Every year, roughly 100 million Americans walk out of an annual physical with a clean bill of health based on 15 to 20 blood markers. A comprehensive longevity panel tests 80 to 120+. That's not a small gap — it's a blind spot the size of a canyon, and it's the difference between catching a problem 15 years early and discovering it after the damage is done.

Your last annual physical probably included a basic blood panel. Your doctor told you everything looked "normal." You felt reassured. But "normal" doesn't mean optimal, and that standard panel is missing most of the biomarkers that actually predict disease, decline, and early death.

I've spent years watching patients come through my office clutching lab results that told them almost nothing useful. A guy in his 40s — fit, eats clean, runs three times a week — came in with a "perfect" annual physical. His total cholesterol was 195. His doctor said he was fine. His ApoB was 142. His fasting insulin was 14. He was a ticking time bomb, and nobody had bothered to check.

That's not an outlier. That's Tuesday.

I'm going to walk you through the most important lab tests for longevity — what each one measures, why it matters, and why your doctor probably isn't ordering it.

Why Standard Blood Work Falls Short

The labs your primary care physician orders are designed to screen for acute disease. They answer a narrow question: Do you have a diagnosable condition right now?

They don't answer the more important one: Are you on a trajectory toward disease?

Take lipids. The standard panel measures total cholesterol, LDL, HDL, and triglycerides. If your LDL cholesterol comes back under 130 mg/dL, your doctor tells you it's normal.

But LDL cholesterol isn't the primary driver of atherosclerosis. What actually drives plaque formation is the number of atherogenic lipoprotein particles penetrating your arterial walls — best measured by ApoB (apolipoprotein B). A person can have "normal" LDL cholesterol and dangerously elevated ApoB. This discordance affects an estimated 10 to 20 percent of the population, according to the CARDIA study published in the Journal of the American College of Cardiology (Otvos et al., 2011).

Those people are walking around thinking their heart health is fine. It isn't.

I see this disconnect constantly. Standard testing is too shallow, too late, and too focused on population averages rather than individual optimization.

The Essential Longevity Biomarkers

What follows is the list of tests that belong in every comprehensive longevity panel. I've grouped them by category, but I want to be clear upfront: this information is educational, not diagnostic. These aren't recommendations for self-diagnosis or self-treatment. Your results need to be interpreted by a qualified physician in the context of your full health picture.

Cardiovascular Risk

Heart disease kills more Americans than any other cause. Yet the standard lipid panel misses most of the actionable risk markers.

ApoB (Apolipoprotein B)

Every LDL particle, VLDL particle, and Lp(a) particle carries exactly one ApoB molecule, so measuring ApoB gives you a direct particle count — far more useful than the cholesterol mass measured by a standard lipid panel.

Many leading cardiologists now consider ApoB the single best blood-based predictor of cardiovascular risk. Dr. Allan Sniderman at McGill University has published decades of research supporting this position. The European Atherosclerosis Society issued a consensus statement (Nordestgaard et al., European Heart Journal, 2012) calling ApoB a superior marker to LDL-C. The 2024 National Lipid Association clinical consensus reinforces this view. Most doctors don't order it because it's not part of the standard lipid panel, and conventional care defaults to the cheapest available tests.

Optimal range: Below 80 mg/dL for moderate risk. Below 60 mg/dL for anyone with elevated risk factors or a family history of heart disease. These targets align with the NLA 2024 consensus and the approach used by leaders in preventive cardiology.

Lp(a) — Lipoprotein(a)

This one's different from everything else on this list, and it's important you understand why. Lp(a) is a genetically determined lipoprotein variant that dramatically increases cardiovascular and stroke risk. You can't change it with diet or exercise — it's hardwired into your DNA. That's exactly why you need to know your number.

Elevated Lp(a) affects approximately 20% of the population and accounts for a significant percentage of "unexplained" heart attacks in otherwise healthy people. The 2024 European Society of Cardiology guidelines now recommend that every adult get tested at least once in their lifetime. Most physicians never order it.

