The “hallmarks of ageing” framework — first published in 2013 and revised in 2023 — lists twelve interconnected processes underlying biological ageing. It is the map most longevity medicine works from. Below is our honest reading of where clinical practice actually reaches.
Well supported, and we act on them
- Deregulated nutrient sensing — insulin resistance responds to nutrition, training and, where indicated, medication. Measurable within weeks.
- Mitochondrial dysfunction — cardiorespiratory training remains the single most effective intervention we have; VO2 max tracks it.
- Chronic inflammation — hs-CRP, IL-6 and lifestyle drivers are measurable and modifiable.
- Loss of proteostasis and muscle — resistance training and adequate protein, tracked by DEXA-equivalent composition scanning and grip strength.
Promising, measured but not oversold
- Epigenetic alterations — measurable with methylation clocks; the interventions that reliably reverse them are not yet established.
- Microbiome disruption — sequencing is informative for nutrition planning; causal claims run well ahead of the evidence.
- Cellular senescence — a genuinely exciting target. No senolytic protocol currently meets our bar for routine clinical use.
Not offered here
Therapies awaiting Ministry of Health licensing are not sold, not scheduled and not hinted at. When that changes, it will be stated plainly on the relevant page.