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Longevity clinics, audited.

Which tests and plans change real decisions — and which are expensive theater. Every service on the menu, graded.

Updated · ~12 min full read · 30 sections

The case in five lines

If you read nothing else

  1. 1. The genuinely valuable parts of a longevity clinic — ApoB and once-in-a-lifetime Lp(a) testing, blood pressure, DEXA at the right age, fitness testing, structured lifestyle coaching — cost hundreds through normal medicine, not tens of thousands.
  2. 2. One test is guideline-backed and widely missed: European consensus says every adult should have Lp(a) measured once in their life. About one in five people carries a risk standard panels never see.
  3. 3. Fitness is the closest thing to a longevity vital sign — in 122,000 patients, low cardiorespiratory fitness rivalled smoking as a mortality risk, with no upper limit to the benefit of being fitter.
  4. 4. The glamour products fail the value test: full-body MRIs find something in ~95% of healthy people (91% of it irrelevant), consumer epigenetic-age tests are noisier than the "years reversed" they report, and no wellness IV drip has an adequately powered trial behind it.
  5. 5. The highest-evidence service on any clinic menu is the least glamorous: DPP-style lifestyle coaching cut diabetes incidence by 58% in a landmark RCT — beating a drug.

The basics

What a "longevity clinic" actually is

The longevity-clinic market spans three decades of price in one label. At the entry end, scan-first startups like Neko Health sell a £299 full-body assessment with a six-figure waiting list. The middle is diagnostics memberships — London's HOOKE from ~£7,900, Berlin's YEARS tiers at €1,900–16,900, US anchors like Fountain Life around $20,000/year. At the top, residential programs: Clinique La Prairie's flagship weeks run CHF 31,800–50,000+.

Under every brand, the same menu recurs: big blood panels, imaging, fitness testing, wearables, a "personalized plan", and an optional layer of drips and hormones. This guide grades the menu items, because that is what you are actually buying — the brand is upholstery.

The value test we apply to every service

A medical test earns its money in exactly one way: by changing a decision that changes an outcome. A cholesterol panel can trigger a statin that prevents a heart attack — value. A full-body scan that finds a probably-nothing nodule and triggers six months of follow-up imaging and anxiety — negative value dressed as vigilance.

So each service below is graded on decision-and-outcome evidence, and overdiagnosis counts against it: false positives, incidentalomas, and noise-driven "biological age" numbers are costs, not features. "More data" is only better when the data are reliable enough to act on — a bar most of the exotic menu does not clear.

Buying it right

The rational package (≈€500–1,500/year, no membership)

What an evidence-first "longevity program" actually contains:

  • Bloods: standard lipids + ApoB, Lp(a) once ever, HbA1c, kidney/liver/thyroid — then annual-ish repeats of the treatable ones.
  • Blood pressure — measured properly, treated boringly.
  • Imaging at the right moments: a CAC scan once around 45–60 if the statin decision is genuinely uncertain; DEXA bone density for women at 65, or earlier post-menopause with risk factors.
  • Fitness vital signs: a VO2max estimate (test or watch) and grip strength — then training that moves them.
  • The national cancer screens you may be behind on — mammography, cervical, colorectal: the screening with actual mortality evidence.
  • A menopause consultation with an actual specialist when symptoms arrive.
  • Structured lifestyle coaching if weight or glucose are drifting — DPP-derived programs exist at consumer prices.

Everything above that line in a clinic brochure is either research-grade or theater. What memberships legitimately add is convenience, aggregation, and accountability — worth something, just not always five figures.

Red flags, and the questions that expose them

Walk-away signals: the clinic sells its own supplement line; the menu is IV-drip-heavy; marketing leads with biological-age reversal or telomere scores; "hormone optimization" targets for normal labs; stem-cell or exosome infusions (often via offshore partners); full-body MRI framed as essential; results delivered by salespeople; unchangeable markers (Lp(a), genetics) re-billed annually.

