What Longevity Science Gets Wrong
Before longevity, we need midlife science
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A decade ago, metformin—a drug for diabetes—was hailed as the future of longevity. The animal studies were promising, and observational data looked strong. But then the disappointments in healthy people started rolling in, including a 2019 study showing that metformin blunted muscle growth in older adults.
This pattern keeps repeating itself. Many longevity drugs and theories eventually fall flat. Remember when fasting was supposed to help us live longer? Another letdown.
From the outside, it might look like I write about longevity. But that’s not what I’m about.
When I first entered this field, I assumed the research was rock solid and it was simply a matter of learning it. I started with hormones, and the deeper I dug, the more I realized: we have surprisingly little research on the midlife stage.
By that I mean the unique needs that show up when aging first begins to reveal itself. And this poses a major issue for everyone in health—including those in longevity science.
Why?
Because if we don’t understand midlife biology, from micronutrient shifts to vascular changes to hormonal transitions, then it’s more likely longevity strategies will fail. It’s like trying to plan a luxury vacation when you can’t even afford groceries. You can dream, but you need to meet your most basic needs first.
Longevity should come after we understand the nutrition and lifestyle needs of midlife and older adults—not before. And right now, we’re skipping the part that matters most.
Let me explain.
Menopause and the unmet needs
Before the WHI study, hormone therapy was widely used for health prevention. The story was (and still is) compelling: women lose estrogen, and their risk for cardiovascular disease and dementia rises—so just give the hormones back.
When the WHI blew everything up, it was as if the medical profession gave up on midlife women. Even though we now understand the limitations of the WHI, it’s still odd how little progress we’ve made outside of drug-based solutions.
Now all these years later bio-identical hormone therapy is being labeled the “ultimate longevity drug.” But once again, it’s not enough on its own.
Take microvascular health. At midlife, women have a higher risk of microvascular dysfunction. I recently found this paper on the KEEPS trial, where researchers compare reactive hyperemia index (RHI - measure of microvascular function) across three groups—transdermal estrogen, CEE, and placebo. Both estrogen groups received micronized progesterone.
After four years of hormone therapy, drumroll….