A standing audit of what medicine can actually do about human aging. Every intervention that claims to slow, stop or reverse it — hormones, senolytics, rapamycin, NAD+, partial reprogramming, stem cells, plasma exchange, skin, hair — is rated on two things only: how far it has been tested in humans, and what came out. Nothing here is advice; the point is to separate what is demonstrated from what is merely sold. Where it stands: 38 out of 100 on the scale below, and at the pace of the last ten years the first milestone that would really count — a randomised trial deferring several age-related diseases at once — arrives around 2036.
Last updated: 5 October 2026. · 11 axes, 49 interventions. Compiled automatically and updated weekly. A working document, not medical advice.
0 interventions have shown, in humans and on a hard clinical endpoint, a slowing of aging itself. One axis carries hard outcome data (GLP-1, SELECT: MACE −20%, n=17,604), 10 interventions earn a favourable verdict on a narrow indication, 13 an unfavourable one — 6 of those after a negative randomised trial.
How far are we, against the goal?
A ladder of qualitative milestones, from nothing to a biological age you can set. It is a judgement scale, and a non-linear one: the milestones are changes of kind, not percentages of progress. Going from 38 to 50 is far harder than going from 8 to 38.
Today: 38 / 100 ████████░░░░░░░░░░░░
- 20 · Risk factors controlled. Not smoking, sound blood pressure and metabolism, physical activity. Very real gains in life expectancy — but this is disease prevention, not modulation of aging.
- 35 · Slowing on biomarkers. Interventions move surrogate endpoints in humans: epigenetic clocks, pace of aging, inflammatory markers. No hard clinical endpoint.
- 50 · Aging clearly slowed. A randomised trial shows, on a composite clinical endpoint in humans, the simultaneous deferral of several age-related diseases. That is exactly what TAME had qualified as an endpoint with the FDA — and what nobody has yet achieved.
- 70 · Aging stopped. Mortality stops doubling every 7–8 years (the end of the Gompertz law) and the incidence of age-related disease stabilises instead of rising. The risk of dying becomes independent of age.
- 90 · Aging reversed. Measurable, durable, multi-organ restoration of function in older humans — not a clock that moves, a physiological function that comes back up and stays up.
- 100 · Control. Biological age becomes a parameter you set, in both directions, with acceptable safety.
Trajectory, 1990 to today
Same scale. At the slope of the last ten years, milestone 50 would be reached around 2036 — that is arithmetic, not a forecast.
| 1990 | ██░░░░░░░░░░░░░░░░░░ 8 | Rudman (NEJM): GH in older men. +8.8% lean mass, no functional endpoint measured. Hormones replaced without knowing what is being changed. |
| 2000 | ██░░░░░░░░░░░░░░░░░░ 12 | Longevity genetics: daf-2 in the nematode, Ames and Snell dwarf mice (+30–40%). Aging becomes a modifiable object in the laboratory. |
| 2009 | ████░░░░░░░░░░░░░░░░ 18 | Rapamycin extends the life of already adult mice (NIA Interventions Testing Program). The first gerotherapeutic reproducible across laboratories. |
| 2013 | ████░░░░░░░░░░░░░░░░ 22 | “Hallmarks of aging” and the Horvath clock. For the first time, a shared mechanistic framework and a quantitative measure. |
| 2016 | █████░░░░░░░░░░░░░░░ 26 | Ocampo: cyclic partial reprogramming extends the life of progeroid mice (+25–33%). First senolytics identified. |
| 2019 | ██████░░░░░░░░░░░░░░ 30 | First human senolytic trials (n=9–14, open-label) and TRIIM (n=9). But RTB101 fails in phase 3 across 1,024 people: scale punishes. |
| 2023 | ███████░░░░░░░░░░░░░ 34 | SELECT: MACE −20% across 17,604 people without diabetes. Randomised plasma exchange. Third-generation clocks (DunedinPACE) that measure a pace rather than an age. |
| 2026 | ████████░░░░░░░░░░░░ 38 | First human dosed with partial reprogramming (9 June, ER-100), and the first lifespan extension by a GLP-1 in mice (+12.4% median, treatment started at 20 months — but HR not reported and maximum survival not analysed). … |
The 49 interventions
Bar length is how far the intervention has been tested, not the result obtained: a long bar with a red marker means well tested, and it did not work. Levels run 1 preclinical, 2 human pilot, 3 pilot RCT, 4 phase 2 RCT, 5 large RCT or hard endpoint. The verdict is the benefit/risk balance in anti-aging use by a person without the corresponding disease — several interventions rated unfavourable here are useful on their medical indication.