Questions worth asking before joining:

  • Which of your tests are supported by ESC/USPSTF/NICE-level guidance, and which are experimental?
  • What is your false-positive and incidentaloma rate, and who pays for the downstream workup?
  • Will a physician who can actually prescribe (statins, antihypertensives, menopause HT) review my results — and do you prescribe them?
  • Can I buy diagnostics à la carte without the supplement and drip layer?
  • What outcome, other than my dashboard, improves after a year — and can you show a member cohort's numbers?

A good clinic answers these cheerfully. A sales funnel changes the subject.

The full breakdown

The clinic menu — what the evidence says

Part 01

The services that change decisions

Strong evidence

The blood-panel core (ApoB, Lp(a), HbA1c)

Guideline-backed and cheap: ApoB counts the particles that cause heart disease; Lp(a) once per lifetime; HbA1c for glucose.

The defensible heart of every longevity panel is small and inexpensive. Lp(a) is the star: the European Atherosclerosis Society consensus recommends every adult be measured at least once in their lifetime — it is genetically fixed, missed by standard panels, and elevated in ~1 in 5 people, where it changes how aggressively everything else gets managed.

ApoB directly counts atherogenic particles and is accepted by ESC/EAS guidance as an alternative (often superior) to LDL-C — particularly with high triglycerides or metabolic syndrome. HbA1c is standard prediabetes screening. hs-CRP adds a little in borderline statin decisions; the surrounding 100-marker panel adds mostly invoices.

Cadence: full baseline once, Lp(a) once ever, then annual or biennial repeats of the treatable markers — not quarterly mega-draws.

Cost
€100–300/year
Strong evidence

DEXA bone-density screening

USPSTF Grade B: all women 65+, and younger postmenopausal women at risk. Silent disease, treatable, undertested.

For this site's audience, bone density is one of the highest-yield tests on any menu. The 2025 USPSTF recommendation (Grade B) is unambiguous: screen all women 65+, and postmenopausal women under 65 with risk factors. Osteoporosis is silent until the first fracture, treatable, and chronically underdiagnosed. Radiation is trivial, the scan takes minutes.

The body-composition add-on from the same machine (visceral fat, lean mass) is interesting for tracking training — but formally its clinical utility is still uncertain; grade it a bonus, not a screen.

Cost
€50–150
Strong evidence

CT coronary calcium score

Guideline-endorsed tie-breaker for the statin decision at intermediate risk — once, around 45–60. Not a universal screen.

A low-dose CT that counts calcified coronary plaque. Its legitimate role is precise: when the statin decision is genuinely uncertain at borderline-to-intermediate risk, ACC/AHA guidance endorses CAC as the tie-breaker — a score of 0 can justify deferring, 100+ favours treating. That describes a very common 50-something decision, which is why it earns "strong" despite the honest caveat that no completed RCT shows scanning itself saves lives.

Who it doesn't help: low-risk thirty-somethings (a guaranteed zero and false reassurance — early plaque isn't calcified yet) and high-risk patients (treat regardless). One scan; "progression tracking" is not a thing worth buying — statins can raise the score while lowering risk.

Cost
€100–300, once
Strong evidence

The plan & coaching layer

Quietly the best-evidenced thing clinics sell: DPP-style coaching cut diabetes incidence 58% in an RCT — beating metformin.

The unglamorous engine. In the Diabetes Prevention Program RCT, structured lifestyle coaching (weight, activity, 16-session curriculum) cut type-2 diabetes incidence by 58% versus placebo — metformin managed 31% — with benefits persisting for two decades of follow-up.

The nuance that keeps claims honest: once disease is established, intensive lifestyle change stopped preventing cardiovascular events in the Look AHEAD trial — coaching moves risk factors reliably and prevents disease best upstream. What predicts a good clinic here: physician-led interpretation, a protocolized curriculum, exercise prescription with progression, and willingness to also prescribe the boring proven drugs. Ironically, DPP-derived programs exist at consumer prices far below memberships.

