Buying guide · Avoid / prioritize / skip
The longevity market sells urgency. Most of its most expensive purchases are optional until a specific, named condition is met and a clinician already owns the follow-up. Here is the threshold to clear first, and eight buys worth delaying until you clear it.
Cover blood pressure, ApoB and a one-time Lp(a), HbA1c, body composition, a strength and cardio benchmark, sleep regularity, and a named clinician who owns abnormal results before spending on a full-body MRI, a biological-age test, NAD+ infusions, a home hyperbaric chamber, stem-cell or exosome treatment abroad, peptides without a prescriber, an open-ended CGM subscription, or an annual clinic membership bought instead of primary care.
Skip until the threshold above is cleared. Every purchase below can be defensible for a named condition with a clinician who owns the follow-up; none of them are a defensible substitute for the boring baseline.
A 2025 meta-analysis of 9,024 asymptomatic people found a 1.57% confirmed-cancer detection rate; an earlier review of 5,373 people found 32.1% had a critical or indeterminate incidental finding, and 16.0% of those were later confirmed false positives. Defensible with a named risk (family history, a genetic syndrome) and a clinician who owns follow-up before you book. Do the Baseline Month first.
A 2025 review found the same sample re-tested on the same clock can swing by up to 9 years, different clocks disagree with each other on the same person, and there is no clinical cutoff telling you what to do with the number. Defensible as a research curiosity tracked over years, not as a purchase that changes what you do this month. Get the boring biomarkers with real treatment thresholds first.
The FDA has flagged compounded NAD+ made from food-grade material for contamination risk, tying it to adverse events including chills, vomiting and shaking consistent with endotoxin exposure, and has never evaluated NAD+ for efficacy in a healthy adult. Defensible only inside a supervised protocol tracking a named marker, never as an open-ended subscription.
The telomere study behind hyperbaric oxygen's aging-reversal reputation used 2.0 ATA on 100% oxygen, supervised, for 60 sessions. Home soft-shell units cap at 1.3 ATA on room air, a different intervention that study never tested, and FDA's 2025 letter to clinicians ties chambers to fire risk and flags unapproved aging-reversal claims. Rent supervised sessions at the studied dose before buying a chamber.
There are no FDA-approved exosome products, and the agency's own consumer alert documents adverse events including infection, blindness and tumor formation from unapproved stem-cell and exosome products. ISSCR's own patient guide warns that clinics market unproven treatments at high cost to the patient and high profit to the clinic. Defensible only inside a registered, IRB-approved clinical trial, never a paid clinic visit.
FDA's own compounding advisory committee met July 23-24, 2026 and voted, non-bindingly, to recommend several peptides including BPC-157 and TB-500 for a compounding list, against its own review staff's safety-data concerns. None of them are FDA-approved drugs, and pharmacies cannot legally compound them until a final rule is in place. See our peptide guide for the process bar: named prescriber, real indication, lawful pharmacy, monitoring, written stop criteria.
OTC clearance changed access, not the evidence bar: the label still tells users not to make medical decisions from the output without a clinician. Useful as a bounded two-week audit of one specific diet question; weak as a forever subscription. Check HbA1c as part of the Baseline Month first.
A membership is not the same relationship as a primary care physician who keeps your records for decades, and venture-backed, physician-staffed clinics have closed within two years of opening. Get a primary care physician and complete the Baseline Month first, then decide whether a membership adds anything beyond that.
None of the eight purchases below are banned. They are ordered. Before any of them, get a home blood-pressure reading taken calmly on multiple days, ask whether ApoB or LDL particle number belongs in your next panel, measure Lp(a) at least once in adulthood, add HbA1c or glucose context, anchor body composition, benchmark grip or strength plus one cardio measure, get a read on sleep regularity, and name the clinician who owns what happens if any of those come back abnormal. The Baseline Month lays out exactly how to do this in a month, not a shopping trip.