✓ Favourable ▲ Watch ● Insufficient ✕ Unfavourable
| Dutasteride 0.5 mg | █████ | 5 · large RCT / hard endpoint | ▲ Watch | Hair |
| Exercise (aerobic and resistance) | █████ | 5 · large RCT / hard endpoint | ✓ Favourable | Exercise |
| Hair transplantation (FUE/FUT) | █████ | 5 · large RCT / hard endpoint | ✓ Favourable | Hair |
| JAK inhibitors (alopecia areata) | █████ | 5 · large RCT / hard endpoint | ✓ Favourable | Hair |
| Levothyroxine “optimisation” | █████ | 5 · large RCT / hard endpoint | ✕ Unfavourable | Hormones |
| Low-dose oral minoxidil | █████ | 5 · large RCT / hard endpoint | ▲ Watch | Hair |
| Melatonin | █████ | 5 · large RCT / hard endpoint | ▲ Watch | Hormones |
| NAD+ / NMN / NR | █████ | 5 · large RCT / hard endpoint | ✕ Unfavourable | NAD+ |
| Oral collagen | █████ | 5 · large RCT / hard endpoint | ✕ Unfavourable | Skin & dermis |
| Oral finasteride 1 mg | █████ | 5 · large RCT / hard endpoint | ✓ Favourable | Hair |
| RTB101 (mTORC1 inhibitor) | █████ | 5 · large RCT / hard endpoint | ✕ Unfavourable | mTOR |
| Semaglutide / GLP-1 agonists | █████ | 5 · large RCT / hard endpoint | ✓ Favourable | Metabolic |
| SM04554 (topical Wnt) | █████ | 5 · large RCT / hard endpoint | ✕ Unfavourable | Hair |
| Testosterone (confirmed hypogonadism) | █████ | 5 · large RCT / hard endpoint | ▲ Watch | Hormones |
| Topical clascoterone 5% (Breezula) | █████ | 5 · large RCT / hard endpoint | ▲ Watch | Hair |
| Topical finasteride (P-3074) | █████ | 5 · large RCT / hard endpoint | ▲ Watch | Hair |
| Topical minoxidil 5% | █████ | 5 · large RCT / hard endpoint | ✓ Favourable | Hair |
| Topical tretinoin | █████ | 5 · large RCT / hard endpoint | ✓ Favourable | Skin & dermis |
| Transdermal MHT + micronised progesterone | █████ | 5 · large RCT / hard endpoint | ✓ Favourable | Hormones |
| ASC-enriched fat grafting (CAL) | ████░ | 4 · phase 2 RCT | ✓ Favourable | Facial volume |
| Fractional laser / RF microneedling | ████░ | 4 · phase 2 RCT | ✓ Favourable | Skin & dermis |
| Growth hormone | ████░ | 4 · phase 2 RCT | ✕ Unfavourable | GH / IGF-1 |
| Intravitreal UBX1325 (Bcl-xL) | ████░ | 4 · phase 2 RCT | ▲ Watch | Senescence |
| Laromestrocel (allogeneic MSCs) | ████░ | 4 · phase 2 RCT | ● Insufficient | Stem cells |
| LLLT (low-level laser) | ████░ | 4 · phase 2 RCT | ▲ Watch | Hair |
| Metformin (gerotherapeutic use) | ████░ | 4 · phase 2 RCT | ● Insufficient | Metabolic |
| Microneedling + minoxidil | ████░ | 4 · phase 2 RCT | ▲ Watch | Hair |
| MK-677 / GH secretagogues | ████░ | 4 · phase 2 RCT | ✕ Unfavourable | GH / IGF-1 |
| Photobiomodulation (red/NIR LED) | ████░ | 4 · phase 2 RCT | ▲ Watch | Skin & dermis |
| PRP (platelet-rich plasma) | ████░ | 4 · phase 2 RCT | ● Insufficient | Hair |