Low risk: Below 75 nmol/L (or below 30 mg/dL) per the EAS consensus statement (Nordestgaard et al., European Heart Journal, 2010). Levels above 125 nmol/L (approximately 50 mg/dL) are considered high risk. Because Lp(a) is genetically fixed, one test is usually sufficient — you don't need to recheck it.

hs-CRP (High-Sensitivity C-Reactive Protein)

Chronic, low-grade inflammation accelerates atherosclerosis, cancer, and neurodegenerative disease. hs-CRP measures that systemic inflammation. The landmark JUPITER trial — 17,802 patients, published in the New England Journal of Medicine (Ridker et al., 2008) — demonstrated that patients with elevated hs-CRP benefited from statin therapy even when their LDL cholesterol was "normal." We're talking a 44% relative risk reduction.

Optimal range: Below 1.0 mg/L per AHA/CDC guidelines for cardiovascular risk stratification. Below 0.5 mg/L is where I want my patients.

Homocysteine

An amino acid that, when elevated, damages blood vessel walls and increases both cardiovascular and stroke risk. It's also linked to cognitive decline and osteoporosis. The good news? It's one of the most fixable risk factors on this list. B vitamins — B6, B12, folate — bring it down reliably in most people.

Optimal range: Below 10 umol/L per general consensus. Many longevity practitioners, myself included, target 4 to 8 umol/L based on data from the Framingham and Hordaland cohort studies linking lower homocysteine to reduced vascular and cognitive risk.

Metabolic Health

Metabolic dysfunction underlies type 2 diabetes, obesity, fatty liver disease, and much of cardiovascular disease. Standard testing catches it years too late — and that's not an exaggeration.

Fasting Insulin

If I could add only one test to every annual physical in America, this would be it. No hesitation.

Fasting insulin tells you how hard your pancreas is working to maintain normal blood sugar. Insulin resistance develops 10 to 15 years before blood glucose becomes abnormal. By the time your fasting glucose hits 100 mg/dL (the prediabetes threshold), your body's been overproducing insulin for years — silently, with no symptoms, and no flags on standard labs. Standard diabetes screening uses fasting glucose and HbA1c. Both miss the early stages entirely.

Studies of centenarians — the people who actually make it past 100 in good health — consistently show fasting insulin levels below 5 uIU/mL throughout their lives (Pignatti et al., Aging Clinical and Experimental Research, 2004).

Optimal range: Below 6 uIU/mL. I target 2 to 5 for my patients.

HbA1c (Hemoglobin A1c)

Measures your average blood sugar over the past 2 to 3 months. Standard medicine uses 6.5% as the diabetes threshold. We use a tighter target.

Optimal range: 5.0 to 5.3%. The ADA defines 5.7% as the prediabetes line, but by that point you've already lost ground.

HOMA-IR

Calculated from your fasting glucose and fasting insulin, this score quantifies insulin resistance in a single number. Think of it as a metabolic stress test for your pancreas. It gives a clearer picture than either marker alone.

Optimal range: Below 1.0, per Matthews et al.'s original 1985 index and validated in subsequent metabolic research. Anything above 2.0 strongly suggests developing insulin resistance.

Uric Acid

Most people hear "uric acid" and think gout. Fair enough — that's the old-school association. But it's increasingly recognized as a marker for metabolic syndrome and cardiovascular risk. Dr. Richard Johnson at the University of Colorado has published extensively — multiple books and peer-reviewed papers — linking elevated uric acid to fructose metabolism dysfunction, fatty liver disease, and hypertension (Nature Reviews Nephrology, 2009; The Journal of Clinical Investigation, 2012).

Optimal range: Below 6.0 mg/dL for men. Below 5.0 mg/dL for women.

Hormonal Health

Hormonal decline doesn't just make you feel lousy. It drives muscle loss, fat gain, cognitive decline, bone loss, and reduced quality of life. Standard medicine rarely screens for it until symptoms are severe — by which point you've already lost years of function.

Total and Free Testosterone (Men and Women)

Testosterone declines 1 to 2% per year after age 30 in men — this is well-established in the Massachusetts Male Aging Study and confirmed by the Baltimore Longitudinal Study of Aging. Low testosterone is associated with increased cardiovascular risk, metabolic syndrome, depression, osteoporosis, and all-cause mortality. Women also produce and need testosterone; deficiency contributes to low libido, fatigue, and reduced muscle mass.

Most physicians only test testosterone if a patient specifically complains of symptoms. And even then, many drag their feet.

Optimization target (men): Total testosterone 600 to 900 ng/dL; free testosterone 15 to 25 pg/mL. A note on context: the AUA defines "low" as below 300 ng/dL, so 600 to 900 isn't a clinical guideline — it's an optimization target used in longevity medicine. There's a wide gulf between "not clinically low" and "functioning at your best." That's the gap we're trying to close.

