What to Order
Most annual labs are missing half the picture
A standard US "wellness" panel usually covers CBC + CMP + lipids + HbA1c. That's a fine start — but it omits the most predictive longevity markers (ApoB, Lp(a), hsCRP, homocysteine, vitamin D, hormones). Knowing what to ask for is half the battle.
The longevity-baseline panel
CBC + CMP + lipid panel WITH ApoB + Lp(a) (once in a lifetime) + HbA1c + fasting insulin + hsCRP + homocysteine + vitamin D + ferritin + TSH + free T3/T4 + hormone panel (sex-specific). This covers ~90% of what a preventive-cardiology clinic actually tracks. Annual frequency for most of it.
Which of these should be on a longevity panel?
Pick every marker worth including in an annual workup.
This step is interactive — open the Thier app to try it.
Direct-to-consumer is a real option now
Quest + Labcorp offer direct-to-consumer panels online — you pick the tests, pay out of pocket ($50–$300 for a comprehensive workup), walk into any draw centre, get results in the mail. Useful when your PCP won't order what you want. Insurance coverage varies widely — ask about cash price before running it through insurance.
Counter-intuitive: "normal range" ≠ "optimal"
Lab reference ranges are built from the **middle 95% of people who walked into the lab** — not from healthy outcomes. If a population is broadly metabolically dysfunctional (which the US is), the "normal" range absorbs that dysfunction. Fasting glucose 99 mg/dL is "normal" but doubles your 10-year diabetes risk vs 85. TSH 4.5 is "normal" but symptomatic hypothyroidism often resolves only below 2.5. Always ask: *normal for whom?* The longevity-optimal range is usually narrower and tighter than the printed reference.
Pre-test prep matters more than the panel
Most longevity markers are sensitive to conditions in the 24 hours before the draw. **Fasting insulin and triglycerides** roughly double after a meal — must be drawn fasted (8–12 h). **hsCRP** spikes 5–10× after intense exercise or any infection — wait 48 h after a hard workout, 2 weeks after a cold. **Cortisol** swings 4× across the day; standardise to morning. **Testosterone** peaks AM in men. **Hydration status** shifts ferritin, hematocrit, and creatinine. Skip the workout the day before and draw before 9 AM in a fasted, hydrated state.
Counter-intuitive: too much vitamin D is also bad
The longevity world fetishises vitamin D, but the relationship to mortality is **U-shaped**. The Copenhagen Heart Study found lowest mortality at 25(OH)D ~50–70 ng/mL; **above 100 ng/mL, all-cause mortality rises again**. Megadosing 10,000+ IU daily without monitoring lands many users above 100 over 6–12 months. Test before supplementing high-dose; aim for the middle of the curve, not the top.
Match the marker to the cadence
Connect each test to how often it's worth re-running.
This step is interactive — open the Thier app to try it.
Key Takeaway
A longevity panel is not a standard panel + inertia. It's a deliberate list — about 15 markers — that captures cardiometabolic, inflammation, thyroid, and hormone function, drawn under standardised conditions, interpreted against optimal ranges (not population averages). Ask for the ones missing. If your PCP won't order them, DTC is now a viable alternative. And remember: "normal" was set by a population whose health you're trying to *exceed*, not match.