricing, branding and positioning. Not on outcomes, not on a molecule, not on a proprietary assay. What got valued was their positioning, their growth, their ecosystem of services and their subscriber list. And they did it very well.

The same logic runs in your practice at a smaller scale. Three physicians raised prices this month and none of them lost the patients they feared losing, because what they sell is not a visit. It is judgment, access, and a relationship that took years to build. Price follows position, and most of us are positioned better than we are priced.

The one who closed his panel understood this best. Scarcity is a positioning decision. A waitlist is a brand asset.

If you have not touched your fees in two years, they are probably outdated. The market moves fast. Testing gets cheaper, more doctors enter, more services launch, and your own experience deepens. So how do you brand, position and price your services differently?

Sneak peek: the Skin, Bone and Muscle Mastermind

October 24, 2026 • New York City

Secure your ticket

Why skin, bone and muscle

It is the front door of longevity care. It is what the patient sees first, what brings them in, and what they use to judge whether any of this is working.

And it is a triad, not three separate problems. Bone and muscle fail together. Skin reports on what is happening in both. Manage them in isolation and you get exactly the results the field has been getting.

The medical community still underrates it. Cardiometabolic gets the seriousness, skin and musculoskeletal get filed under aesthetics, and the patient goes looking for answers somewhere other than a physician’s office.

That is the gap we are closing in one day.

Physician-led sessions. Every one sends you home with a protocol or a framework. Full program drops next week. Here is a sneak peek:

• Skin, Bone and Muscle. The clinical triad of healthy longevity.

• The Evidence. Where the science stands today, and where it is going.

• New Diagnostics. The biomarkers, AI and devices you can use in practice now.

• The GLP-1 Tax. Protecting skin, bone and muscle in patients already on the drug.

• The Regenerative Menu. Stem cells, peptides and photons, with a risk-tiered framework for each.

• Advanced Protocols. What to implement, and in whom.

• The Debate. Where the money is versus where the data is. Choosing a service line you can defend in five years.

Front-row access to the physicians pioneering skin, bone and muscle longevity. One day in New York City. Breakfast, lunch and a VIP dinner. Clinical protocols and scientific breakthroughs you can put to work Monday.

For physicians only. Limited to 150.

Tickets are open. Pricing increases next week.

Apply for Membership

From Colorectal Surgery to Women’s Metabolic Health: Dr. Mayoni Gooneratne’s Journey to Medicine

Dr. Mayoni Gooneratne spent years as a pelvic floor and colorectal surgeon in the UK before an inflection point sent her into what she calls her “wilderness years.” Today she’s Functional Medicine Doctor & Executive Medical Director at PHC (Personalized Health Clinics) in London, building a metabolic health practice for women, and a Certified longevitydocs.^™ CLD graduate.

Q: Take us back to the beginning. What first pulled you into medicine?

My mom gives this fantastic story of being 8 or 9 years old, and she just said I always wanted to be a studier and to help people. I think medicine is that incredible opportunity to do both. Both my parents are doctors, and they always strongly supported my journey into medicine without forcing the issue, but also very clearly identified when I was beginning to struggle within the structures I was working with in the UK.

As I entered medical school, all I wanted to do was to be a surgeon, and I completed my surgical training. I did a period of research as a fellowship towards a PhD during my surgical training, and that was when I first encountered the huge gap that women faced in healthcare, because I was looking specifically at control of the large bowel. That really meant, in clinical terms, helping women who had suffered with fecal incontinence for many years. That was when I discovered there was a huge underserving of these women. I was a young surgeon, I didn’t really think much more of it, but I remember clocking that. And then I completed my surgical training.

When I entered the end of that time, looking at my colleagues and my mentors who were also coming to the end of theris, I felt a very difficult moment, I realized it was a do or die point, a real inflection point in my training, and with a lot of support and a lot of counseling, I decided to leave.

My parents supported me in that decision, because they could see how difficult it was for me. It was not easy. I had my wilderness years, as I describe it. I had my children while I was recalibrating, and all women who’ve had children, and I think even women who have not had children, have these points in their career where they really have to reformat. I describe them as iOS updates.

I had my first update then, and just had to look around me and pivot, and I set up my first esthetics clinic as an opportunity to really financially grow at that point. But I very quickly discovered a group of women who were like me, who were tired, a bit broken, perimenopausal, balancing all the things, and needed support with lots of things. I put together this process of Skin Fit, Mind Fit, Body Fit, which then evolved over time as I added to my training. I’m a portfolio doctor, really, with multiple services I’ve collated to be of the highest service to the women who come to me, so that we’re offering this wraparound service. They’re not having to shop around, they’re not having to go to different providers either; it was me delivering that service, or a trusted group of clinicians and practitioners who would do that for them under my umbrella. Covid happened, and Human Health evolved out of that. And essentially now I’ve stepped out of that role to be the Functional Medicine Doctor and Executive Medical Director for PHC, where I’ve taken a lot of my learnings to help this incredible space.

Q: When did longevity medicine first land on your radar?

Like many people, both in the general public space and in the medical space, I’d been hearing this word for a while, and I think that was probably first about four years ago. I met David Luu and joined longevitydocs.^™ and at that point I was very much on the outside just looking in, curious, watching this space and looking up to these incredible peers and mentors who have gone before us for the last 20 odd years.

I think, much like functional medicine, you’ve got this incredible group of pioneers who are carving out a space, but what is the actual point of difference? I think about people like Dr. Yurth, who talks about sitting at the level of the cell, and my own passion for the mitochondria has grown over many years, because women fail to understand that connection between their cellular health and why they’re exhausted at 4pm. They’ve been on the go, they’ve woken up, they’ve not eaten; that is not fasting, by the way. They’re not fueling their bodies in the best possible way, and then they hit lunchtime, they grab a sandwich, they’re eating at their desk, and suddenly they’re crashing and burning.

