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From Anti-Aging Medicine to Precision Healthspan Pharmacology: Evidence Domains, Monitoring Requirements, and Practical Boundaries
Summary
This review paper argues that "anti-aging medicine" should be reorganized into a more precise system—matching specific drugs, hormones, and supplements to specific body functions (like metabolism, muscle, or brain health) based on how strong the evidence actually is, rather than treating every product with an "anti-aging" label as equally trustworthy. Importantly, the authors stress that no pill can replace the basics—good nutrition, sleep, exercise, and social connection—especially since today's environments expose us to more contaminants than before, including microplastics in our water and air and pollutant residues in food, which add extra strain on the body that supplements al
Pharmacological anti-aging is a rapidly expanding and heterogeneous field. It includes approved drugs used beyond their original indications, repurposed medications, metabolic therapies, hormone optimization, neuroactive compounds, psychedelics, peptides, anabolic agents, nutraceuticals with medication-like effects, and selected experimental compounds. These interventions differ substantially in indication, mechanism, evidence strength, regulatory status, monitoring burden, interaction potential, and long-term risk. This paper presents a conceptual evidence-mapping review that reframes anti-aging medicine as precision healthspan pharmacology. It argues that anti-aging should not be reduced to disease treatment, survival medicine, or passive acceptance of age-related decline. Its central aim is to exceed age-imposed biological constraints by preserving and expanding functional reserve. Pharmacological intervention should therefore be organized into functional domains: metabolic healthspan, nutrient and electrolyte correction, environmental burden, female and male hormone optimization, neuroendocrine and circadian adjuncts, neuroimmune modulation, vascular support, muscle and skeletal preservation, neurofunctional and neuroenergetic activation, psychedelic neuroplasticity, neuropeptide research, experimental longevity peptides, repair peptides, nutraceutical-pharmacological overlap, and mechanistically heterogeneous experimental compounds. The central criterion is not whether a compound is marketed as anti-aging, but whether it plausibly supports a defined healthspan domain and whether its evidence maturity, monitoring burden, interaction profile, and safety profile justify its classification. The paper also emphasizes that pharmacology cannot replace the foundations of human physiology and psychosocial health: adequate nutrition, sufficient protein and essential amino acids, essential fatty acids, micronutrients, fiber, minerals, sunlight, movement, resistance training, deep sleep, recovery, structured stress reduction, meaningful social contact, personally significant goals, purpose and meaning in life, and the reduction of avoidable metabolic, toxicological, and inflammatory stressors. These foundations are especially important because modern environments differ substantially from earlier human environments: food is quantitatively abundant but not always nutrient-dense, air pollution is widespread, water and air may contain microplastics, and animal-derived foods may carry contaminant burdens such as veterinary drug residues, hormonal growth-promoter residues, or heavy metals in fish. The conclusion is that precision healthspan pharmacology should be organized around functional domains, evidence maturity, sex-specific evaluation, biomarker monitoring, nutrient and electrolyte status, environmental burden, protocol-level risk, psychosocial meaning, and long-term safety.