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Longevity and cellular research.
A category built almost entirely on surrogate markers.
6 compounds tracked in this category
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In theory, this class is designed to slow or partially reverse the cellular changes that accumulate with age, restoring NAD+ levels, clearing senescent cells, protecting telomeres, supporting mitochondrial function. The individual mechanisms are legitimate areas of research. The difficulty is that nobody can run a trial long enough to test the actual claim, so everything here is validated against markers instead of outcomes.
Unmarked, FDA approved° legal over the counter† under FDA review, not yet permitted* not FDA approved‡ documented safety concern
| Compound | What is known |
|---|---|
| Epitalon† | Advisory panel voted 7–4 in favor July 2026 on minimal human evidence. Longevity claims rest largely on older Russian-language work. |
| SS-31 (elamipretide)* | Investigational, in late-stage trials for Barth syndrome. Not approved. |
| NAD+ (injectable)* | Injectable NAD+ is unapproved. Oral precursors are a separate regulatory question, and NMN has its own drug-preclusion history. |
| FOXO4-DRI* | Preclinical senolytic. No human data. |
| Thymalin, Pinealon* | Bioregulator peptides with minimal Western evidence. |
| Glutathione (IV)* | Compounded IV use has drawn FDA attention on limited supporting evidence. Oral is a supplement. |
The science behind this category
You cannot run a trial on human lifespan. A study that randomised people and waited to see who lived longer would take fifty years and cost more than any sponsor would spend. So longevity research runs on surrogate markers instead, telomere length, NAD+ levels, senescent cell burden, methylation clocks. Every compound in this category is validated against markers, not outcomes.
Surrogate markers have a poor track record in medicine. Drugs that improved the marker and worsened the outcome are a recurring story, antiarrhythmics that suppressed the arrhythmia and raised mortality, hormone therapy that improved lipids and increased cardiovascular events. Moving a biomarker in the right direction is a reason to keep studying something. It is not evidence that it helps.
NAD+ decline with age is real and well documented, and precursor supplementation does raise NAD+ levels in humans. That much is established. What has not been established is that raising it produces clinical benefit. Injectable and IV NAD+ is unapproved, has essentially no controlled outcome data, and raises real questions about how much intact molecule reaches cells.
Thymalin, Pinealon, Epitalon and related compounds come from a Soviet and Russian research lineage with limited peer-reviewed Western replication. Epitalon received a favourable advisory vote in July 2026 on evidence that FDA's own reviewers considered insufficient. The underlying studies are difficult to evaluate against current standards.
SS-31 (elamipretide) is the outlier, a genuine investigational drug in late-stage trials for Barth syndrome, developed through the normal regulatory pathway. It is not approved, but it is being studied the way a drug should be. FOXO4-DRI, by contrast, is a preclinical senolytic with no human data at all.
Understanding a category is the first step. Whether any of it applies to you is a question for a licensed physician who knows your history.
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