But it’s also, I think, thriving medicine. One of my programs is called Thrive, because women have, somewhere along the way, forgotten that life is not just for existing. Having been that woman who’s worn all the hats, I think it’s important for women to know there is life after the perimenopause, but there’s also life at all the metabolic inflection points: PCOS, endometriosis, pregnancy. These are all critical points where the mitochondria are under attack, but we can support it. That, to me, is what longevity is about, how to thrive.

Q: For physicians watching who feel that pull but haven’t taken the leap, what would you tell them?

Do it. It’s the best possible medicine you will ever have practiced. It’s a question we’ve all been talking about at this Congress: what is medicine actually for? It was not to operate more. It was not to prescribe more. It was not to navigate systems and bureaucracy better. It was to truly connect with that human, and to really help them, and to go back to what my mum always reminds me of: it was to take the best of our academic and scientific excellence and bring it to the clinical room.

Q: What’s one thing you loved about the Certified longevitydocs. CLD certification?

Definitely, just number one, knowing that there’s this huge, vast capacity of knowledge, with the capacity to learn more, but also just collating it. I was going through it, going, oh yeah, I know that, I know that, but then actually I don’t know that. And suddenly pulling it together and having a really coherent model to deliver things. A lot of my programs already ticked some of those boxes, but there was a whole load of more information and scope to improve what I’m doing.

Q: Is there one thing that would help you practice most fully?

Number one, for us to be fully present as clinicians with our patients is what’s going to drive our practice and enhance it. So anything that helps with that, whether it’s administrative tasks or knowledge and access to community, and knowing that morally and ethically we are doing the right thing. I think we find that within the longevitydocs.^™ group. But also, for me leading a clinic, it’s actually having other clinicians that I can pull into our system. We’re looking to recruit; we need more people who are trained up, because I can’t do this alone, and we can’t change global health alone. It is definitely a we program, not an AI program.

This is exactly why we are building The Certified Longevitydocs.™ (CLD) the certification and training for the longevity physician of the future. Every doctor should be a longevity doctor.

Join the Certification Next Cohort

Cellular Senescence Repositioned as an Upstream Driver of Coronary Disease

A new review in Ageing Research Reviews argues that senescent vascular smooth muscle cells and endothelial cells generate a SASP that directly propagates plaque instability, positioning senescence as an upstream accelerant of coronary disease rather than a downstream consequence of atherosclerosis Ageing Research Reviews, Li et al., 2026.

Associations of testosterone, sex hormone-binding globulin, and related hormones with risks of cancer

Lower total testosterone or dihydrotestosterone concentrations in men were associated with a higher risk of cancer death, and mid-range SHBG or luteinising hormone concentrations were associated with a lower risk. Men with lower SHBG or luteinising hormone concentrations had an associated higher risk of incident prostate cancer. Sex hormones could serve as biomarkers for cancer risk, warranting further investigation of these observed associations. Lancet Healthy Longevity

Biological mechanisms of different exercise modalities in improving sleep disorders: A review

This narrative review aims to consolidate and examine the contemporary body of scientific evidence elucidating how distinct forms of exercise, primarily categorized as aerobic endurance training, resistance or strength training, and mindful mind-body practices, act to alleviate various sleep disturbances. The underlying biological pathways through which these exercise modalities exert their positive effects are complex and interconnected, encompassing thermoregulatory processes, neurochemical adaptations, endocrine signaling, and shifts in autonomic nervous system balance. IBRO

Every week, I track funding, FDA approvals, product launches, and breakthrough announcements shaping longevity medicine.

DIAGNOSTICS

Full-Body AI Skin Imaging

Founded by Deezer co-founder Jonathan Benassaya after his own melanoma was nearly missed, SkinBit closed a $6M pre-seed from Boost VC, Cleo Capital, Manna Ventures, and Profluent Capital, with participation from board-certified dermatologists and angel investors. The proprietary scanner completes a 20-minute automated full-body scan, maps and categorizes marks, and builds a longitudinal skin baseline physicians can track over time. First scanners are landing in medspas, longevity clinics, and dermatology offices, with three locations live in 2026 and 15 planned by the end of 2027.

TECH

Hers App Offers Doctor-Led Care

Hims & Hers, the leading health and wellness platform, today announced a first-of-its-kind intelligent care experience that puts AI directly inside customers’ care, not on the sidelines of it. Rolling out first to Hers weight loss members, this proactive care experience delivers personalized guidance, real-time attention to her progress, and keeps her motivated so she can hit her goals.

Whoop Helps You Track Fertility

WHOOP partners with Natural Cycles°, a FDA-cleared medical device, that uses biomarker data, including temperature and heart rate data, to identify fertile and non-fertile days, helping users prevent pregnancy without hormones while also providing fertility insights. Beyond birth control, the app also supports users through pregnancy planning, pregnancy, postpartum, and perimenopause with dedicated modes tailored to each stage of their reproductive journey.

RESEARCH

Gene Therapy Center for Rare Diseases

The New York Times profiled ARPA-H’s THRIVE initiative, Treating Hereditary Rare Diseases with In Vivo Precision Genetic Medicines, which is building infrastructure to make single-intervention precision genetic medicines faster and cheaper to develop, aiming to move rare disease treatment past the one-drug, one-disease model most pharmaceutical companies avoid on cost. An estimated 95% of rare conditions still have no approved treatment.