This is not "never buy these." It is "not yet, and not instead of this." The cheapest useful purchase is usually the measurement that talks you out of the expensive one, or the measurement that tells you the expensive one is actually worth it for your specific numbers.
A whole-body MRI in a healthy, average-risk adult is the clearest example of marketing outrunning evidence. The American College of Radiology's 2023 statement says there is no documented evidence that total-body screening is cost-efficient or effective in prolonging life for people with no symptoms, risk factors or family history. A 2025 systematic review pooling 9,024 asymptomatic people found a confirmed-cancer detection rate of 1.57%, and a 2019 review of 5,373 subjects found 32.1% had a critical or indeterminate incidental finding, with 16.0% of those reported findings later confirmed false positives. What would change the verdict: a named risk, such as a strong family history of a screenable cancer or a genetic predisposition syndrome, plus a clinician already lined up to own the follow-up.
A biological-age or epigenetic-age test sells a single number as the truth about how fast you are aging. A 2025 review in Epigenomics found that technical replicates of the same blood sample, re-run on the same clock, have produced age estimates up to 9 years apart, and that different clocks are trained on different aging aspects and routinely disagree on the same person. There is no gold-standard reference and no clinically validated cutoff telling you when the number means you should act. What would change the verdict: a specific research protocol tracking the same clock in the same person over years, read as a trend rather than a diagnosis, and never bought instead of a lipid panel.
An open-ended continuous glucose monitor subscription for someone without diabetes sells personalized metabolism. The FDA's 2024 clearance of Dexcom Stelo as the first OTC CGM was an access change, not new efficacy evidence for the metabolically healthy, and the agency's own safety communication is blunt that no smartwatch or ring measures glucose on its own, and that CGM output should not drive medical decisions without a clinician. What would change the verdict: a bounded two-to-four-week audit of one specific question, such as whether a post-meal walk flattens a spike, not a monthly charge that runs indefinitely.
NAD+ IV therapy is sold as cellular renewal, priced from roughly $250 to $1,500 a session and $8,000 to $18,000 a year for people using it as an ongoing protocol. The FDA has told compounders directly that food-grade NAD+, sold by repackagers for use in IV products, is not suitable for sterile compounding without proper processing because of contamination risk, and it has received adverse-event reports of severe chills, shaking, vomiting and fatigue consistent with endotoxin exposure. The agency has never evaluated NAD+ itself for safety, efficacy or quality. What would change the verdict: a supervised protocol at a clinic using pharmaceutical-grade material, tracking a specific named marker, not a rotating monthly package.
Peptides marketed for recovery, repair or fat loss sit in a regulatory gray zone that is actively moving, which is exactly why buying one without a prescriber is premature rather than settled. On July 23-24, 2026, the FDA's Pharmacy Compounding Advisory Committee met to decide whether BPC-157, KPV, TB-500, MOTS-c, Semax and Epitalon should be added to the 503A Bulks List that governs what compounding pharmacies may legally use, and voted to recommend most of them for inclusion, reportedly against its own review staff's concerns about limited safety data. That vote is non-binding: pharmacies cannot compound these substances until the FDA completes a formal rulemaking, none of them are FDA-approved drugs, and a favorable committee vote is not a safety finding. Our peptide guide lays out the actual bar before any of them make sense: a named prescriber, a real indication, a lawful pharmacy source, baseline labs where relevant, monitoring, and written stop criteria. Vials sold as research-use-only are a walk-away signal regardless of what a committee votes on.