Estradiol (E2)

The primary estrogen. Critical for both sexes. In men, estradiol needs to stay in balance with testosterone — too high or too low creates problems. In women, estradiol decline during perimenopause and menopause triggers a cascade of cardiovascular, bone, and cognitive risks that the WHI data and subsequent reanalyses have illuminated over the past two decades.

Optimal range (men): 20 to 40 pg/mL per clinical consensus in functional and longevity medicine.

DHEA-S (Dehydroepiandrosterone Sulfate)

A precursor hormone produced by the adrenal glands that declines steadily with age. DHEA-S supports immune function, bone health, and serves as a reservoir for sex hormone production. Multiple studies have identified it as one of the most reliable biomarkers of biological aging (Barrett-Connor et al., New England Journal of Medicine, 1986).

Optimal range: Age-dependent, but longevity physicians generally target the upper third of the reference range for the patient's age bracket.

Full Thyroid Panel (TSH, Free T3, Free T4, Reverse T3, Thyroid Antibodies)

Standard care only orders TSH. That's one piece of a five-piece puzzle. TSH can be "normal" even when free T3 is low or reverse T3 is elevated — I see this at least twice a week in my practice. Subclinical thyroid dysfunction affects energy, metabolism, mood, and cognitive function, and it's completely invisible on a TSH-only screen.

Optimal range: TSH 1.0 to 2.0 mIU/L per functional endocrinology consensus (Wartofsky & Dickey, Journal of Clinical Endocrinology & Metabolism, 2005). Free T3 in the upper third of the reference range.

Cortisol (AM) and SHBG

Cortisol, your primary stress hormone, should be measured in the morning when it peaks. Chronically elevated or suppressed cortisol points to HPA axis dysfunction — often driven by chronic stress — which disrupts sleep, metabolism, immune function, and recovery.

SHBG (sex hormone binding globulin) is the protein that binds sex hormones and reduces their bioavailability. Here's why it matters: high SHBG can make your total testosterone look perfectly adequate on paper while your free testosterone — the stuff that actually does the work — is tanked. You can't interpret a hormone panel accurately without it. Period.

Nutrient Status

Deficiencies in key nutrients are far more common than most people realize, and they're invisible on standard panels.

Vitamin D (25-OH) Optimal range: 50 to 80 ng/mL per the Endocrine Society's higher-target recommendations and longevity literature (Holick, New England Journal of Medicine, 2007). Most Americans are below 30. That's not a small miss — it's a chasm.

Vitamin B12 Optimal range: Above 600 pg/mL. The standard "normal" range starts at 200, but functional deficiency — with real neurological and cognitive symptoms — begins well above that cutoff (Lindenbaum et al., New England Journal of Medicine, 1988).

Ferritin Optimal range (men): 50 to 150 ng/mL per functional medicine consensus. Elevated ferritin (above 300) can signal iron overload, inflammation, or liver stress. Low ferritin is equally concerning — don't assume it's only a women's issue.

RBC Magnesium Serum magnesium is tightly regulated by your kidneys and doesn't reflect what's actually inside your cells. RBC magnesium is a far more accurate measure of your body's true magnesium status. Optimal range: Above 6.0 mg/dL per functional medicine targets (Elin, Clinical Chemistry, 2010). The standard reference range bottoms out at 4.2 — that's too low for optimization.

Omega-3 Index Measures the percentage of EPA and DHA in your red blood cell membranes. This isn't just a cardiovascular marker — it's tied to cognitive function, mood, and inflammatory status. Optimal range: Above 8% per the work of Dr. William Harris and the OmegaQuant research database (Harris & Von Schacky, Preventive Medicine, 2004). The average American sits around 4 to 5%, which is associated with significantly higher cardiovascular and cognitive risk.

Additional Advanced Markers

IGF-1 (Insulin-Like Growth Factor 1) Reflects growth hormone activity. Important for muscle preservation and tissue repair, but excessively high levels may be associated with increased cancer risk based on epidemiological data. The sweet spot matters — more isn't always better.

GGT (Gamma-Glutamyl Transferase) A liver enzyme that, even within the "normal" range, correlates with oxidative stress, fatty liver, and cardiovascular risk when elevated. Don't ignore it just because it's technically "in range."