AI

AI-designed Unknown Functional Virus

Stanford researchers used generative AI models Evo1 and Evo2, trained on genetic sequences from viruses, bacteria, plants, and humans, to design 302 candidate bacteriophage genomes from scratch. Sixteen proved fully functional in the lab, replicating and killing E. coli. It’s the first time a complete viral genome has been AI-designed rather than edited, a milestone researchers are calling a turning point for computer-designed biology, with near-term potential in phage therapy for antibiotic-resistant infections. BBC

CONSUMER

Thorne sold to P&G for $3.8B

Procter & Gamble has agreed a $3.8bn deal to acquire supplements maker Thorne, delivering an outsized return for LVMH-backed private equity group L Catterton less than three years after it bought the company. FT

The Home of Longevity Medicine

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Editorial Disclaimer:

This newsletter is published exclusively for licensed physicians and qualified healthcare professionals. It is not intended for consumers or patients.

All content, including the Buzz in the Chat section, is for continuing medical education and professional information purposes only. It reflects emerging research, science, and technology that may have implications for the practice of medicine. It does not constitute medical advice, clinical recommendations, or treatment guidance for any individual patient.

Peer-to-peer discussions reproduced in this newsletter represent the personal clinical opinions of individual physicians. They do not reflect the official position of longevitydocs and have not been reviewed or endorsed by any regulatory, medical, or professional body.

References to specific therapies, compounds, devices, or protocols are provided for educational context only. Some may be investigational, off-label, or not approved by the FDA, EMA, or equivalent regulatory authorities in your jurisdiction. Physicians are responsible for independently evaluating all information in accordance with current evidence, applicable law, and the standards of their licensing board.

longevitydocs does not promote, endorse, or recommend any specific product, treatment, or commercial entity. Nothing in this newsletter should be construed as a solicitation or as influencing prescribing behavior.

By reading this newsletter, you confirm that you are a licensed healthcare professional and that you will apply the information contained herein within the bounds of your clinical judgment, professional obligations, and applicable regulations.

If you are a patient or consumer reading this newsletter, please note that this content should not be used to make any health or medical decisions. Please consult your personal physician or a qualified healthcare provider for guidance specific to your situation.

Hey Doc,

Today is issue 100. It started the newsletter as a way for me to share the latest science, the technology, the market insights with a small group of physicians. The ecosystem got bigger as longevity became mainstream. Longevitydocs’ mission remains the same: democratize longevity medicine.

And we are getting there! Testing is cheaper. Care is more accessible. More physicians are moving into the space. More research is funded. More regulation and policy on the books. More health systems offering longevity services.

Longevity is becoming an industry beyond medicine. That is evolution, and it is also the reason the patient in front of you Monday arrives with more claims, more products, and fewer people qualified to sort them. Physicians will still play a role. Knowledge first, then care.

This is what I learned writing them (don’t expect copywriting tips)

1. Fringe becomes standard faster than you think. Plenty of what this newsletter covered as cutting-edge in 2024 is now used by millions of people, reimbursed, approved. Stay open.

2. Innovation impacts everything. Science, pricing, patient behavior, policy, regulation, and what gets taught in medical school. Keep building.

3. Longevity is a long-term game. Real science takes time. So does a real product. The companies that tried to skip that step are gone, and they took a lot of patient trust with them on the way out. Be patient.

4. Community creates impact. I do not agree with everyone in ours. That is the point. Same mission, same patients. Stay united.

5. It is about the patient. Every so often it is worth zooming out and asking why any of us are doing this. The answer has not changed in a hundred issues. Remember why.

The newsletter was always meant to be shared freely with our community. For 100, I am opening it up to trusted physicians from that community, in their own words, on the questions they actually get asked in clinic, the protocols they use, the work they do in the field.

Dr. Josh Starbuck goes first: peptides and the FDA.

Thank you for reading every Sunday. All hundred of them.

Dr. David Luu, Founder, longevitydocs.™

PS: I visited Milan, Shanghai and Venice. 3 things that struck me:

• In Milan I stood in front of the Duomo that took six hundred years. The people who laid the first stone knew they would never see it finished. They laid it anyway.

• In Venice, millions of wooden trunks driven into the mud, on the bet that wood underwater would not rot. The city is still standing on them.

• In Shanghai I watched a city that went from bicycles to electric everything inside of twenty years.

Three cities. Six hundred years, a thousand years, twenty years. I have been thinking about it since.

Each week, I try to explore one idea that could advance longevity medicine and hopefully support physicians in bringing it to life. This week, Dr. Joshua Starbuck shares his perspective from the FDA's PCAC hearing on peptide compounding.

The FDA’s Pharmacy Compounding Advisory Committee recommended six peptides for inclusion on the FDA’s compounding list.

Dr. Joshua Starbuck, MD, IFMCP - Makena Health

The question at hand was never whether these compounds should be FDA approved. It was whether a licensed 503A compounding pharmacy should be legally permitted to prepare them for an individual patient holding a valid prescription from a licensed clinician.

That distinction collapses fast in translation. The 503A Bulks List is the mechanism that allows this kind of compounding, and a substance only lands on it after a full sequence: nomination, a PCAC recommendation like this one, a comment period, then formal rulemaking through the Federal Register. Even in the fastest scenario, that takes roughly 90 days from here. The last time the list actually gained anything new was 2019, six substances, five of them topical, and those six remain the only ones ever added across fourteen meetings of this committee. Fourteen meetings, six substances. That’s a fair question to sit with on its own: whether the list was ever built to move at the pace patients actually need.

Separate from the Bulks List, and important not to confuse with it, sits FDA’s category system, an interim enforcement policy built because the rulemaking path is so slow. Category 1 means FDA doesn’t currently intend to act against compounding while it works through evaluation. Category 2 means the agency identified safety concerns. Category 3 means the nomination lacked sufficient data. A substance in Category 1 is not on the Bulks List, and can sit there for years without the rulemaking that would make it official ever finishing.

Patients have been asking about these compounds for years, evidence gaps and all, because the alternative was never no access, it was unregulated access.

The votes were close, not unanimous, and each went against FDA’s own scientific staff, who had recommended against inclusion. The evaluation framework runs on four factors regardless: characterization, safety, efficacy if known but not required, and history of use.