A home hyperbaric chamber at 1.3 ATA is usually sold on the back of a single 2020 study that found telomere lengthening and reduced senescent-cell counts in 35 healthy adults over 64. That study used a clinical dose, 2.0 ATA on 100% oxygen, supervised, for 60 sessions over three months, at a cost of $27,999 and up for a hard-shell chamber that can reach it. The soft-shell units sold for home use, priced from roughly $5,000 to $25,000-plus, cap at 1.3 ATA on room air, a different and weaker intervention the study never tested. FDA's 2025 letter to health care providers separately ties hyperbaric devices to fires causing serious injuries and deaths, and flags centers promoting unapproved aging and longevity claims. What would change the verdict: a physician-supervised course at the studied 2.0 ATA dose for a named medical indication, not an unsupervised home unit bought on the strength of one small, industry-linked study.
Stem-cell or exosome treatment abroad is sold as regenerative medicine unavailable at home, typically priced from $5,000 to $25,000 and sometimes far higher for travel packages. There are currently no FDA-approved exosome products, and the FDA's own consumer alert on regenerative medicine documents adverse events from unapproved stem-cell and exosome products including infection, blindness and tumor formation. The International Society for Stem Cell Research publishes its own patient guide specifically because, in its words, a growing number of clinics market unproven treatments at great cost to the patient and great profit to the clinic. What would change the verdict: enrollment in a registered, IRB-approved clinical trial you can look up, not a clinic visit paid for out of pocket with no control arm and no public safety data.
Longevity-clinic memberships range from Fountain Life's $595-a-year BASE tier up to five-figure annual programs, and they are sold as a coordinated replacement for scattered, rushed primary care. The catch is not the testing menu; it is what happens if the company does not survive to deliver the follow-up. Eternal raised $13 million, ran physician-led programs with DEXA and VO2 max testing in two US cities, and closed both clinics within roughly two years, leaving patients to ask what happens to their records, referrals and follow-up plans. A membership is not the same standing relationship as a primary care physician who has owned your chart for a decade. What would change the verdict: you genuinely have no existing primary-care relationship, you value coordinated testing enough to pay for it, and you have the closure-contingency answer in writing before you pay, not after.
Nothing here is individual medical advice, and nothing here is a blanket ban. A named clinical indication from a clinician who has examined you overrides every row above: a real family history, a real symptom, a real referral changes the math completely. The point of this page is narrower than "avoid these forever." It is that the order matters, the boring measurements are cheaper and more decisive than the expensive purchases, and a purchase sold as urgency deserves the same scrutiny as any other five-figure decision.
For most healthy people, the weakest purchases are the ones sold as urgency without a named condition behind them: an elective full-body MRI with no risk factor, a biological-age test bought instead of standard bloodwork, an open-ended NAD+ or CGM subscription, and stem-cell or exosome treatment abroad. Each can be defensible for a specific person with a specific reason; none are defensible as a default first purchase.
Not reliably at the individual level. A 2025 review found that re-testing the same sample on the same epigenetic clock produced age estimates up to 9 years apart, and different clocks disagree with each other on the same person. Treat the number as a population-level research tool, not a personal diagnosis.
Usually not as a first purchase. The American College of Radiology says there is no documented evidence total-body screening extends life in average-risk people, and published research puts the odds of a confirmed cancer finding at roughly 1.57% against a roughly 32.1% chance of a critical or indeterminate incidental finding. It becomes more defensible with a named risk factor and a clinician ready to own the follow-up.
For most healthy people, no. The FDA has flagged compounded NAD+ for contamination risk from food-grade source material and has never evaluated NAD+ itself for efficacy. It is a weak open-ended subscription and a more defensible one-time or supervised protocol if you are tracking a specific named marker.
They are not FDA-approved drugs. An FDA advisory committee voted in July 2026 to recommend several peptides, including BPC-157 and TB-500, for a compounding list, but that vote is non-binding and pharmacies cannot legally compound them until a final rule is in place. Buying research-use-only vials directly is a walk-away signal, not a gray area.
By David Persson · Updated 2026-08-24 · Corrections: hi@agewell.guide
The Agewell Briefing
A sourced weekly read on longevity products, clinics and research, with a clear answer on what is worth trying.
One email a week. Unsubscribe with one click.