Cost
€300–1,500/year
Strong evidence

Menopause care, done properly

The one hormone service with guideline backing: HT is the most effective symptom treatment and protects bone near menopause onset.

Inside the hormone menu hides one genuinely guideline-based service. The Menopause Society position statement: hormone therapy is the most effective treatment for vasomotor symptoms and genitourinary syndrome and prevents bone loss, with benefits generally outweighing risks for women under 60 or within 10 years of menopause onset without contraindications.

What it is not: a longevity drug — the same guidance explicitly declines to endorse HT for chronic-disease prevention. A clinic that evaluates symptomatic perimenopausal women properly is delivering real medicine; one selling compounded "bioidentical pellet optimization" against invented target levels is not.

Cost
Consultation €100–300
Moderate evidence

VO2max / fitness testing

The strongest mortality association in preventive medicine, and fully actionable through training — though no trial tests the testing.

In 122,007 patients, cardiorespiratory fitness was inversely associated with mortality with no upper limit — being unfit carried risk comparable to smoking or diabetes. The American Heart Association argues fitness should be a clinical vital sign.

Unlike most longevity metrics, this one sits on a modifiable causal pathway with a known intervention: structured endurance and interval training reliably raises VO2max, and a retest verifies it. A lab CPET adds training zones and diagnostic detail; a watch estimate captures much of the signal free. Baseline, train 6–12 months, retest.

Cost
€150–400 (CPET)
Moderate evidence

Grip strength & functional testing

A €30 dynamometer out-predicted blood pressure for mortality in 140,000 people. Marker of robustness — train the whole body.

In the PURE study (~140,000 adults, 17 countries), every 5 kg less grip strength meant 16% higher all-cause mortality — a better death predictor than systolic blood pressure. Chair-stands, gait speed, and balance carry similar signals, and all of it screens for the sarcopenia that accelerates around menopause.

The honest framing: grip is a window, not a target — training your forearms doesn't fool mortality. Progressive resistance training of the whole body is the intervention; the dynamometer is just the scoreboard. If a clinic charges hundreds for "functional assessment", the price is the problem, not the test.

Cost
~€0–30

Part 02

The frontier: promising to premature

Emerging evidence

Multi-cancer blood tests (Galleri)

The most serious new screen — its 142,000-person RCT missed the primary endpoint but cut stage-IV diagnoses. Mortality data pending.

Galleri looks for tumour DNA fragments across ~50 cancers in one blood draw. It is the rare longevity product with a real randomized trial: NHS-Galleri (142,000+ adults, three annual rounds) missed its primary endpoint (no overall late-stage reduction) while showing >20% fewer stage-IV cancers in later rounds, 25% fewer cancers found via emergency presentation, and a positive-predictive value just over 50%.

Translation for a would-be buyer: a "positive" is a coin flip for cancer (far better than most screens); a "negative" must never defer mammography, colonoscopy, or cervical screening. Mortality results are pending and the NHS is reviewing rather than rolling out. Rational stance: watch closely; don't anchor a prevention plan on it yet.

Cost
~€900–1,000/draw
Emerging evidence

CGM for non-diabetics

Modest short-term glycaemic effects as a feedback tool; nobody has shown healthy wearers end up healthier.

Continuous glucose monitors are genuinely useful in diabetes. In healthy people, systematic reviews land on "unclear": modest glycaemic effects as a behaviour-change tool, mechanisms uncertain, and no evidence of durable behaviour change or outcomes in non-diabetics. Meanwhile normal post-meal spikes get pathologized and sensor error is proportionally largest exactly in the normal range.

Defensible uses: prediabetes, a history of gestational diabetes, or a clinician-interpreted 2–4-week experiment. As a standing subscription for the metabolically healthy, it's a data product, not medicine.

Cost
€60–120/month
Emerging evidence

DEXA body composition & visceral fat

Correlates well with metabolic risk and tracks training — but its clinical utility as a screen is formally uncertain.