| Rapamycin (“anti-aging” dose) | ████░ | 4 · phase 2 RCT | ● Insufficient | mTOR |
| Senolytics dasatinib + quercetin | ████░ | 4 · phase 2 RCT | ▲ Watch | Senescence |
| Setipiprant (PGD2 pathway) | ████░ | 4 · phase 2 RCT | ✕ Unfavourable | Hair |
| Systemic DHEA | ████░ | 4 · phase 2 RCT | ✕ Unfavourable | Hormones |
| PP405 (follicle stem cell activation) | ███░░ | 3 · pilot RCT | ▲ Watch | Hair |
| Therapeutic plasma exchange (TPE) | ███░░ | 3 · pilot RCT | ● Insufficient | Plasma |
| Topical senolytic RLS-1496 | ███░░ | 3 · pilot RCT | ▲ Watch | Senescence |
| Exosome and stem cell clinics | ██░░░ | 2 · human pilot | ✕ Unfavourable | Stem cells |
| Hair exosomes | ██░░░ | 2 · human pilot | ✕ Unfavourable | Hair |
| HIFES / Emface | ██░░░ | 2 · human pilot | ● Insufficient | Facial volume |
| Partial reprogramming (ER-100, OSK) | ██░░░ | 2 · human pilot | ▲ Watch | Reprogramming |
| TRIIM-X (thymus: GH + DHEA + metformin) | ██░░░ | 2 · human pilot | ● Insufficient | GH / IGF-1 |
| Verteporfin (neogenesis) | ██░░░ | 2 · human pilot | ✕ Unfavourable | Hair |
| Anti-FSH antibody (MS-Hu6) | █░░░░ | 1 · preclinical | ▲ Watch | Hormones |
| Cell therapy / follicle neogenesis | █░░░░ | 1 · preclinical | ● Insufficient | Hair |
| Recombinant klotho | █░░░░ | 1 · preclinical | ▲ Watch | Plasma |
| Reversing grey hair | █░░░░ | 1 · preclinical | ● Insufficient | Hair |
| Senolytics on dermal papilla | █░░░░ | 1 · preclinical | ▲ Watch | Hair |
| SFRP1 / WAY-316606 | █░░░░ | 1 · preclinical | ✕ Unfavourable | Hair |
The decisive datum behind each rating — trial name, sample size, p value — lives in the weekly note. This page carries the ratings; the notes carry the arguments.
The gap that defines the field
Two ratings out of 10 per axis: what the biology promises, and what is demonstrated in humans. The wider the gap, the further the axis is sold beyond its evidence. A judgement scale, not a measurement.
| plausibility | demonstrated | gap | |
| Partial reprogramming | ██████████ 10 | █░░░░░░░░░ 1 | 9 |
| mTOR / rapamycin | █████████░ 9 | ██░░░░░░░░ 2 | 7 |
| NAD+ / sirtuins | ████████░░ 8 | █░░░░░░░░░ 1 | 7 |
| Senescence / senolytics | █████████░ 9 | ███░░░░░░░ 3 | 6 |
| GH / IGF-1 | ███████░░░ 7 | █░░░░░░░░░ 1 | 6 |
| Plasma & circulating factors | ██████░░░░ 6 | █░░░░░░░░░ 1 | 5 |
| Stem cells / exosomes | ██████░░░░ 6 | ██░░░░░░░░ 2 | 4 |
| Hair & follicle | ████████░░ 8 | ████░░░░░░ 4 | 4 |
| Exercise | █████████░ 9 | █████░░░░░ 5 | 4 |
| Hormone replacement | ██████░░░░ 6 | ███░░░░░░░ 3 | 3 |
| Facial volume / fat | ███████░░░ 7 | ████░░░░░░ 4 | 3 |
| Skin & dermis | ████████░░ 8 | ██████░░░░ 6 | 2 |
| Metabolic (GLP-1, metformin) | ████████░░ 8 | ███████░░░ 7 | 1 |
The ten readouts that will settle it
A trial that slips from year to year is itself information.