Fibrinogen A clotting factor that, when elevated, increases both cardiovascular and stroke risk. It's also a downstream marker of chronic inflammation, which makes it useful as a cross-check against your hs-CRP.

How to Get These Tests

You've got several paths, and they aren't all equal.

Ask your primary care physician. You can request specific tests. Some doctors will order them willingly; many won't, either because they're unfamiliar with the markers or because the standard care model doesn't include them.

Use a direct-to-consumer lab service. Companies like Quest and Ulta Lab Tests let you order blood work on your own without a doctor's order. The limitation: you're on your own to interpret the results, and that's where most people get stuck.

Work with a longevity-focused medical practice. This is the most comprehensive approach. At Rebel Health Alliance, all of these biomarkers — and more — are included in our standard workup drawn from a library of over 3,000 diagnostic tests. Your results are interpreted by a physician who understands optimal ranges, not just reference ranges, and your full team — physician, dietitian, and strength coach — builds a personalized protocol based on what the data shows. You can read more about how our practice works and what our members experience.

The Difference Between "Normal" and Optimal

This is the single most important concept in longevity lab work, and it's the one that most people — including many doctors — still don't fully grasp.

Reference ranges on standard lab reports are based on the middle 95% of the population who had that test done at that lab. That population includes sick people, sedentary people, and people on five medications. Being in the "normal" range means you aren't a statistical outlier. It doesn't mean you're healthy.

Optimal ranges are based on the levels associated with the lowest disease risk and best function in published clinical research. They're almost always narrower and more demanding than standard reference ranges.

A couple of examples to make this concrete:

A TSH of 4.0 is "normal" by standard criteria. But research links it to subclinical hypothyroidism and higher cardiovascular risk (Rodondi et al., Archives of Internal Medicine, 2010). You'd never know that from the lab report your doctor hands you.

Your goal shouldn't be to land somewhere in the reference range. It should be to know where you stand relative to optimal — and close the gap.

Building Your Longevity Lab Routine

Annually at minimum:

Every 6 months if you're actively optimizing:

Once in your lifetime:

At Rebel Health Alliance, we handle all of this. Members have access to over 3,000 diagnostic tests — the most comprehensive diagnostic assessment on the market. Our initial workup includes the full panel, and your physician is available on demand with follow-up testing to track your progress. Your full team — physician, dietitian, and strength coach — works from the same data. You're never guessing. You always have data.

Frequently Asked Questions

How much does comprehensive longevity blood work cost? It depends on the path you take. Direct-to-consumer panels with these markers typically run $400 to $1,200 depending on the scope. Through a longevity-focused practice like ours, testing is included as part of your membership — you're not paying per test. Either way, it's a fraction of what a missed diagnosis costs you down the road.

Will my doctor order these tests if I ask? Some will. Many won't. It's not because they disagree with the science — it's because the standard care model doesn't reimburse for preventive optimization. If your doctor pushes back, you can order most of these through direct-to-consumer labs. Or work with a practice that already includes them.

How often should I retest? Annually at minimum. Every six months if you're actively working to improve specific markers. Lp(a) only needs to be tested once — it's genetic and doesn't change. Everything else should be tracked over time so you can see trends, not just snapshots.

What if my results come back "normal" but I still don't feel right? That's exactly the scenario this whole article is about. "Normal" means you aren't a statistical outlier — it doesn't mean you're optimized. A TSH of 3.8 is "normal." It's not optimal. A fasting insulin of 11 is "normal." It's not where you want to be. If you don't feel right, your numbers are probably telling you why — you just need the right tests and the right person reading them.

Are these tests safe? Any risks? It's blood work. The risk is a needle stick and maybe a small bruise. The far bigger risk is NOT knowing these numbers and walking around with a false sense of security from a panel that only checked 15 markers.

Stop Settling for "Normal"

The biomarkers on this list aren't exotic or experimental. They're validated, well-studied, and clinically actionable. The only reason most people have never seen them on a lab report is that the conventional medical system isn't set up to order them.

That's a system failure, not a science failure. You don't have to accept it.

Want to see what your blood actually reveals about where your health is headed? Schedule a free consultation with Rebel Health Alliance. We'll walk you through exactly what we test, why we test it, and how we use the data to build a protocol specific to you — not a population average.