The Biggest Advances in Longevity Medicine in 2025 — What Actually Matters for Your Healthspan

As 2025 comes to an end, it’s the perfect moment to reflect on what truly advanced longevity medicine this year — not in mice, not in theory, but in real humans.

Here are the developments that meaningfully shape how we age going into 2026 and beyond.

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1. Hormone Therapy for Women Was Finally Set Free

On November 10, 2025, the FDA and HHS removed the long-standing boxed warning from many menopause-related hormone therapy products.

For more than 20 years, this warning frightened women and prevented many from receiving appropriate treatment. But two decades of follow-up made the truth clear:

• When hormone therapy is started before age 60 or within 10 years of menopause, benefits outweigh the risks for most women. Hormone therapy can still be done at a later age but at a slower pace to prevent adverse effects.

• HRT can reduce all-cause mortality, improve cardiovascular health, strengthen bones, and dramatically improve quality of life.

The only boxed warning that remains is for unopposed estrogen in women with an intact uterus. I believe that no woman should take estrogen supplementation without balancing it with progesterone.

How this changed my practice

I now have more confident, open conversations with women navigating menopause. For the right patient, HRT is not just appropriate — it’s a meaningful longevity tool.

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2. Testosterone Therapy Received Its Own Green Light

In February 2025, the FDA also removed the warning label from testosterone therapy, confirming what modern evidence has long shown:

• Properly prescribed TRT does not increase cardiovascular risk.

• It often improves energy, metabolism, muscle mass, libido, motivation, and mood — all fundamental components of healthspan.

What’s new in my practice

I now offer Testosterone Replacement Therapy for both men and women — including pellet therapy, which provides:

• Very stable hormone levels

• Excellent symptom control

• Convenience (3–4 procedures per year)

• Avoidance of peaks and crashes associated with other methods

For many patients, pellet therapy is the most consistent and effective option.

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3. Pregnenolone: The Missing Link in Brain Aging

Across dozens of patient assessments this year, one pattern stood out:

Pregnenolone levels decline significantly with age, and directly affects the brain.

Pregnenolone is a key neurosteroid, supporting:

• Memory

• Mood

• Focus

• Sleep regulation

• Stress resilience

• Neuronal communication and repair

When restored gently to physiological levels (never overdosed), the improvements can be substantial.

What I observed in my practice in 2025

Among patients who tried pregnenolone this year:

→ About 80% felt it was beneficial enough to continue long-term.

They most commonly reported:

• Less brain fog

• Improved clarity and concentration

• Better mood stability

• Greater stress tolerance

• More restorative sleep

• Stronger cognitive endurance

Pregnenolone has become one of the most underrated tools in longevity medicine, particularly for patients concerned about cognitive aging or chronic stress.

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4. Nicotinamide (Vitamin B3) Cut Skin Cancer Risk in High-Risk Adults

A large 2025 U.S. veterans study showed that nicotinamide (niacinamide) 500 mg twice daily significantly reduced new non-melanoma skin cancers:

• ~14% reduction overall

• Up to 54% reduction in patients with prior skin cancers

• Particularly strong effects for squamous cell carcinoma

This form of B3 does not cause flushing and supports DNA repair in skin cells.

I now often recommend nicotinamide for patients with:

• Actinic keratoses

• History of basal or squamous cell carcinoma

• High cumulative sun exposure

It’s safe, inexpensive, and effective.

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5. Shingles Vaccination Was Linked to Lower Dementia Risk

A major 2025 Welsh cohort study found that older adults who received a shingles vaccine were:

• Less likely to develop dementia

• Less likely to die from dementia-related causes

• Showing lower all-cause mortality

This reinforces a core principle of modern longevity medicine:

Preventing neuroinflammation is key to protecting the brain.

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6. Metformin vs. Rapamycin: 2025 Finally Drew a Line in the Sand

For years, the longevity community has debated two drugs: metformin and rapamycin.