- 2026 Q4 — TRIIM-X — thymus, epigenetic age. Randomised phase 2, n=85 targeted, primary completion announced for December 2025 — now 308 days overdue with no results filed, and a ClinicalTrials.gov record frozen since 7 May 2025, i.e. …
- 2026 — VIBRANT — rapamycin and ovarian aging. n=50 women aged 35–45 (NCT05836025), “active, not recruiting”. Primary completion ACTUAL on 21 October 2025, enrolment ACTUAL at 50, record unchanged since 26 December 2025; re-checked without change on 5 …
- 2027 — Anti-FSH (MS-Hu6) — first human dosing. Still no public IND and no registered human trial (re-checked 5 October 2026): the status has not moved in over a year. The package remains entirely preclinical, NIH funding U01AG073148. …
- 8 October 2026 — ER-100 — the first human reprogramming data. n=18 targeted (12 open-angle glaucoma across two doses, 6 NAION), no placebo arm, OSK transgene switched on by eight weeks of oral doxycycline. …
- 2027 — Clascoterone (Breezula) — regulatory filings. SCALP-1 (actual n=703, completed 26 January 2026) and SCALP-2 (actual n=762, completed 16 July 2025): two trials of the same protocol, eighteen months apart. …
- 2029–31 — PP405 — the phase 3 exists. The only genuinely new mechanism in the hair field (metabolic awakening of follicle stem cells). No phase 2b was ever registered: after the phase 2a (NCT06393452, n=78), the programme goes straight to phase 3. …
- 2028 — SToMP-AD phase 2 — senolytics and Alzheimer’s. n=48, randomised double-blind, tau-positive (NCT04685590), “active, not recruiting”, record maintained (April 2026), unchanged as of 5 October 2026. Primary completion confirmed for January 2028. …
- 2028 — Rapamycin pre-frailty, Arizona. Phase 3 announced 1 April 2026: $12M in philanthropic funding (R. Ken Coit gift), University of Arizona and Banner Health, principal investigator Bonnie LaFleur, two years of treatment then one year of follow-up, co-endpoints …
- 2028–29 — TRIAD — Dog Aging Project. About 580 large-breed dogs, randomised double-blind, 3 years of treatment then lifelong follow-up, $7M from the NIA. …
- 2028+ — TAME — metformin. n=3,000, ages 65–79. Still no registration, ten years on: AFAR is still publicly soliciting donors to launch the trial, funding (about $75M) remaining incomplete. In practice, to be reclassified from “watch” to “moribund”. …
Axis briefs
Hormone replacement — ✕ Unfavourable
Established. Correcting a documented deficiency, or treating menopausal symptoms. Transdermal oestradiol + micronised progesterone: no increase in thrombosis. …
Missing. Any evidence that a hormone slows aging. Skin: KEEPS, 4 years, no effect on wrinkles. And the “optimisation” side keeps backfiring: restoring euthyroidism loses 1.39 kg of which 0.95 kg is lean mass for 0.75 kg of fat (23 …
Tipping point. The anti-FSH antibody — the only endocrine idea that is not about topping a gauge back up, and whose human argument has just strengthened (FSH and amyloid burden, n=884). Still zero trials, zero public IND. …
GH / IGF-1 — ✕ Unfavourable
Established. That the intuition is inverted, and the case is strengthening on both sides. In animals: knocking out the GH receptor not at birth but in mid-life (inducible KO at 12 months, Aging Cell, 5 Sept 2026) extends median survival …
Missing. A functional benefit in humans. The IGF-1/mortality relationship is U-shaped — “as low as possible” is wrong too. …
Tipping point. Tesamorelin, the only branch with a real indication (visceral fat, steatosis), and specifically TRIUMPH (PMID 42419889), whose protocol for tesamorelin plus exercise on physical function was published on 8 July 2026 with no …
Senescence / senolytics — ▲ Watch
Established. Since 1 October 2026, a randomised placebo-controlled primary endpoint met. Dasatinib + quercetin in MASH (Nature Metabolism, PMID 42823536, NCT05506488), n=31, double-blind, intermittent dosing over three 7-week …
Missing. Precision, replication, and a clinical endpoint. The MASH result is positive but not precise: no confidence interval is reported, n=31 means one patient flips the p value, and the 7% placebo rate sits well below the …
Tipping point. SToMP-AD (n=48, January 2028), which is now the real efficacy test of the class in a neurodegenerative disease. RLS-1496 topically, venetoclax as a brain senolytic in mice, and senolytic preconditioning of the recipient bed before …
mTOR / rapamycin — ● Insufficient
Established. The most reproducible of animal gerotherapeutics. In humans: acceptable tolerance on a weekly dose.