None of this is FDA approval. The 505 pathway demands an IND, full clinical trials, and often hundreds of millions to billions of dollars before a single indication is granted. This vote doesn’t touch that pathway, and these peptides remain unapproved drugs regardless of what the rulemaking eventually does. That gap between a recommendation and an actual legal listing is where the real work now sits.

That work took shape during the public hearing, the most human part of two otherwise procedural days. Dr. Elizabeth Yurth’s testimony on BPC-157 nearly brought me to tears, she named patients describing lives improved dramatically after years searching for a provider willing to try it. Reading the public docket alongside testimony like hers made the process feel less abstract, a decision with real suffering and real relief on the other side of it.

The hearing is also where the practical path forward took shape, as speakers spent less time arguing the science and more time proposing a safer bridge while rulemaking grinds forward. Dr. Jeffrey Egler and others laid out pieces of it: a verified-sourcing registry for API suppliers, something like a greens list; expanded state-level regulatory pathways; and a structured adverse-event reporting system, the same instinct behind VAERS. None of that needs a final rule, and none builds itself either. The next challenge isn’t waiting for these six to clear rulemaking, it’s building those guardrails now, so access arrives the right way instead of just faster.

Underneath all of it, the foundation this community already knows doesn’t change. Sleep, nutrition, hydration, movement, community, stress management, and recovery carry the weight. Peptides, if they arrive on the list at all, are the icing, not the cake. Physicians carry a real responsibility to model that hierarchy rather than let it invert, appropriate use, not overuse. A reason for use rooted in the patient in front of you, informed consent that’s honest, and monitoring that catches problems early.

Get that part right, and the rest follows. When patients win, we all win.

Dr. Joshua Starbuck, MD

Sneak peek: the Skin, Bone and Muscle Mastermind

October 24, 2026 • New York City

Why skin, bone and muscle

It is the front door of longevity care. It is what the patient sees first, what brings them in, and what they use to judge whether any of this is working.

And it is a triad, not three separate problems. Bone and muscle fail together. Skin reports on what is happening in both. Manage them in isolation and you get exactly the results the field has been getting.

The medical community still underrates it. Cardiometabolic gets the seriousness, skin and musculoskeletal get filed under aesthetics, and the patient goes looking for answers somewhere other than a physician’s office.

That is the gap we are closing in one day.

Physician-led sessions. Every one sends you home with a protocol or a framework. Full program drops next week. Here is a sneak peek:

• Skin, Bone and Muscle. The clinical triad of healthy longevity.

• The Evidence. Where the science stands today, and where it is going.

• New Diagnostics. The biomarkers, AI and devices you can use in practice now.

• The GLP-1 Tax. Protecting skin, bone and muscle in patients already on the drug.

• The Regenerative Menu. Stem cells, peptides and photons, with a risk-tiered framework for each.

• Advanced Protocols. What to implement, and in whom.

• The Debate. Where the money is versus where the data is. Choosing a service line you can defend in five years.

Front-row access to the physicians pioneering skin, bone and muscle longevity. One day in New York City. Breakfast, lunch and a VIP dinner. Clinical protocols and scientific breakthroughs you can put to work Monday.

For physicians only. Limited to 150.

Early access tickets are open now. Pricing goes up next week.

SECURE YOUR TICKET

Navigating Risk in Telemedicine - Dr. Suneer Chander

Dr. Suneer Chander, an ER physician and co-founder of Air Physician Academy, argued that malpractice fear is overblown in telemedicine and that the real exposure is regulatory. He built a four-bucket compliance framework, licensure, modality, standard of care, and treatment-specific rules, and walked through why state-by-state nuance around peptides and compounding pharmacies is shifting faster than most practices can track.

5 KEY TAKEAWAYS

• Malpractice risk in telemedicine is low and priced accordingly by underwriters (roughly $5,000-$12,000/year nationally, versus ~$30,000 for emergency medicine and $40,000-$200,000 for OB-GYN), because most telemedicine is low-acuity care with no procedures attached. When claims do arise, roughly two-thirds involve misdiagnosis, making the real discipline knowing when telemedicine is the wrong tool and referring to in-person care.

• Chander frames the actual risk in four buckets: licensure, modality, standard of care, and treatment-specific rules. Physicians must be licensed in the state where the patient is physically located, not where the physician sits, which is why he holds licenses in all 50 states plus DC to see patients nationally.

• Modality rules vary meaningfully by state. Synchronous video, audio-only, and asynchronous store-and-forward or questionnaire-based care are each permitted differently, so a state like Texas may restrict an asynchronous chat workflow that a state like Mississippi allows, and a compliant setup in one state can be a violation in the next.

• Treatment-specific rules for controlled substances, GLP-1s, TRT, and peptides are set at both the federal and state level and shift roughly every three to six months. A single compliance mistake in one state gets reported to every state medical board where a physician holds a license, forcing them to defend the same incident everywhere at once, even in states where the rule in question doesn’t exist.

• Chander’s practical fix is a tracking system, as simple as a spreadsheet or a service like Mockingbird, to monitor licensure renewals and rule changes before expanding into a new state. Best read as an operational discipline rather than a one-time compliance setup: the regulatory landscape here is a moving target, not a fixed checklist.

longevitydocs. ROOMS™ are 20-minute, live-audio, unscripted peer conversations available exclusively for our members in the longevitydocs.ai platform. Sessions are designed to answer your questions in real-time.

Apply for Membership

Meet the Longevity Doctor of the Year Redefining Women’s Health

We sit down to interview Dr. Jessica Shepherd, a board-certified OB-GYN and Chief Medical Officer of Hers, named this year’s Longevity Doctor of the Year at Longevitydocs.™ Cannes 2026.

When did longevity medicine first end up on your radar?