The same scanner that measures bone can quantify visceral fat and lean mass — genuinely useful for tracking resistance training and muscle preservation (not least in the GLP-1 era), and visceral fat tracks cardiometabolic risk in cohorts. Formal reviews still class the clinical utility of the adiposity metrics as uncertain, and a tape measure plus scale captures most of the decision value free. A worthwhile add-on when you're scanning anyway; not a reason to scan.

Cost
€50–150
Limited evidence

Epigenetic "biological age" tests

Valid research tools at cohort level; individual results wobble by years between runs of the same sample. The noise is the business model.

Methylation clocks (GrimAge, DunedinPACE and their consumer wrappers) genuinely predict morbidity and mortality across cohorts. The product problem is individual-level reliability: technical noise makes major clocks deviate 3–9 years between replicates of the same blood sample, and a 2025 multi-study analysis found most clocks only moderately reliable — with short-term stress alone shifting scores.

So the "you got 2.3 years younger on our program" retest sits comfortably inside measurement error, and no trial shows clock-guided decisions improve anything. Research endpoint: promising. Consumer product: the noise is the business model.

Cost
€200–400/test
Limited evidence

Full-body MRI screening (Prenuvo-style)

~95% of healthy adults show "something"; 91% of findings are irrelevant; radiology societies recommend against it.

The sector's flagship product, and its best example of unproven medicine at scale. The American College of Radiology's position: no documented evidence that whole-body screening is effective in prolonging life in asymptomatic people, with explicit concern about cascades of non-specific findings. The numbers behind it: across 12 studies, 95% of asymptomatic adults had at least one abnormal finding, 91% irrelevant; cancer yield ~1–2% with no shown survival benefit — and the whole-body protocol has missed breast cancers that mammography catches.

No radiation is a genuine plus, and rare high-risk genetic syndromes (e.g. Li-Fraumeni) are the legitimate exception. For everyone else: €2,000 for a lottery ticket whose usual payout is follow-up imaging and a bad month.

Cost
€1,500–2,500
Limited evidence

Carotid intima-media thickness (CIMT)

Formally removed from guidelines (Class III: No Benefit) — a 45,828-person meta-analysis showed it adds ~nothing to risk models.

The cautionary tale clinics hope you won't look up. After a meta-analysis of 45,828 people showed adding CIMT to standard risk models improved reclassification by well under 1%, the ACC/AHA guideline rated routine CIMT Class III: No Benefit — the explicit "don't do this" category. (Carotid plaque on ultrasound retains some standing as a risk modifier; millimetre-tracking "vascular age" reports are the discredited version.) A clinic still leading with CIMT is running a 2005 playbook.

Limited evidence

Telomere length testing

Assays vary ~20% run to run, individual variability swamps the signal — dismissed outside rare-disease genetics.

Consumer telomere tests answer differently on different days — the qPCR assays vary by around 20% between runs — and telomere length varies so much between healthy same-age people that it fails standard biomarker-of-aging criteria. Real telomere biology matters in rare telomere syndromes, diagnosed by specialists with clinical-grade assays. No consumer decision improves with this number.

Limited evidence

Consumer microbiome testing

Identical samples get different answers from different providers; consensus statements find no proven clinical value.

When researchers sent identical stool samples to multiple consumer services, between-provider variability rivalled the biological difference between two people. An international consensus statement is blunt: these tests are sold without proven value in clinical practice; "dysbiosis" has no agreed definition, and the report funnels into probiotic sales. The evidence-based gut advice — fibre, plants, fermented foods — requires no €300 report.

Part 04

The hidden cost

Overdiagnosis — the harm nobody itemizes

False positives and incidentalomas cost money, procedures, and months of fear — and the scan menu produces them at scale.

Screening healthy people has a mathematical property brochures omit: when true disease is rare, most "findings" are false alarms. A full-body MRI "abnormality" rate of ~95% with 91% irrelevance means the typical outcome of a scan is a finding, and the typical finding means follow-up imaging, sometimes biopsies, and weeks of fear — occasionally with real complications from the workup itself.

