Longevity clinics, and what the evidence shows

Most visits follow the same shape. You complete a history questionnaire, give blood, and sit through a battery of tests a standard appointment would not order. The clinic then produces a report with a risk profile and a plan, usually some combination of exercise and diet coaching, supplements, prescription drugs, and repeat testing at intervals.

What varies is the ratio of diagnostics to treatment. Counting what the 131 clinics in this directory list on their own websites:

• Comprehensive biomarker panels, meaning blood tests covering dozens to hundreds of markers rather than the handful a routine check-up runs: 115 clinics
• Concierge membership, an annual fee for continuing access to a named doctor: 65
• Executive physical, a half-day or full-day diagnostic package: 73
• Hormone optimisation, meaning testosterone or hormone replacement therapy: 54
• Intravenous vitamin infusions: 60
• Full-body MRI screening, scanning someone who has no symptoms: 49
• Biological age testing, which estimates the age of your body from chemical marks on your DNA rather than from your birth certificate: 54
• Peptide therapy, short chains of amino acids prescribed to act on metabolism, healing or appetite: 35
• NAD+ infusions, a drip of a molecule cells use to release energy from food: 39

Below those sit VO2 max testing at 35 clinics, platelet-rich plasma injections at 30, cryotherapy and red light therapy at 29 each, hyperbaric oxygen therapy at 28, stem cell therapy and DEXA scans at 26 each, and continuous glucose monitoring at 20.

The shape of that list is the point. Measurement is close to universal; the treatments bolted onto it differ a great deal between clinics, and so does the evidence behind them.

A standard check-up looks for disease you already have, using a short list of tests that national screening bodies consider worth running on everyone. A longevity clinic runs a much longer list, aimed at risk that may surface in 10 or 30 years, and bills you directly, because insurers do not generally pay for tests no screening body has endorsed.

That difference cuts both ways. More tests find more things: some worth catching early, others harmless anomalies that lead to further scans, biopsies and worry. The clinic is selling you information, and information has a cost beyond its price.

Anti-ageing clinic, age-management clinic, longevity centre and healthspan clinic all describe the same commercial category. The label tracks the era more than the medicine: anti-ageing came out of the hormone-prescribing practices of the 1990s, age management out of the 2000s, longevity out of the past decade of research into the biology of ageing. Judge a clinic on what it tests, what it prescribes, and who signs the prescription, not on which of those words is above the door.

We do not publish prices, because we do not have them. We hold a coarse band, from $ to $$$$, for 84 of the 131 clinics and nothing at all for the other 47, and a band is not a price. Anyone quoting a precise figure for a clinic that does not publish one is guessing.

What we can describe is the shape of the market, which has three tiers rather than a single number.

• Single tests bought on their own. A DEXA body-composition scan, a VO2 max treadmill test, a full-body MRI. Priced per item, and the cheapest way in.
• A diagnostic package. The half-day or full-day workup: bloods, imaging, fitness testing and a consultation to explain the results. 73 of the 131 clinics list one.
• Annual membership. Continuing access to a doctor, repeat testing through the year, and a plan that gets revised. 65 clinics offer one and 24 require it to take you on at all.

The gap between a quoted price and a final bill is usually made of the items billed on top: repeat blood panels, follow-up scans prompted by a finding, prescriptions, supplements bought from the clinic, and any specialist you are referred to. Ask for an itemised written quote covering the first 12 months, naming what is included and what is extra.

Few clinics publish a full price list, so comparison is difficult by default. Where one does publish, that is itself worth noting.

This is the half of the category that other directories leave out. It is possible to list every clinic selling hyperbaric oxygen therapy without ever saying what the evidence for it amounts to.

Twelve of the 20 services in this directory have an evidence page on this site, each written from the primary research. Three of them give the flavour.

• Hyperbaric oxygen therapy, offered by 28 of the 131 clinics. The claim that it reverses ageing rests on one study of 35 people that has never been repeated.
• NAD+ infusions, offered by 49 clinics. The only randomised trial gave the infusion to 180 adults whose heart muscle had been weakened by blocked arteries, over seven days. It measured none of the things people actually book a drip for: energy, weight, mental sharpness, skin.
• Full-body MRI screening, offered by 39 clinics. In people without symptoms the evidence comes down to a single study of 298 adults, in which 29% of examinations flagged something worth reporting. Its authors concluded that screening scans should not be done outside a research setting.

