Longevity biomarkers are measurable signals, like VO2 max, grip strength, ApoB, and fasting insulin, that track how well your body is aging. They don't predict your lifespan, but they show where to focus. TelosRX ranks ten worth tracking.
Your birthday tells you how old you are. It says nothing about how fast you're aging. That's the job of longevity biomarkers.
The trouble is choice. Some clinics sell 100-marker panels.
Most of those numbers won't change a single decision. This list sticks to ten markers with strong research behind them, and it's honest about the ones that are still experimental.
What Are Longevity Biomarkers?
A biomarker is anything you can measure that reflects a process in the body. A longevity biomarker is one linked to how well, and how long, people tend to live.
The best ones share three traits:
- They're linked to outcomes. Large studies tie them to heart disease, diabetes, disability, or death.
- They change with age. They drift in predictable directions over decades.
- They respond to action. Exercise, diet, sleep, or medication can move them.
That last point matters most. A marker you can't influence is trivia. A marker you can influence is a to-do list.
The 10 Longevity Biomarkers at a Glance
Here's the full list before we break each one down.
| Biomarker | What it reflects | How it's measured | Typical recheck |
|---|---|---|---|
| VO2 max | Heart and lung fitness | Treadmill or bike test; wearables estimate it | Every 6 to 12 months |
| Grip strength | Overall muscle strength | Handheld dynamometer (grip gauge) | Every 6 to 12 months |
| ApoB | Number of artery-clogging particles | Blood test | Yearly, or after changes |
| Lipoprotein(a) | Inherited heart risk | Blood test | Usually once in a lifetime |
| Fasting insulin | Insulin resistance | Fasting blood test | Yearly |
| HbA1c | Average blood sugar over about 3 months | Blood test | Yearly, or every 3 to 6 months if elevated |
| hs-CRP | Low-grade inflammation | Blood test | Yearly |
| Blood pressure | Strain on heart, brain, and kidneys | Cuff, ideally at home | Regularly at home |
| Hormone panel | Testosterone, estradiol, thyroid, and more | Morning blood test | Based on symptoms and therapy |
| Epigenetic clock | Estimated pace of biological aging | Blood or saliva DNA test | Optional; research-grade |
1. VO2 Max
VO2 max is the most oxygen your body can use during all-out effort. It's the gold-standard measure of cardiorespiratory fitness.
The evidence here is striking. A study of 122,007 adults who had treadmill tests found mortality risk fell steadily as fitness rose. People in the lowest fitness group had about five times the risk-adjusted mortality of elite performers.
The researchers also found that low fitness carried risk comparable to or greater than smoking or diabetes. And there was no fitness level where the benefit stopped.
How to move it: a mix of steady cardio and harder intervals. It's the rare biomarker that responds within weeks.
2. Grip Strength
Grip strength is a quick, cheap stand-in for your total muscle strength. You squeeze a gauge. That's it.
In the PURE study of nearly 140,000 adults across 17 countries, each 5 kg drop in grip strength was linked to a 16% higher risk of death from any cause. Grip was a stronger predictor of all-cause and cardiovascular death than systolic blood pressure.
Grip isn't magic. It's a window into muscle, and muscle protects mobility and metabolism as you age.
How to move it: strength training two or more days a week. Carries, rows, and deadlifts all build grip.
3. ApoB
ApoB counts the particles that carry cholesterol into your artery walls. Each LDL particle carries one ApoB protein, so the test tells you how many there are.
Why not just LDL cholesterol? LDL measures the cholesterol cargo, while ApoB counts the trucks.
Two people can share an LDL number but carry very different particle counts.
Many lipid specialists now consider ApoB a more precise risk marker than LDL alone. It's a simple add-on to a standard lipid panel.
How to move it: diet quality, weight, fiber, and, when appropriate, prescription therapy.
4. Lipoprotein(a)
Lp(a) is a cholesterol particle whose level is mostly set by your genes. Diet and exercise barely touch it.
So why test it? Because a high level is a hidden heart risk that standard panels miss. Knowing it can change how aggressively you and your clinician handle every other risk factor.
Most people only need this test once. Many guidelines now suggest checking it at least once in adulthood.
How to use it: if it's high, tighten control of ApoB, blood pressure, and blood sugar.
5. Fasting Insulin
Fasting insulin shows how hard your pancreas works to keep blood sugar normal. It often rises years before glucose does.
That's the value. Your glucose can look fine while insulin quietly climbs to hold it there. Clinicians sometimes combine fasting insulin and glucose into HOMA-IR, a simple insulin resistance score.
Reference ranges vary by lab, and there's no single agreed "optimal" number. Trends over time matter more than one reading.
For the bigger picture, see our guide to insulin resistance and how GLP-1s affect it.
6. HbA1c
HbA1c reflects your average blood sugar over roughly the past three months. It measures how much sugar has stuck to your red blood cells.
Standard diagnostic cut points are widely used:
- Below 5.7%: normal range
- 5.7% to 6.4%: prediabetes range
- 6.5% or higher: diabetes range, confirmed with repeat testing
Anemia, recent blood loss, and some genetic traits can skew HbA1c. Pair it with fasting glucose and insulin for a fuller picture.
7. hs-CRP
High-sensitivity C-reactive protein (hs-CRP) picks up low-grade, body-wide inflammation. Chronic inflammation is tied to heart disease and faster aging.
Cardiology groups commonly sort hs-CRP into three bands: under 1 mg/L is lower risk, 1 to 3 is average, and above 3 is higher. A cold, a hard workout, or a sore tooth can spike it for days.
So never read one high value alone. Retest when you're well, a few weeks later.
How to move it: regular exercise, better sleep, not smoking, and weight management.
