The Bloodwork Panel
Fewer than fifty markers. Every one with a decision rule attached.
Problem
Labs will happily sell you a panel of two hundred markers. Your primary care doctor's default panel is ten. Which markers actually carry signal for a longevity program, and which are noise you're paying to be anxious about?
Solution
Fewer than fifty markers. Every one attached to a decision.
A wide net initially — hundreds of markers across multiple panels — filtered down to the compact set below. Everything on the list below is here because if the value comes back out of range, I can tell you exactly what changes.
| Cluster | Markers |
|---|---|
| Lipids & cardiovascular | ApoB · LDL-P or LDL-C · HDL · triglycerides · Lp(a) (once in life) · hs-CRP |
| Glucose & insulin | Fasting glucose · fasting insulin · HbA1c · HOMA-IR (calculated) |
| Hormones age- & gender-appropriate | Total & free testosterone · DHEA-S · estradiol · TSH · Free T3 · Free T4 · SHBG |
| Nutrients clinically impactful when low | 25-OH vitamin D · B12 · folate · ferritin · RBC magnesium · homocysteine |
| Liver & kidney | ALT · AST · GGT · eGFR · BUN/creatinine |
| Inflammation + CBC | hs-CRP (overlap) · ESR · CBC with diff |
Annual cadence for most of these. Lp(a) is genetic; do it once. Hormone panels are age-dependent; order what applies.
RBC magnesium, not serum magnesium. Serum sits inside a tight homeostatic band and stays normal until deficit is severe; erythrocyte (RBC) magnesium catches sub-clinical deficit earlier and is worth the small extra cost.
| What you buy | Cost | Grade |
|---|---|---|
| Focused panel, DTC | $200–$500/yr | A |
| "Premium" 200-marker panel | $800–$2,000/yr | Skip |
| Executive physical | $5,000+ | Marble lobby |
Discussion
The discipline behind the list: do not add a marker without a decision rule attached. A test that will not change what you do next is a test you do not need. A two-hundred-marker panel contains a lot of tests that fail that question.
In the US, direct-to-consumer lab services (Function Health, Marek Health, Quest's direct portal, and others) will let you order these without going through your primary care doctor. Insurance may cover some if you go through a physician. Either route works; the panel matters more than the route.
The other failure mode: reading any single result in isolation. An elevated homocysteine reading on its own is ambiguous. The same elevated homocysteine together with a reduced MTHFR enzyme variant from your exome and a diet light on leafy greens is three converging signals pointing at one change. That is when a recommendation gets specific enough to act on. § 3.2 Personalized Supplements covers how to put that together.
See Also
- § 2.1 · Exome vs. WGS — the genetic layer the bloodwork pairs with
- § 3.2 · Personalized Supplements — how converging signals translate into a small dose list
- § 3.3 · What to Ignore — why the premium panel is mostly a waste