Missing. A primary endpoint met, and we are now at three consecutive failures. PEARL missed its own (p=0.94), RAPA-EX-01 too (p=0.089, and per-protocol it goes the wrong way, with a signal of antagonism to exercise adaptation), and …
Tipping point. VIBRANT, whose actual primary completion is confirmed at 21 October 2025 — the readout is therefore 349 days late, not imminent, and its estimated study completion of 1 September 2026 has now been passed too, with the …
NAD+ / sirtuins — ✕ Unfavourable
Established. That oral precursors raise blood NAD+ reliably and dose-dependently. But it must be added: that number is not a marker of aging. Across seven independent cohorts (Nature Metabolism, May 2026), blood NAD+ varies …
Missing. Everything else. Muscle, glucose, lipids, biological age: null in meta-analysis — and the most recent (15 RCTs, n=383, July 2026) produces a single positive endpoint across a whole battery, −2.43 mmHg of diastolic …
Tipping point. Nothing, clinically. This is now a well-characterised negative whose very biomarker is contested, and the axis was swept again on 5 October 2026 across 36 records with no randomised NMN or NR trial published in the window …
Partial reprogramming — ▲ Watch
Established. In animals: vision restored, +109% of remaining life expectancy from systemic OSK in 124-week-old mice.
Missing. Any human efficacy data. And a route to systemic use: no dosing paradigm, no in vivo monitoring of loss of cell identity.
Tipping point. NCT07290244, and for the first time the appointment has an hour on it. Life Biosciences announced on 1 October 2026 that it will present the first-in-human data from the ER-100 phase 1 at Eyecelerator @ AAO 2026, on 8 October …
Stem cells / exosomes — ✕ Unfavourable
Established. A single controlled signal survives: laromestrocel, +63.4 m on the walk test in the phase 2b frailty trial (n=148, p=0.008 at 9 months, non-significant at 6 months).
Missing. Everything sold at retail. Zero approved exosomes, documented infections and blindings, no RCT in aging; the most cited meta-analysis in the aesthetic field (39 human trials, ASJ March 2026) reports only relative percentages, …
Tipping point. There is still no phase 3 of laromestrocel, and the 5 October reading is that there will not be one soon: no SEC filing at all in the window, and a company release of 30 September announcing three investor conferences …
Plasma & circulating factors — ● Insufficient
Established. That the mechanism is probably removal of pro-geronic factors, not addition of youthful ones: in mice, saline equals young plasma.