Longevity Medicine actually was on my radar very early. I actually had an undergrad degree in exercise physiology and kinesiology, and that’s really where I saw what the body is able to do and the mechanics of the body, really looking at it from a nutritional and an exercise perspective. Going through medicine is when I started to hear women in their struggles, and I realized we were really looking at health from a disease perspective. I knew there was a way I could teach my patients to practice better, in a way they could understand their body and work from that aspect. About 7 or 8 years ago is when I saw that I needed to shift my practice and move more into education and lifestyle, and hence longevity, where we are now.

What does it mean to you to be Longevity Doctor of the Year?

I was completely shocked, in a way, because a lot of what you do, you’re just so passionate about it, and if you really love it, you just keep doing it because you love it. So to put a title to it, or an award-winner aspect to it, is really shocking, but so inspirational, because deep down you’re like, I’m doing what I’m supposed to be doing. I think a lot of times in longevity you feel it’s siloed, or you feel that you’re alone, because that’s not the structure of medicine, and that’s not how we’re trained. So to be a longevity doctor really means you have to fundamentally, wholeheartedly believe what you do.

What’s one piece of advice you’d leave a young physician watching this?

Always think big and stay curious. I never would have imagined where I started, and even when I finished training, that I would be where I am today. There’s so much that is kind of untraditional when we think of medicine, and that can be, I wrote a book on menopause, I never thought that would be something I would do, or being chief medical officer of a company who really understands that what we deliver in healthcare is not always what people need. So I would say think big, stay curious, because being curious breeds growth.

How a CLD Grad Discovered Longevity Medicine Through Her Current Patients

Dr. Angela Contreras, an anesthesiologist and interventional pain physician in Chicago and founder of Integer Health, didn’t set out to become a longevity doctor. The shift happened almost by accident, in Hawaii, right as a wave of newly separated veterans started asking her for something her training hadn’t prepared her to give.

When did longevity medicine first come on your radar?

Longevity medicine is something that I really came into touch with kind of right before I moved to Hawaii. I moved to Hawaii back in 2024 to open an interventional pain clinic for the federal government, for the VA health system. Right before that, I started noticing my interest in longevity and wanting to shift toward an approach to medicine that wasn’t as reactive, and wasn’t just treating diseases as they were surfacing for patients, but rather getting to the root of the problem. I was really fortunate to have a wonderful patient population of new veterans, individuals right out of active duty, at the pinnacle of their physiological health. They were asking me for things patients hadn’t really ever verbalized before, ways to heal their bodies in a nontraditional way, not just with interventional pain injections, but with a more holistic approach. It was the perfect timing. These patients were asking for it at the same time I was seeking something different. Longevity became something I couldn’t just ignore.

You graduated from CLD. What was one of your key takeaways from the certification?

Because the field is so novel, there’s a lot of unknowns. The certification allowed me to at least recognize what I don’t know, and gave me the framework to build some of these foundational concepts of longevity that aren’t necessarily something you can find at one conference, or in one journal, because it spans all the different specialties and then some, and it spans the basic sciences. The course allowed me to build a framework for what I need to delve into further. I would have been very lost without it. It’s navigating unknown territory.

What’s one piece of advice you’d give a physician looking to get into longevity medicine?

I would encourage them to do it. I think now is the time, the field is evolving quickly. It’s exciting, it’s novel. For a lot of physicians, this fills a void that seemed to have been there, taking the more traditional approach. So I would say just do it.

This is exactly why we are building The Certified Longevitydocs.™ (CLD) the certification and training for the longevity physician of the future. Every doctor should be a longevity doctor.

Prognostic Value of Blood-Based P-Tau217 Levels for Progression to Cognitive Impairment

In a pooled sample of multiple selected cohorts of cognitively unimpaired older adults, higher plasma p-tau217 levels were consistently associated with increased risk of clinical progression and accelerated cognitive decline. By providing time-specific absolute risk estimates, these findings support the potential of p-tau217 for prognostic model development, with direct implications for future trial design. JAMA

Metformin added to lifestyle intervention for physical function

The RCT published in Lancet suggest that in older adults with obesity undergoing intensive lifestyle intervention, metformin does not provide additional improvement in physical function. These results support prioritising lifestyle-based strategies to improve functional outcomes in this population. Lancet Healthy Longevity

Functional, molecular, and digital measurements of biological age

In this state-of-the-art Review, we explore historical and modern approaches to estimating biological age and highlight key conceptual, technical, and translational challenges that remain unresolved. As geroscience-guided interventions are incorporated into clinical evaluations, robust and accurate interpretable measures of biological aging are crucial to ascertain treatment effects in clinical trials. JCI

Every week, I track funding, FDA approvals, product launches, and breakthrough announcements shaping longevity medicine.

AI

OpenAI Health is Live

Health launched July 23 to US users 18+, all plans, web and iOS. Patients can connect Apple Health, One Medical, Function Health, and supported hospital system records. ChatGPT then reads labs, medications, conditions, visit notes, sleep, and activity, and carries that context into any conversation, not a separate health tab. OpenAI says connected records are not used for training or ads, and that permission is requested per response unless the patient switches it to always-allow.

Caristo Diagnostics' CaRi-Heart® Coronary Inflammation Technology Authorized by U.S. FDA

Developed from research at the University of Oxford, CaRi-Heart's flagship technology uses advanced AI to detect inflammation-related changes in the fat surrounding the coronary arteries and quantify them as a fat attenuation index score (FAI-Score™), Caristo's validated proprietary biomarker of coronary inflammation. The analysis also generates the CaRi-Heart® Risk score, a personalized estimate of a patient's risk of cardiovascular mortality over 10 years.

