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Chapter 3 · § 3.4 · Recipe

Prescription Considerations

Statins, metformin, GLP-1s, HRT, TRT — through a physician.

By · Updated March 2026 · Last reviewed March 2026 · ~6 min

Problem

A few drug categories have real outcome data in the longevity context, and several are in active consumer conversations — statins, metformin, GLP-1s, testosterone and hormone replacement. None of them are a biohack. All of them are a conversation with a physician. What actually belongs in that conversation?

Solution

Five drug classes worth discussing. Each with real trade-offs.

DrugCost/yrEvidenceIndication & posture
Statin
for elevated ApoB		 $50–$200 A Decades of outcome data. If elevated ApoB + lifetime cardio risk: yes, with physician.
Metformin
non-diabetic longevity use		 $50–$200 B Prediabetes, insulin resistance. TAME trial pending. Reasonable with a physician.
GLP-1 agonists
semaglutide · tirzepatide		 $10,000+ A Real tool for obesity / T2D with strong weight-loss and cardio data. Real trade-offs in muscle and GI. Do not use to avoid strength training.
Testosterone replacement
men		 $1,000–$3,000 A Only if clinically low with symptoms. Not a biohack. Requires ongoing monitoring.
Menopausal HRT
women		 $600–$2,000 A For appropriate candidates. If you dismissed it based on old Women's Health Initiative reporting, re-evaluate.
△ Warning Not on this list: rapamycin (off-label, consumer use). The mechanism is interesting. The long-term human outcome data is not there yet. If a physician you trust is doing careful low-dose intermittent work with you, that is a considered medical decision; if you are buying it online and self-dosing, that is a different thing. I stay out.

Discussion

The posture I take toward every one of these is the same: not a biohack, a medical decision. Find a physician who takes longevity seriously enough to actually read the literature, who knows the difference between a statin decision grounded in ApoB vs. one grounded in old LDL-C thresholds, and who will weigh hormone replacement route-by-route and risk-by-risk instead of flinching at the word.

The GLP-1 conversation deserves its own paragraph. These drugs work. The weight-loss data is real. The cardiovascular data is real. They also reduce lean mass at rates that, without deliberate strength training, are a problem you will regret in your sixties. If you go on one, go on one in combination with the § 4.1 strength training protocol, with explicit protein-floor management, and with a plan to come off. Losing fat while losing muscle is not the same thing as getting healthier. It is getting smaller.

Menopausal HRT was dismissed for a generation by clinicians who had read headlines rather than the actual WHI subgroup data. For appropriate candidates — timing matters, route of administration matters, individual risk profile matters — the evidence base is much better than most women of that generation were told. If this applies to you, the question to ask is not "is HRT safe." It is "given my timing, my route, and my risk profile, what is the actual trade-off?" A physician who cannot answer that question in specifics is not the physician making the decision.

ℹ Note This recipe intentionally does not list doses. Doses are personal and require ongoing monitoring. Categories and postures here; specifics with your physician.

See Also

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