The Longevity Blood Panel: Which Tests to Order
A defensible panel is about twenty analytes, most of them on standard tests, with three additions that are commonly omitted and matter.
The Short Answer
A useful longevity panel is shorter and cheaper than the packages marketed for the purpose. Roughly twenty analytes cover cardiovascular exposure, metabolic function, inflammatory load, organ function, the common reversible nutrient contributors and thyroid status. Most sit on standard tests that cost very little. Three additions, apolipoprotein B, lipoprotein(a) once and fasting insulin, are the ones commonly missing and the ones that change decisions.
The Core Panel
| Test | Why |
|---|---|
| Apolipoprotein B | Counts atherogenic particles; the causal cardiovascular exposure |
| Lipid panel | Triglycerides, HDL, and the free triglyceride to HDL ratio |
| Lipoprotein(a), once | Inherited, causal, elevated in roughly one in five, rarely measured |
| HbA1c | Average glycaemia over roughly three months |
| Fasting insulin | Earlier signal than glucose; enables HOMA-IR |
| hs-CRP | Inflammatory load; responsive and cheap |
| Full blood count with differential | Anaemia, red cell indices, neutrophil to lymphocyte ratio |
| Ferritin with transferrin saturation | Iron status; interpret with hs-CRP |
| Comprehensive metabolic panel | Kidney, liver, electrolytes, calcium, albumin |
| GGT | Hepatic fat and metabolic integrator; on most panels and under-read |
| TSH with free T4 | Thyroid function |
| Vitamin D (25-OH) | Commonly low and correctable |
| Vitamin B12 with folate | Reversible cognitive and haematological contributors |
| Urine albumin to creatinine ratio | Early kidney damage; not on standard panels |
That is the panel. It is not exotic, and it covers the ground that outcome evidence supports.
The urine albumin to creatinine ratio deserves a specific note, since it is not a blood test and is arguably more important than several that are. It detects early kidney damage before eGFR falls, and it matters most in anyone with hypertension, diabetes or cardiovascular risk.
Reasonable Additions by Situation
If cognition or fatigue is a concern: homocysteine with methylmalonic acid where B12 is borderline, coeliac serology, and a mood screen. Plus an audiogram, which is not a blood test and carries more cognitive evidence than most of this panel.
If hormonal symptoms are present: the sex-appropriate panel with correct timing, covered in the male and female panel articles. Not in the absence of symptoms.
If bone is a concern or you are over the guideline age: DEXA, plus parathyroid hormone if corrected calcium is raised.
If supplementing omega-3 or eating little oily fish: the omega-3 index, which closes a loop most supplements leave open.
If cardiovascular risk is intermediate and a medication decision hangs on it: a coronary artery calcium score, as a clinical conversation.
If muscle mass or function is a concern: not a blood test. Grip strength, sit-to-stand and a fitness estimate cost nothing and predict more.
If liver enzymes are raised: FIB-4 calculated from the panel you already have, plus a review of alcohol, medications and supplements.
What to Leave Off
Broad hormone panels without symptoms. More analytes produce more incidental abnormalities requiring explanation, and the base rate of a value falling outside a reference range rises with the number measured.
Multi-cytokine inflammatory panels. hs-CRP does the job at a fraction of the cost with better assay reliability.
Salivary cortisol curves and adrenal panels. Not validated for the purpose they are sold for.
Food sensitivity IgG panels. Advised against by allergy societies, and the eliminations they generate reduce dietary variety.
Organic acid and comprehensive stool panels for optimisation. Interpretive narratives exceed what the analytes support.
Heavy metal panels without an exposure history. Provoked urine testing after a chelating agent is not a valid assessment method and is used to justify chelation.
Epigenetic age clocks and microbiome tests, which are interesting and not decision-changing.
NMR lipoprotein subfractionation where apoB is available.
The general test: name the two possible results and what you would do differently for each. If the answer is the same, the test is information rather than a decision.
Getting the Conditions Right
A well-chosen panel drawn under the wrong conditions produces misleading results, and the conditions cost nothing to get right.
Fast 8 to 12 hours for fasting insulin and glucose. ApoB and HbA1c do not require it; triglycerides are better fasting.
Morning draw, before 10am, if testosterone is included.
Avoid hard or unaccustomed exercise for 48 to 72 hours, which raises hs-CRP, AST, ALT and creatine kinase and lowers fasting insulin.
Not during or within a few weeks of acute illness, which raises hs-CRP and ferritin, lowers cholesterol, distorts thyroid results and lowers testosterone.
Note cycle day if female reproductive hormones are included.
Declare biotin, which interferes with thyroid and troponin immunoassays.
Hold high-dose biotin and, where advised, other supplements for a few days beforehand.
Same laboratory for serial comparison, since between-assay differences can exceed real change.
Hydrated but not overhydrated, since dilution affects haemoglobin and haematocrit.
Reading It as a Whole
The value of a panel is in the pattern, and the common patterns are worth recognising.
Raised triglycerides, low HDL, raised fasting insulin, raised GGT and ALT, raised uric acid, raised ferritin with normal transferrin saturation, central adiposity. One finding: insulin resistance with hepatic fat. Not seven problems.