PHARMA

Eli Lilly Pays $2.8B for a Psychedelic-Medicine Bet

Forbes reports Eli Lilly is acquiring AtaiBeckley, the psychedelic-medicine biotech Christian Angermayer built after a personal mushroom trip convinced him FDA-approved drugs could come from psychedelics, in a $2.8 billion deal. Forbes

TECH

Why Eli Lilly is collaborating with Oura

Eli Lilly’s digital healthcare platform announced a marketing collaboration with Oura. Get a free Oura ring sizing kit. Marketing deal only, no data sharing between the two.

The partnership announcement also comes just weeks after Oura announced a new in-app tool called GLP-1 Insights, which helps GLP-1 users track their doses, side effects, and weight.

POLICY

Montana’s plan to become an experimental medical hub just pushed forward

As of this week in Montana, any biotech company with an experimental drug has a clear path to selling it to consumers. Companies whose drugs have been through preliminary testing—sometimes in as few as 10 healthy people—can pay $12,500 to apply to a newly established review board for approval. Once its treatment is rubber-stamped, the company can set the price of the drug and sell it via experimental treatment clinics, the first of which is likely to be up and running around the end of this year. MIT

CULTURE

How the Longevity Movement Is Transforming Luxury Real Estate

The findings suggest a fundamental shift in how luxury real estate is viewed. The modern trophy home isn’t necessarily the largest or most extravagant property on the block, but rather something of a tool to help owners live better, longer, and more independently for decades to come. Robb Report

The Home of Longevity Medicine

longevitydocs.™ is the largest vetted community of longevity physicians in the world, and the home of the credential that defines the field. 1,200+ doctors. 68 countries. Building the new standard of care. Every doctor should be a longevity doctor.™

Apply to Join

Editorial Disclaimer:

This newsletter is published exclusively for licensed physicians and qualified healthcare professionals. It is not intended for consumers or patients.

All content, including the Buzz in the Chat section, is for continuing medical education and professional information purposes only. It reflects emerging research, science, and technology that may have implications for the practice of medicine. It does not constitute medical advice, clinical recommendations, or treatment guidance for any individual patient.

Peer-to-peer discussions reproduced in this newsletter represent the personal clinical opinions of individual physicians. They do not reflect the official position of longevitydocs and have not been reviewed or endorsed by any regulatory, medical, or professional body.

References to specific therapies, compounds, devices, or protocols are provided for educational context only. Some may be investigational, off-label, or not approved by the FDA, EMA, or equivalent regulatory authorities in your jurisdiction. Physicians are responsible for independently evaluating all information in accordance with current evidence, applicable law, and the standards of their licensing board.

longevitydocs does not promote, endorse, or recommend any specific product, treatment, or commercial entity. Nothing in this newsletter should be construed as a solicitation or as influencing prescribing behavior.

By reading this newsletter, you confirm that you are a licensed healthcare professional and that you will apply the information contained herein within the bounds of your clinical judgment, professional obligations, and applicable regulations.

If you are a patient or consumer reading this newsletter, please note that this content should not be used to make any health or medical decisions. Please consult your personal physician or a qualified healthcare provider for guidance specific to your situation.

Hey Doc,

I just got back from Shanghai and Seoul, and I am fired up. I visited clinics, hospitals, met dozens of physicians and owners, all building longevity care on opposite sides of the planet. The infrastructure is here, and it is going up fast.

Look at this week. Neko raised $700 million to put prevention within reach of everyone, not just the wealthy. Lilly became the first trillion-dollar drug company by betting on preventive medicine. A $13,500 robot performed live surgery with the physician in the loop the whole time.

Prevention is being democratized. The tools are getting cheaper, the reach is getting wider, and for the first time we can bring this to millions of patients, on every continent, not a lucky few.

That is our mission. The infrastructure is being built right now. Super grateful to be meeting the physicians building it around the world!

Dr. David Luu, Founder, longevitydocs.™

Each week, I try to explore one idea that could advance longevity medicine and hopefully support physicians in bringing it to life.

Field Notes from Shanghai and Seoul

What I Learned Visiting Clinics and Hospitals in China and South Korea

I just spent two weeks in Shanghai and Seoul, meeting physicians and leaders and walking through their clinics and hospitals. Here is my honest summary, the opportunities and the challenges:

Opportunities

• Experience. Some of these clinics and hospitals are designed like five-star hotels. Impeccable amenities, real architecture, the finish of a luxury property. The space itself tells the patient this is serious.

  

• Equipment and technology. Rooms full of the latest imaging, CT, MRI, DEXA, functional diagnostics, at a level most Western clinics would think twice before buying. Some cosmetic-focused clinics run twenty-plus devices worth several million dollars, the newest of everything, all under one roof.

  

• Price. They can be strikingly competitive, a full workup for a few thousand dollars. And even when they reach Western prices, they deliver it in a few hours instead of spreading it across days.

• Scale and speed. Care moves fast, sometimes finished in hours, and they handle large numbers of patients at once without the experience falling apart.

  

• Longevity tourism. Put the price, the equipment, the experience, and the speed together and you have a destination, not just a clinic. Patients will travel for a week of diagnostics and a level of care they cannot get, or cannot afford, where they live. Asia is quietly positioning itself to be where they land.

Challenges

• Regulation. Every country has its own rules, and in most of them nobody has defined what longevity medicine even is yet. That is freedom and risk in the same breath, because what is allowed today can close tomorrow and no one is building on ground they trust.

  

• Language. It is a wall that works in two directions. A patient will not fly toward a place they cannot talk to, and the best training and literature still move in English, so both the patients and the knowledge travel slower than they should.

  

• Communicating the care. Nobody has figured out how to explain this medicine simply, to patients or to referring physicians, what it does and why it is worth paying for. The value is real. The language for it is not built yet.

• Patient acquisition and competition. Beautiful buildings, serious equipment, strong teams, and the hardest question in every room is still how to fill the schedule. The category is getting crowded fast, so differentiation stopped being optional, and nobody has actually solved acquisition.