I’ve always strongly believed in metformin.

And I’ve always been skeptical of rapamycin.

This year validated that stance.

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Metformin: Backed by Real Human Longevity Data

2025 delivered the largest and most rigorous human analysis yet, using a target-trial emulation of the Women’s Health Initiative:

• Women who initiated metformin had a significantly higher likelihood of reaching age 90 and beyond.

These are not theoretical models — these are real humans.

Metformin also supports:

• Insulin sensitivity

• Mitochondrial function

• Lower inflammation

• Reduced cancer risk in several populations

• Better cardiovascular outcomes

It remains one of the most trusted and biologically sound longevity tools we have today.

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Rapamycin: Hype Without Human Proof — and Now Even More Doubt

Many longevity “experts” have promoted rapamycin for decades.

I never did.

Why? Because it never had convincing human data behind it.

And 2025 confirmed this:

• No meaningful or consistent human evidence of lifespan or healthspan extension

• Minimal and inconsistent biomarker improvements

• Persistent concerns about immune function

• Growing skepticism from major reviewers and researchers

I’m glad to see the field catching up to what I’ve been saying all along:

Rapamycin is not ready for real-world longevity use.

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7. Biological Aging Measurement Took a Major Leap Forward

In 2025, multi-omic aging clocks became dramatically more accurate. These tools combine:

• Blood biomarkers

• Genetics

• Inflammation data

• Metabolomics

• Microbiome profiles

• Imaging

• Hormone patterns

They now predict disease risk, functional decline, and mortality far better than chronological age.

These tools are shaping the future of precision longevity medicine, and I have already incorporated validated biomarkers into my practice.

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8. A Major Upgrade for the Galleri Multi-Cancer Detection Test

One of the most exciting advancements of 2025 was the upgrade to the Galleri test, now featuring:

• Improved sensitivity for early-stage cancers

• Substantially lower false-positive rates

• More accurate tissue-of-origin predictions

• Enhanced methylation-pattern specificity

This translates to:

• More true positives

• Fewer unnecessary scans

• More confidence in early detection

I have offered the Galleri test in my office for 3 years now.

for patients seeking advanced early cancer detection as part of their preventive strategy.

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How 2025 Changed My Longevity Practice

Summarizing the year:

• Hormone therapy is safer and more evidence-based than ever.

• Pregnenolone emerged as a powerful, overlooked neurosteroid.

• Nicotinamide and shingles vaccination offer real protection.

• Metformin remains foundational; rapamycin remains unproven.

• Multi-omic aging tools are improving rapidly.

• And advanced cancer detection became more accurate, and is available in our office.

But despite the breakthroughs, longevity still rests on fundamentals.

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The Real Foundation of Longevity Medicine (My Philosophy)

Longevity is not about megadoses or experimental drugs.

It is about restoring what the body is missing, nothing more, nothing less.

The pillars I emphasize in every patient:

1. Strength training

The single best protection against frailty, osteoporosis, metabolic disease, and cognitive decline.

2. Daily movement

The simplest way to reduce inflammation and improve mitochondrial health.

3. High-quality nutrition

Protein-forward, whole-food, metabolically balanced.

4. Restorative sleep & stress regulation

This is when the body repairs, detoxifies, and rebuilds.

5. Vitamin & mineral optimization

Supplement only what your body is lacking, always to physiological, not supraphysiologic, levels.

6. Hormone optimization

Physiologic replacement of estrogen, progesterone, testosterone, and pregnenolone when indicated.

7. Community, purpose, and emotional wellbeing

Your nervous system is one of the most powerful longevity organs.

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What should I write about next in 2026?

• Hormone optimization

• Pregnenolone and neurosteroids

• Cancer prevention

• Biological age testing

• Longevity labs

• Nutrition for healthy aging

• Strength training for lifespan

Your questions guide my next posts. Share what you want to learn about next.

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To Your Good Health,

The Longevity Doctor®