Low ferritin, low MCV, raised RDW, raised platelets, fatigue. Iron shortfall. In men and postmenopausal women, requires a cause.
Normal apoB, raised lipoprotein(a), family history of premature disease. The panel looks fine and the risk is not. This is where a standard panel most misleads.
Raised hs-CRP with everything else normal. Check timing relative to illness and exercise, repeat, and consider periodontal disease and adiposity.
Everything normal but the person feels unwell. Look at sleep including sleep-disordered breathing, mood, medication burden, and whether the panel included ferritin, B12, thyroid function and coeliac serology.
Slow drift within the reference range across years. The most informative pattern of all, and only visible with serial results kept in one place.
Cost, and What Is Worth Paying For
Almost everything in the core panel is inexpensive, which is worth stating because the marketed longevity panels are not.
Full blood count, comprehensive metabolic panel, lipid panel, HbA1c, TSH, ferritin, vitamin D and B12 are standard tests available at low cost or through routine care in most systems. ApoB, hs-CRP, fasting insulin, free T4 and a urine albumin to creatinine ratio add modestly. Lipoprotein(a) is a single lifetime cost.
What the expensive packages add is mostly the tests on the leave-off list, plus presentation. The presentation has value if it makes someone act, and it is not measurement value.
Where money is worth spending, in rough order: getting the core panel at all if you have never had one; adding apoB and Lp(a) if your panel lacks them; a coronary calcium score where it would change a medication decision; a DEXA at the appropriate age; and an audiogram from midlife. Those five buy more decision-relevant information than any biological age product.
And the free measures still outperform much of the list. Home blood pressure across a week, waist circumference, grip strength, sit-to-stand and honest sleep and activity records cost nothing and predict a great deal.
The AEONNN Perspective
This is close to the panel AEONNN reads. Roughly twenty analytes, most of them standard and inexpensive, covering cardiovascular exposure, metabolic function, inflammatory load, organ function, the common reversible nutrient contributors and thyroid status.
Three additions are the ones the platform most often finds missing, and each changes a decision: apolipoprotein B as the causal cardiovascular exposure, lipoprotein(a) once as a lifetime calibrator, and fasting insulin as the earlier metabolic signal. A urine albumin to creatinine ratio is the fourth, and it is not a blood test at all.
The Quality layer governs the conditions, because a well-chosen panel drawn during illness or within three days of hard training produces misleading results at no saving. And the platform reads patterns rather than flags: raised triglycerides with low HDL, raised insulin, raised GGT and ALT, raised uric acid and raised ferritin is one finding, insulin resistance with hepatic fat, rather than six. That is the Pillar Matrix doing its job, and the most informative pattern of all, slow drift within the reference range across years, is only visible with a kept sequence.
Pillar Matrix mapping
Longevity and Biological Age, Metabolic and Cardiovascular Health
Database Matrix layers
- Meta / Consensus Layer (JAMA, BMJ, specialty society positions)
- Evidence Layer (PubMed, Cochrane, ClinicalTrials.gov)
- Quality / Formulation Layer (ConsumerLab, Labdoor)
- Population Layer (UK Biobank, NHANES)
Frequently Asked
What should a longevity blood panel include?
Apolipoprotein B, a lipid panel, lipoprotein(a) once, HbA1c, fasting insulin, hs-CRP, a full blood count, ferritin with transferrin saturation, a comprehensive metabolic panel, GGT, TSH with free T4, vitamin D, B12 with folate, and a urine albumin to creatinine ratio.
Which tests are usually missing?
Apolipoprotein B, lipoprotein(a), fasting insulin and the urine albumin to creatinine ratio. Each changes decisions and each is commonly absent from standard panels.
What should I leave off?
Broad hormone panels without symptoms, multi-cytokine panels, salivary cortisol curves, IgG food panels, organic acid and comprehensive stool panels, heavy metal panels without exposure history, and NMR subfractionation where apoB is available.
What conditions matter for the draw?
Fast 8 to 12 hours for insulin and glucose, morning if testosterone is included, avoid hard exercise for 48 to 72 hours, not during or shortly after illness, note cycle day, declare biotin, and use the same laboratory for comparisons.
How do I read the panel as a whole?
Look for patterns. Raised triglycerides with low HDL, raised insulin, raised GGT and ALT, raised uric acid and raised ferritin is one finding, insulin resistance with hepatic fat, rather than six problems.
Is an expensive longevity panel worth it?
Mostly not. The core panel is inexpensive and standard. Expensive packages largely add tests that do not change decisions, plus presentation.
What is the general test for whether to order something?
Name the two possible results and what you would do differently for each. If the answer is the same, the test is information rather than a decision.
Evidence and review
Any dosage ranges cited here reflect the ranges used in published human trials, not personal recommendations. Evidence in this field moves, so this article is reviewed quarterly and carries its last-updated date above. Nothing here is intended as medical advice, and supplementation should be discussed with a qualified clinician, particularly alongside prescribed medication or an existing condition.