• No institutional framework. There is no shared standard, no common credential, no agreed definition of what a longevity clinic actually is. Everyone is building their own version.

• Access to education. The hunger to learn was everywhere I went, and it genuinely moved me. But the training pipeline is narrow and expensive, demand far outruns supply, and it still needs to be adapted to local culture and regulation.

• Recruiting doctors. You can buy the machines. You cannot buy the physician who knows how to read them, and everyone is chasing the same short list of people who can. The talent is the bottleneck, not the capital.

  

I came back genuinely impressed. What they are building in preventive, cosmetic, and dental care is real and moving fast, and longevity is firmly on the map. They will deliver.

And what I saw in Shanghai and Seoul is the same everywhere. This is not an Asia story, it is the shape of the field worldwide. Longevity care is becoming an economic asset, the way a country’s hospitals and universities already are. The investment will build the infrastructure, the buildings, the machines, the scale, with or without us.

Capital builds the infrastructure. Trained physicians deliver the care, and that is what makes them the most valuable asset in the building. So if you run a clinic or a hospital, the highest-return investment you can make is not another scanner. It is training your doctors.

That is exactly what we are building at longevitydocs.™: the certification and the training program for the longevity physician of the future. Every doctor should be a longevity doctor.

Certify Your Doctor

Therapeutic Plasma Exchange - Dr. Dobri Kiprov

Dr. Dobri Kiprov, a 40-year veteran of therapeutic apheresis, explained how therapeutic plasma exchange (TPE) removes pro-inflammatory factors and may reverse aspects of immune aging. He reviewed clinical experience in autoimmune disease (myasthenia gravis, lupus), the AMBAR Alzheimer’s trial, and a placebo-controlled longevity study, plus emerging adsorption-column filtration technology.

5 KEY TAKEAWAYS

• TPE is performed via centrifugal or membrane apheresis to separate plasma from cells. It is used across more than 90 diseases, the majority autoimmune, with indications graded by the American Society for Apheresis (ASFA) every three years.

• The concept is “subtractive medicine”: removing offending factors (autoantibodies, cytokines, chemokines, circulating immune complexes) rather than adding drugs that can trigger new pathways and side effects.

• Kiprov targets three aging hallmarks: inflammation, immunosenescence, and cell senescence/SASP. He reports that TPE removes SASP factors effectively and can restore proliferation of naive CD4 and CD8 T cells, shown by flow cytometry.

• The AMBAR Alzheimer’s trial (sponsored by Grifols) tested amyloid removal by albumin-bound plasma exchange. Amyloid was found not to be the sole driver of disease, and outpatient TPE proved safe and well tolerated. Kiprov framed it as evidence the modality is viable in neurodegeneration, not as a head-to-head comparison against approved anti-amyloid therapies.

• In a single double-blind, placebo-controlled study in adults 50 and older, TPE was associated with a lower biological age and an immune profile roughly 7 to 9 years younger, alongside reduced SASP and inflammatory markers, measured by DNA methylation clocks including organ-specific aging. Best read as preliminary, single-study results resting on epigenetic-clock surrogates still under validation.

Estrogen, Statins, and Lipids - Dr. Amy Killen

Dr. Amy Killen discussed how estrogen loss at menopause and statin therapy exert overlapping negative effects (particularly on mitochondria and insulin sensitivity) in women, yet the interaction between hormone therapy and statins has not been studied since the 1990s. She argued for prioritizing hormone therapy and lifestyle before statins in appropriate patients and challenged long-held assumptions about lower-dose estrogen being safer.

5 KEY TAKEAWAYS

• A June 2026 observational study of about 1,200 postmenopausal women across 9 countries found statin users reported more severe menopause symptoms (47% vs 31%), more severe muscle and joint pain (53% vs 34%), and roughly twice the rate of sarcopenia.

• No study since the late 1990s has examined how menopausal status or estrogen therapy affects statin efficacy or side effects. JUPITER is the only major lipid trial that even addresses menopause status, and it does so by excluding premenopausal women.

• Estrogen acts protectively at multiple levels of lipid metabolism (production, absorption, and clearance). Its loss at menopause drives up LDL, ApoB, and triglycerides.

• Statins and estrogen loss produce a “double hit” on mitochondria: statins block CoQ10 synthesis, and estrogen loss reduces mitochondrial resilience. Both also worsen insulin resistance, likely explaining why statins cause more muscle side effects and diabetes risk in women.

• Killen questions the “lowest dose, shortest duration” estrogen dogma, noting it was never actually studied. A 2019 Lancet analysis found the lowest Premarin dose (0.3 mg) carried the highest associated breast cancer risk, with all other doses carrying roughly equal risk.

Every week, the longevitydocs.™ App feels like a front-row seat to the future of medicine. Here’s what had doctors buzzing:

Should everyone with elevated Lp(a) be on aspirin?

One doc asked the cardiologists directly:

“Where are we on aspirin for everyone with Lp(a), or not?”

Those are some of the answers:

“I give it if they have plaque on CT or ultrasound carotids, clopidogrel as opposed to aspirin. If no plaque, I don’t.”

“You need evidence of significant cardiovascular disease to increase the odds that the CV benefit outweighs the bleeding risk.”

Aspirin is not a free intervention, and elevated Lp(a) alone does not settle the risk-benefit math.

“There is a guideline answer and a practical answer. Give aspirin if there is any evidence of atherosclerosis, especially if accelerated. The monogenic and polygenic information matters: there is real benefit for Lp(a) carriers and the high polygenic-risk group, the top 20 percent. And isoforms matter, shorter ones drive higher levels, and the damage is proportional to the plasma level.”

Another doc pushed on the genetic angle, raising a commercial LPA-genotype panel that “apparently suggests aspirin benefit.”