None of that makes these treatments useless, and none of it is a verdict on any clinic that offers them. It means the confident version of the sales claim, that these things slow ageing, is ahead of the evidence, and the gap is what you are paying for.

Two caveats in the other direction. Eight of the 20 services have no evidence page yet, which means we have not reviewed them, not that they failed a review. And rapamycin, the drug with the most consistent record of extending life in mammals, adding 14% to the lifespan of female mice and 9% to males across three independent centres, is publicly listed by none of the 131 clinics here. The gap between what the evidence favours and what the market sells runs both ways.

The full mapping of service to evidence is below.

Six questions, in the order worth asking them.

Who is the doctor, and on which register? A licence to practise medicine is not a qualification in the biology of ageing. Longevity medicine is not a speciality recognised by the American Board of Medical Specialties, nor an entry on the UK General Medical Council's specialist register, so certificates displayed in clinic waiting rooms usually come from private organisations rather than a national board. Ask which register the doctor appears on and in which speciality, then check the register yourself.

What happens when a result comes back abnormal? A clinic that finds a shadow on a scan and hands you the report has sold you a problem rather than care. Ask what the referral route is, who follows it up, and who pays for the next scan.

Does the clinic profit from what it prescribes? In-house dispensing of supplements, hormones or infusions is a conflict of interest. It is not disqualifying, plenty of ordinary medicine works that way, but ask the question and note how readily it is answered.

What is the evidence for the signature therapy? Ask for the studies by name. A trial you can look up afterwards is an answer. A count of satisfied patients is not.

What does the first year cost in total? In writing, itemised, including repeat testing.

What is being promised? A clinic saying it will reverse your biological age is describing something no published trial has demonstrated in people. A clinic saying it can lower specific measured risk factors is describing something ordinary preventative medicine also does, which is a more modest claim and a more credible one.

Screening healthy people is not a neutral act.

Incidental findings. In the one study of full-body MRI in people without symptoms, 29% of examinations turned up something worth reporting. Most such findings are harmless, but each has to be chased, and the chase means more imaging, sometimes a biopsy with its own complication rate, and weeks of waiting.

Overdiagnosis. Some of what screening finds would never have caused symptoms in your lifetime. Treating it anyway carries all of the harm of treatment and none of the benefit.

Prescribing without a deficiency. Testosterone replacement has randomised evidence behind it for men with a deficiency confirmed on blood tests, where it improves sex drive, erectile function and bone strength. It has not been shown to slow ageing in anyone else.

Products whose regulation varies. Stem cell therapy is listed by 22 of these clinics and peptide therapy by 33, and how tightly either is regulated depends on the country you are standing in. A doctor may lawfully prescribe a licensed drug outside its licensed use. That is a legal fact, not evidence of an effect on ageing.

The number itself. A report saying your biological age is 47 moves depending on which method produced it and which tissue was sampled. Treat it as a measurement with error attached, not a verdict.

The 131 clinics here sit in 89 cities across 14 countries: 56 in the United States, 12 in the United Kingdom, 10 in Switzerland, nine in Italy, seven in Austria, six in Spain, five each in France, Canada, Germany, the United Arab Emirates and the Netherlands, four in Mexico, and one each in Denmark and Qatar.

That distribution reflects where this market has grown fastest and where clinics publish enough on their own websites to be verified. It is not a judgement about quality, and it is not a map of the whole market. A clinic missing from this list has not been rejected. It has not been checked yet.

Browse by city below, or by service if you are looking for a specific test.

Every fact on a clinic page comes from one of two places: that clinic's row in our database, or the clinic's own website. We do not repeat claims from other directories, press releases or third-party lists.

We do not rank clinics. There is no top 10 here and no scoring system, because we have no defensible basis for one. Listings are ordered alphabetically within a city or service.

No clinic pays to appear. There are no affiliate links on this page, no booking commissions and no sponsored placements.

What we do not hold, again: no patient reviews at all, a coarse price band on 84 of 131 clinics and none on the rest, and a founding year on only 19. Where a field is missing from a clinic page, it is missing because we could not verify it, not because it was edited out.

What we do hold, and what the rest of this category does not publish, is an evidence page for twelve of the 20 services these clinics sell, including the ones where the honest answer is that the research does not support the claim.

If you run a clinic listed here and something is wrong, tell us and we will correct it. Everything on this page is educational and is not medical advice. Speak to a doctor who knows your history before starting or stopping any treatment.