8. Blood Pressure
Blood pressure is the least exciting marker on this list, and one of the most important. It strains your heart, brain, kidneys, and eyes for years before symptoms show up.
Current U.S. guidelines define normal as below 120/80 mmHg. Single office readings can mislead, so home monitoring gives a truer picture.
A few tips for accurate home readings:
- Sit quietly for five minutes first.
- Keep your feet flat and your arm supported at heart level.
- Take two readings a minute apart and average them.
- Skip caffeine and exercise for 30 minutes beforehand.
9. Hormone Panel
Hormones shape energy, muscle, bone, mood, and metabolism. A panel shows whether they're in a healthy range for your age.
Useful markers for longevity include:
- Testosterone (total and free), in men and women
- Estradiol, especially around menopause
- TSH and free T4 for thyroid function
- DHEA-S, an adrenal hormone that declines with age
Timing matters. Testosterone is best checked in the morning. Our hormone panel test guide covers what each marker means and how to prepare.
Want your hormones reviewed? TelosRX offers asynchronous, online hormone and longevity care for men and for women.
Any prescription is subject to medical approval by a licensed provider. Compounded options are not FDA-approved.
10. Epigenetic Clocks
Epigenetic clocks estimate biological age from chemical tags on your DNA. These tags, called methylation marks, shift in patterns as you age.
Newer clocks try to measure the pace of aging, not just a single age number. One example is DunedinPACE, a DNA methylation measure of the pace of aging, developed from decades of follow-up in one birth cohort.
The honest caveat: clocks are fascinating research tools, but results can vary between labs and tests. They don't yet guide clinical decisions the way ApoB or blood pressure do. Think of them as optional, not essential.
Honorable Mentions
These didn't make the top ten, but they're worth a look for many people:
- Kidney function (eGFR, cystatin C): kidneys quietly lose function with age.
- Vitamin D: low levels are common, especially in winter.
- Omega-3 index: reflects long-term fish and omega-3 intake.
- Waist-to-height ratio: a free, quick read on belly fat.
- Resting heart rate and HRV: easy to track with a wearable.
How Often Should You Test Longevity Biomarkers?
More testing isn't better testing. The right cadence depends on what you're trying to change.
- Baseline: one full set to see where you stand.
- Active changes: recheck the relevant markers in 3 to 6 months.
- Stable and healthy: most blood markers once a year is plenty.
- One-time tests: Lp(a) rarely needs repeating.
Always compare results from the same lab when you can. Different labs use different methods and ranges.
Common Mistakes When Tracking Longevity Biomarkers
Even good data can mislead you. These are the slip-ups we see most often.
- Chasing one number. A single marker rarely tells the story. Look at patterns across several.
- Testing while sick. Colds and hard training sessions can distort inflammation and blood sugar readings.
- Switching labs. Different methods produce different numbers. Stick with one lab when you can.
- Ignoring the free markers. Blood pressure, waist size, and fitness cost little and say a lot.
- Buying the biggest panel. More tests mean more false alarms, not more insight.
- Skipping the follow-up. A result only helps if it changes what you do next.
The goal isn't a perfect lab report. It's a few numbers moving in the right direction over years.
How to Start Tracking Without Overwhelm
Start with what's cheap and actionable. Then add the rest.
- Free this week: measure waist, resting heart rate, and home blood pressure.
- At your next physical: ask to add ApoB, Lp(a), fasting insulin, HbA1c, and hs-CRP.
- Within a few months: get a grip strength and fitness test.
- If symptoms point there: order a morning hormone panel.
- Optional: try an epigenetic clock if you're curious.
Then pick one or two markers to improve. Our list of evidence-based longevity protocols is a good next read.
Frequently Asked Questions
What is the best single biomarker for longevity?
There isn't one perfect marker. Cardiorespiratory fitness, measured as VO2 max, has some of the strongest links to long-term survival in large studies. Many clinicians pair it with ApoB for heart risk and a blood sugar marker like HbA1c. A small set of well-chosen markers beats any single number.
What blood tests are used for longevity?
Common longevity blood tests include ApoB, lipoprotein(a), fasting insulin, fasting glucose, HbA1c, hs-CRP, a hormone panel, and kidney markers like eGFR. Some people add vitamin D and an omega-3 index. Ask your clinician which tests fit your history, since more tests don't always mean better decisions.
Are epigenetic age tests accurate?
They're useful research tools but not yet precise clinical tests. Results can vary between labs and between different clocks, and they can shift with short-term factors. Newer measures like DunedinPACE aim to track the pace of aging. For now, they work best as an optional add-on, not a replacement for standard markers.
Can you improve longevity biomarkers?
Most of them, yes. VO2 max, grip strength, blood pressure, fasting insulin, HbA1c, and hs-CRP all respond to exercise, diet, sleep, and weight changes. ApoB responds to diet and, when appropriate, medication. Lipoprotein(a) is mostly genetic and changes very little with lifestyle, which is why it's usually tested once.
How much does longevity biomarker testing cost?
Costs vary widely. Many core markers, such as a lipid panel, HbA1c, and blood pressure, are often covered in routine care. ApoB, Lp(a), and fasting insulin are usually inexpensive add-ons. VO2 max testing and epigenetic clocks tend to cost more and are rarely covered by insurance.
At what age should you start tracking longevity biomarkers?
Earlier is better, often in your 30s or 40s. Many longevity markers, like ApoB and blood pressure, reflect exposure that builds over decades. Starting early gives you a baseline and more time to act. It's never too late, though, since fitness and strength respond at any age.
TelosRX is LegitScript-certified. Compounded medications are not FDA-approved and are prepared under federal compounding regulations. Approval is subject to evaluation by a licensed provider; approval is not guaranteed. Individual results vary. TelosRX operates as an online-first, asynchronous telehealth service.
Start your private evaluation at TelosRX.