The case for aspirin specifically in high-Lp(a) patients rests on genotype-subgroup data, not a prospective trial built for the question. A Women’s Health Study analysis found that carriers of an Lp(a)-raising variant got a cardiovascular benefit from low-dose aspirin, and a 2022 ASPREE genotype analysis in JACC pointed the same direction, reduced events in carriers of the Lp(a)-raising genotype, bought at the cost of bleeding.

Meanwhile the broad primary-prevention aspirin trials, ASPREE, ARRIVE, and ASCEND, landed on net neutral or net harm in unselected patients, which is exactly why universal aspirin fell out of favor in the first place. Current guidelines treat elevated Lp(a) as a risk-enhancing factor, a thumb on the scale, not a standalone indication to treat.

So the practical synthesis matches where the group landed. Aspirin for elevated Lp(a) is a targeted decision, not a blanket one. Reach for it when there is evidence of subclinical atherosclerosis, plaque on CT or carotid imaging, or a genuinely high genetic burden, and weigh it explicitly against bleeding risk in each patient. In an asymptomatic person whose only finding is a high number, the honest position is that the trial you would want does not exist, and a risk-enhancer is not a mandate.

One structural point worth saying out loud. We are debating aspirin partly because there is still no approved therapy that lowers Lp(a) itself, with several agents in phase 3. Until those read out, aspirin and aggressive management of every other modifiable risk factor around the Lp(a) are the levers we actually have. That is the real reason this question keeps coming up, and the real reason it stays unsettled.

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Prognostic Value of Blood-Based P-Tau217 Levels for Progression to Cognitive Impairment

A single blood marker, plasma p-tau217, predicted 5-year risk of cognitive decline in healthy older adults, from 12% in the lowest group to 38% in the highest, and it held up even after adjusting for amyloid PET. New JAMA pooled analysis of 2,684 cognitively unimpaired adults, the clearest case yet for a scalable, blood-based Alzheimer's risk test in prevention. JAMA

Addressing benchmarking gaps in large language models for health and medicine

The models that ace medical benchmarks fall apart under pressure: 94% of initially correct answers failed dynamic robustness testing, 86% of privacy scenarios leaked protected health information, and hallucination hit 74% across widely used LLMs. New Nature Health study red-teaming 15 state-of-the-art models, and it should temper how much any of us lean on these tools unsupervised in the clinic. Nature

Every week, I track funding, FDA approvals, product launches, and breakthrough announcements shaping longevity medicine.

CARE

Neko Raises $700M to Scale Longevity Care

Neko Health, Daniel Ek’s preventive full-body-scan company, raised $700 million at a near $7 billion valuation. Their proprietary 60-minute scan includes non-invasive full-body imaging with skin photos, blood work, ECG, and arterial and body-composition analysis, screening for skin cancer, cardiovascular disease, and diabetes. It has run 100,000 scans across eight UK and Sweden clinics with 350,000 more waitlisted, and now opens its first US clinic in New York.

TECH

A $13,500 Robot Performs Live Surgery

Two off-the-shelf Chinese humanoids, Unitree G1s at around $13,500 each, performed the first live-animal surgery by general-purpose robots: two porcine gallbladder removals at UC San Diego, published in Nature. The detail that matters is that these were not purpose-built surgical devices. Surgeons teleoperated standard humanoids holding the same laparoscopic instruments already in every OR, one run pairing a robot with a human surgeon, another pairing two robots.

BIOTECH

World’s First CAR-T Cell Therapy For Solid Cancer Approved in China

China’s NMPA just approved CARsgen’s satri-cel, the first CAR-T cell therapy to clear regulators for a solid tumor: claudin18.2-positive, HER2-negative advanced gastric and GEJ adenocarcinoma after at least two prior lines. In the phase II trial Peking University’s Lin Shen led, published in The Lancet, median overall survival was 7.9 months versus 5.5 on physician’s choice in the ITT population, and 12-month survival was 39% versus 27%. The catch: 99% of treated patients had grade 3 or higher adverse events, and 95% developed cytokine release syndrome.

PHARMA

Lipfendra: The First PCSK9 You Swallow

The FDA just approved enlicitide (Lipfendra), Merck’s once-daily oral PCSK9 inhibitor, for adults with hypercholesterolemia and heterozygous familial hypercholesterolemia. In CORALreef Lipids it dropped LDL by 57.1% versus a slight rise on placebo at 24 weeks, and CORALreef HeFH showed a 59.4% between-group reduction, both with placebo-level tolerability. It joins the injectables (inclisiran, evolocumab, alirocumab, lerodalcibep) as the first one you swallow.

POLICIES

Annual Testosterone Testing for US Soldiers

Defense Secretary Pete Hegseth will require every male service member 30 and older to be screened for low testosterone, with the option of testosterone replacement therapy (TRT) if levels come back low, framed around "lethality" and optimizing performance. That is a large population: more than 300,000 active-duty men over 30.

BUSINESS

Lilly Bets On Longevity Medicine

Eli Lilly became the first drugmaker worth more than a trillion dollars, and CEO Dave Ricks told The Economist the obesity franchise is only the on-ramp. The real bet is reinventing pharma around prevention: GLP-1s expanding into cardiovascular, sleep apnea, and kidney disease, donanemab tested in asymptomatic Alzheimer’s, and $7.8 billion spent on a sleep biotech. More than half of new GLP-1 starts now begin online through LillyDirect.

WELLNESS

IM8 Secured $1B to Support Growth

David Beckham’s supplement brand IM8, built under Danny Yeung’s Prenetics (public co), secured $1 billion from General Catalyst. It reports over $200 million in revenue since its December 2024 launch, roughly $17 million a month, projecting a $300 million run-rate by year-end. The flagship is a 90-ingredient “Daily Ultimate Essentials” powder.

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