Missing. Any clinical endpoint. −2.6 years of biological age is a surrogate, in a small commercially sponsored trial, never replicated — and the only category that does not respond in the 51-intervention reanalysis is medical …
Tipping point. Klotho: an effect in primates with an inverted dose-response, and zero human trials to date. The alpha-klotho mRNA phase 1b announced in February 2026 has produced no data, and the announcements page re-checked on 5 October 2026 …
Metabolic (GLP-1, metformin) — ✓ Favourable
Established. The only axis with hard outcome data: SELECT, MACE −20% across 17,604 people without diabetes. But state it precisely, which until 5 October 2026 we did not: the win is on events, not deaths. …
Missing. The demonstration that the effect is gerotherapeutic and not merely cardiometabolic — and the post hoc of 16 September 2026 pushes that demonstration further away: in SELECT stratified by frailty index, only the middle …
Tipping point. EASD Milan read out, and nothing there is a second SELECT. TRIUMPH-2 (retatrutide, 29 September, Lancet, n=1,152, placebo-controlled, 80 weeks) meets its primary endpoint on weight, a surrogate, at −18.8% vs …
Hair & follicle — ▲ Watch
Established. That three drugs work, modestly, and mainly as brakes: finasteride +54 hairs/cm² at 5 years, topical minoxidil +18, and extended-release oral minoxidil +23 to +26 net against placebo at 6 months (n=519). …
Missing. Any human follicle neogenesis demonstrated in a controlled trial. And severe baldness is arithmetically unsolvable by surgery: about 7,000 grafts available in a lifetime against 10,000–15,000 needed. …
Tipping point. EADV Vienna, 30 September to 3 October, has been and gone, and the androgenetic axis got nothing. All three daily round-ups were read: no clascoterone, no androgenetic alopecia, no skin-aging item; the hair programme was …
Skin & facial volume — ✓ Favourable
Established. That tretinoin and fractional laser work, modestly, on the dermis. And that ASC-enriched grafting retains 73% of the graft in the face.
Missing. Any non-surgical method of recreating fat volume. And deep RF/HIFU can worsen an already hollow face (documented fat atrophy). …
Tipping point. The CP-A/LIFR biology (Science 2025) taken in reverse: inducing adipose progenitors locally in a depleted compartment. Nobody is asking this question. …
Watch log
Updated weekly; the 10 latest of 54 entries.
- 5 October 2026. Correction of our own inconsistency, prompted by an outside challenge: we never applied the broken-hierarchy rule to SELECT itself. Asked to defend the GLP-1 rating specifically on overall mortality, the answer is …
- 5 October 2026. Exercise is added to the ratings, as the baseline this dashboard was missing. It was raised as an objection worth answering: is exercise not simply stronger than the best-rated molecule here? On the evidence hierarchy, …
- 5 October 2026. A senolytic meets a randomised primary endpoint for the first time. The verdict on dasatinib + quercetin moves from “insufficient” to “watch”. Nature Metabolism, 1 October, PMID 42823536, NCT05506488 — a phase …
- 5 October 2026. Metformin as a gerotherapeutic loses ground twice in one week, and the epigenetic clocks lose more. (1) DPPOS, nineteen years of randomised follow-up, null. Respiratory Medicine, October 2026, PMID 42551713: …
- 5 October 2026. EASD Milan: two incretin readouts, no second SELECT, and one estimand lesson worth keeping. TRIUMPH-2 (retatrutide, 29 September, simultaneous Lancet publication) is the genuine premiere: n=1,152 …
- 5 October 2026. ER-100: the first human data from partial reprogramming now have a date and an hour, three days after this window closes. Life Biosciences broke a silence running since 10 August with a release on 1 October 2026: it …
- 5 October 2026. Registries, EADV and coverage: the primary source is gone for a third cycle, one long-standing question is settled, and one is deliberately left open. ClinicalTrials.gov is now unusable — API v2 in …
- 28 September 2026. Correction: SURPASS-CVOT is not an upcoming readout, the trial has already read out, and there is no second SELECT. Our notes and this dashboard billed SURPASS-CVOT at EASD Milan as “the field’s second hard endpoint after …
- 28 September 2026. Longeveron: the governance point opened on 21 September is closed, and it closes on the mundane side. The 8-K covering the ELPIS II topline was indeed filed, on 23 September 2026 (report period 16 September, …
- 28 September 2026. Rapamycin: the dosing of the third negative RCT is obtained, and it changes how the three failures read. Record NCT04996719 (Mayo Clinic, trial run May 2022 to August 2023): sirolimus 0.5 mg every other day for 2 …