This is why guideline bodies are conservative: the national cancer screens (mammography, cervical, colorectal) earned their place through mortality trials that netted out the false-alarm harms. The longevity-menu extras haven't. A rational buyer treats every non-guideline test as having two prices — the invoice, and the expected cost of what it finds by accident.

Part 05

Frequently asked questions

Are longevity clinics worth the money?

Mostly no

The components with real evidence — the blood core, blood pressure, CAC in borderline cases, DEXA at the right age, fitness testing, coaching, menopause care — are assemblable for €500–1,500/year through a good GP or internist. Memberships legitimately add convenience, aggregation, and accountability; the exotic layer adds invoices. If those service benefits are worth the premium to you, buy them with open eyes — à la carte, minus the drips.

What single test is most underused?

Lp(a), once

European consensus explicitly recommends every adult be measured once. Roughly one in five people carries elevated Lp(a) that standard panels never see, and the result durably changes how aggressively everything else — LDL, blood pressure, lifestyle — should be managed. It costs about as much as lunch.

Should I get a full-body MRI "just to be safe"?

No

The ACR advises against whole-body screening in asymptomatic people: ~95% of scans show something, ~91% of findings are irrelevant, cancer yield is 1–2% with no proven survival benefit — and "just to be safe" routinely converts into months of follow-up. Put the money toward the screens with mortality evidence you may actually be behind on.

My clinic says I got 3 years "biologically younger". Real?

Probably noise

Leading epigenetic clocks can differ by 3–9 years between duplicate runs of the same blood sample, and week-to-week biology (stress, illness) shifts scores further. Group averages in research mean something; your individual before-and-after usually doesn't. Judge the program by blood pressure, ApoB, fitness, and strength instead — those numbers are real.

Is the Galleri cancer blood test ready for routine use?

Not yet

The NHS trial missed its primary endpoint while cutting stage-IV diagnoses by over 20% — genuinely promising, genuinely unfinished. Reasonable for informed early adopters who keep every standard screen; not a replacement for anything, and a negative result must never postpone your mammogram or colonoscopy.

If I do only three things from a clinic menu, which?

Numbers, fitness, bones

One: measure and treat ApoB, Lp(a) (once), blood pressure, and HbA1c. Two: build cardiorespiratory fitness and strength — the mortality gradients rival smoking, and they're trainable. Three: for women, treat bone density and menopause care as first-class medicine at the guideline ages. All three are cheap; none needs a membership.

Interactive

Build your testing year

Pick one option per row — your plan appears below. Saved to your browser only.

Bloods

strong

Imaging

strong

Fitness vital signs

moderate

Frontier (optional)

emerging

The plan layer

strong

Your year

Pick at least one option above to see your plan.

Plus the national cancer screens you're due — the ones with mortality evidence.

The market

Clinic tiers compared

What each price band actually buys — graded by the evidence of its typical menu, not its lobby.

emerging

Scan-first startups

Neko-style annual assessments — slick screening bundles whose extra scans are exactly the unproven part.

≈ €350 / visit
emerging

Diagnostics memberships

HOOKE/YEARS/Fountain-class programs: guideline core + frontier extras + concierge glue. Value tracks the physician, not the dashboard.

€2,000–20,000 / yr
limited

Residential longevity spas

Clinique-La-Prairie-style weeks: superb hospitality wrapped around mostly ungraded medicine.

CHF 17,000–50,000+
strong

Your GP + this guide

The rational package: every guideline-backed item on the menu, bought à la carte through normal medicine.

≈ €500–1,500 / yr

References & further reading

All claims cite guidelines, trials, or professional-society positions, linked inline within each section. Primary sources: ESC/EAS, USPSTF, ACR, NEJM, JAMA, The Lancet, PubMed/PMC.

Educational content, not medical advice. Screening decisions depend on your personal and family history — make them with a clinician who knows both.