When high-end gym chain Equinox rolled out its $40,000 longevity programme last year, some saw it as an attempt to chart a new (and expensive) path toward healthy living. Others wondered what, exactly, they would be paying for.

The company teamed up with Functional Health, a longevity startup, on Optimize, a series of personalised health programmes which include a range of biotests, personal training sessions, as well as access to a nutritionist and a sleep coach all aimed at “optimising” the health of its clients.

“At $40,000 a year, the programme better make me immortal,” one TikTok user wrote.

The company, however, isn’t promising to extend its clients’ lifespan, clarified Julia Klim, vice president of strategic partnerships at Equinox.

“We’re not going to be selling promises that we can’t fulfill,” Klim said, adding that Equinox’s definition of longevity places emphasis on “vitality and happiness.”

The disconnect between what customers are hoping for versus what they are getting is indicative of broader consumer confusion over the burgeoning longevity market, which casts a wide net over a range of preventative health measures, including diet, sleep, genetics, even skincare, and of course fitness, all aimed at slowing down the biological process of ageing. In many ways it has replaced the formerly buzzy wellness. While there is no universal definition of longevity, figures in this space often use it to describe the pursuit of longer life, healthier life, performance enhancements or mere anti-ageing benefits.

What there is consensus around, however, is that longevity connotes luxury.

“Real scarcity today isn’t found in rare materials like gold or diamonds, but in something far more valuable: time,” said Christian Kurtzke, chief executive of luxury consultancy The Together Group, which has observed a shift away from material goods and curated experiences towards “personal growth and self-actualisation,” according to a recent report.

There is an inherent tension in positioning health, which is fundamentally a human right, as a luxury service. Most Americans are dissatisfied with the healthcare system, and the US Congress is in the process of stripping funding from Medicaid, a government-backed healthcare programme that supports low-income individuals and children. Longevity clinics offer an attractive alternative for high-earners looking to distance themselves from the inadequacies of the current health system via concierge services and cocktails of prescription medications, supplements and skincare.

The global longevity industry is expected to reach $650 billion by year end, according to the Global Wellness Institute, a non-profit wellness research organisation. In the US alone, there are already over 800 longevity clinics in operation.

Some founders are wary that their industry is already falling victim to bad actors.

“There’s plenty of companies popping up claiming to be longevity companies just because they heard someone on a podcast talk about an ingredient,” said Chris Mirabile, founder and chief executive of longevity clinic Novos, which offers supplements that promise to extend life. “I’d argue that they’re really just a clever marketing company taking advantage of a consumer.”

As the industry continues to grow, understanding how longevity can be defined and what drives significant investment from clients is increasingly crucial.

Extending Lifespan

The best-known definition of the longevity economy is also its most consequential offer: Extending lifespan, i.e. helping people live longer.

The science behind lifespan extension remains scant. However, many experts point to ongoing research efforts like the Longevity Study by the Biomarkers of Aging Consortium, a collaboration between Harvard Medical School and Stanford Medicine, as promising evidence of the field’s future. The average life expectancy in the US as of 2023 (the last year data is available) is 78.4 years, according to the CDC.

Founders of longevity clinics are interpreting already-existing ageing-focused research to create programmes and products that promise their clients an extra 20 to 30 years of life. Novos’ Mirabile has created a “natural” supplement line made up of ingredients like magnesium and hyaluronic acid that promises to reverse the course of ageing and “extend life” by targeting chronic inflammation and mutations in mitochondrial DNA.

The traditional pharmaceutical approach is time-consuming, said Mirabile who expressed concern over the “long term risks and implications” of this type of approach to longevity.

Novos’ longevity kit includes four kinds of supplements and costs $2,273, and has been tested on a group of 12 people over a six month span, who claim to have seen a reduction in their biological age (a number calculated after a battery of tests that measures cellular age). The company’s supplements are not regulated by the Food and Drug Administration, and its website also states that its products are “not intended to diagnose, treat, cure, or prevent any disease.”

Extending Healthspan

Healthspan extension, which focuses on preventing age-related diseases through lifestyle choices, is distinct from lifespan, which only promises to extend the number of years lived. Healthspan extension describes the work of primary care physicians and public health experts everywhere, whose goal is to improve overall health. The term “longevity” implies a concierge twist.

Clinics like Hooke, a London-based longevity centre, are in the business of revamping a standard annual physical. Instead of a yearly visit, Hooke offers ongoing assessments for physical fitness and cognitive function, imaging in the form of MRI, ultrasound and ECG tests and genome sequencing to offer personalised diet or exercise plans to combat the onset of diseases such as diabetes. The centre offers four types of membership plans which range in price from £12,000 ($15,531) to £54,000 ($60,892) annually.

“The inspiration really came from sports medicine, which is one of the only medical fields that really looks at optimising people, rather than addressing problems, concerns and issues as they arise,” said Kate Woolhouse, chief executive of Hooke.

The goal, according to Woolhouse, is to establish a risk of disease profile for each client and encourage a preventative approach to healthcare.

Body Optimisation

Biohacking, or longevity as optimisation, is concerned with improving physical and cognitive performance, and often lends itself to more newfangled treatments.

Bio-hackers are commonly the poster children of the longevity industry. Bryan Johnson, 47, a tech entrepreneur, went viral in January 2023 for his extensive “health optimisation” routine, which included procedures such as exchanging blood plasma with his teenage son. Johnson takes 50 supplements daily and participates in gene therapy, as shown in his Netflix documentary “Don’t Die: The Man Who Wants to Live Forever,” to boost his physical and mental performance. In 2023, Johnson estimated he spends $2 million annually on biohacking treatments.

Clinics such as Austin Regenerative Therapy in Texas offer “young plasma exchange” therapy – the process of replacing an older adult’s blood plasma with that of a younger donor in order to introduce “a fresh, youthful profile of proteins” that help purge disease-causing agents from the body. The clinic also offers stem cell therapy (to generate healthy cells) as well as peptide therapy (to boost collagen production). Neither of these treatments are regulated by health authorities.

Anti-Ageing

As the term ‘anti-ageing’ loses its appeal, longevity has emerged as its successor in the beauty and wellness industries.

Clients undergoing facelifts, breast augmentations and hair transplants can sidestep the vanity stigma typically linked to these procedures by associating the treatments with longevity. Medspas, like the one run by the Manhattan-based physician Dr. Syra Hanif have begun to brand Botox, microneedling and laser therapies as skin longevity treatments.

Once considered part of wellness, weight loss medications like Wegovy and Ozempic, as well as treatments for sexual dysfunction, have also been increasingly included under the longevity umbrella for companies such as Austin Regenerative Therapy. These medications are now being marketed through a focus on extending metabolism and enhancing pleasure.

“The big thing about the space of longevity in health and wellness is that, unfortunately, we’re being sold so much out there that the consumer has no choice but to really do the work themselves,” said Equinox’s Klim.