Performance & Longevity Medicine
Perform now. Age well later. Same data, same doctor.
One clinical program, two emphases. Whether your goal is more energy, better recovery, and sharper output today — or compressing the last decade of disease and decline — the underlying medicine is the same: advanced biomarkers, targeted interventions, and a clinician who actually reviews the data.
What it is
Performance and longevity medicine treat the gap between "not sick" and operating at your ceiling — and the gap between "feeling fine now" and quietly drifting toward the diseases that actually steal the last decade of life. Both sides use objective data — blood markers, hormones, body composition, metabolic rate, biological age — to identify what's really limiting you, then build a protocol that addresses it.
Why TWW
Standard primary care is designed to catch disease, not optimize function or compress morbidity. If your labs are "in range" but you feel flat, slow to recover, or stuck — or if you're 45, asymptomatic, and your trajectory matters more than your snapshot — the answer isn't a pep talk. It's a closer look at the data, interpreted against performance and longevity ranges, not disease thresholds.
Two emphases, one framework
Same panel. Different center of gravity.
Most of our patients move between these emphases over time. Performance work in your 30s and 40s naturally tilts toward longevity in your 50s and 60s — because the same levers (insulin sensitivity, hormones, body composition, sleep, training quality) drive both.
Performance emphasis
For busy professionals and serious athletes. Focus: energy, cognition, recovery, training adaptation, hormone optimization, body composition. Ranges: performance, not population averages.
Longevity emphasis
For patients whose 60s, 70s, and 80s matter as much as today. Focus: ApoB, Lp(a), insulin sensitivity, biological age, NAD+, neurodegeneration risk, cancer screening discipline. Time horizon: decades.
What's covered
Included protocols & diagnostics
- Comprehensive biomarker panel — 60+ markers, reviewed quarterly, interpreted against performance and longevity ranges
- Epigenetic biological age testing — TruAge by TruDiagnostic (included in Performance and Longevity memberships)
- Functional nutritional & metabolic panel — TruHealth, 180+ biomarkers including vitamins, antioxidants, fatty acids, and toxin exposure
- Hormone panel — total and free testosterone, estradiol, DHEA, cortisol, thyroid, with optimization protocols when clinically indicated
- Cardiovascular risk — ApoB, Lp(a), lipid particle size, coronary calcium score guidance
- Metabolic markers — fasting insulin, HOMA-IR, HbA1c trend, lipid particle size, insulin sensitivity optimization
- Inflammation, recovery, & nutrient status — hsCRP, homocysteine, ferritin, HRV trends, Vitamin D, B12, magnesium, omega-3 index
- Body composition & resting metabolic rate (InBody + indirect calorimetry)
- NAD+ precursor protocols and IV therapy (select cases)
- Cognitive & neuroprotective protocols
- Sleep, HRV, and recovery optimization
- Preventive screening coordination with your primary care
How it works
Your path from first visit to ongoing care
Deep intake
60-minute new-patient visit. Full history, family history, current biomarkers, training and recovery, and the goals that actually matter to you.
Comprehensive panel
Advanced lab panel beyond standard physicals — cardiovascular, metabolic, hormonal, inflammatory — plus InBody and metabolic testing where relevant.
Protocol & strategy
Written plan with clear targets and measurable endpoints. Performance protocols run on weekly to monthly feedback; longevity strategy runs on a 12-month arc.
Execute & reassess
Quarterly strategy visits, concierge messaging between visits, repeat panels at the cadence the data demands. We change what the data tells us to change.
What we measure
The biomarkers that actually move the needle.
Standard physicals miss most of what predicts how you'll perform this year and how you'll age over the next four decades. Our panels are built to surface the early signals — when there's still time to change the trajectory.
ApoB, Lp(a), and lipid particle count
Standard cholesterol panels miss the actual driver of plaque: the number of atherogenic particles in your blood. ApoB is a direct count of every plaque-causing particle. Lp(a) is genetically determined and largely fixed — but knowing it changes the aggressiveness of every other lever you pull. Together they predict cardiovascular events better than LDL ever did.
Fasting insulin, HOMA-IR, and HbA1c trend
Insulin resistance precedes type 2 diabetes by 10–20 years and silently accelerates aging across every organ system. By the time HbA1c is "abnormal," the train has been moving for a long time. We track fasting insulin and the HOMA-IR ratio to catch it early — and we track the trend, not just the snapshot.
Testosterone, estradiol, thyroid, and cortisol
Sex hormones, thyroid function, and cortisol drive energy, body composition, mood, recovery, and cognition. "In range" on a standard panel often means "compatible with not being sick" — not "where you'd feel and perform best." We interpret these against optimization ranges and the patient in front of us, not population averages skewed by a sicker-than-average baseline.
Biological age & inflammatory markers
Chronological age is the candle on your birthday cake. Biological age is what your body actually is. Epigenetic clocks (DunedinPACE, GrimAge) and inflammatory markers (hs-CRP, GlycA) reflect the rate at which you're aging on a cellular level — and they respond to interventions. Sleep, training, nutrition, body composition, and select peptide protocols all show up in this data.
Epigenetic & functional testing
TruAge and TruHealth — the objective measures behind every protocol.
Standard bloodwork answers "am I sick?" These two tests answer the harder questions: how fast am I actually aging, where is my body aging fastest, and what's driving it at the nutritional and metabolic level. Both are run by TruDiagnostic in a CLIA-certified laboratory and have been used in over 30 peer-reviewed clinical trials.
TruAge — biological age & pace of aging
A simple finger-prick blood spot, analyzed across more than 900,000 sites on your DNA. TruAge measures the chemical marks layered on top of your genome — patterns that shift in response to sleep, training, nutrition, stress, and the protocols we build together. What you'll see in your report:
- Pace of aging (DunedinPACE) — how fast you're aging right now. The single most responsive marker we have for tracking whether your protocols are working. A score below 1.0 means you're aging slower than your chronological age.
- Biological age (OMICmAge) — your true cellular age, developed in collaboration with Harvard researchers.
- Organ-system ages (SYMPHONYAge) — separate aging scores across 11 organ systems including cardiovascular, immune, metabolic, and inflammatory, developed at Yale. Tells us where you're aging fastest so we can target interventions precisely.
- Telomere length, 12-cell immune profile, and disease-risk markers — including cancer, type 2 diabetes, and cardiovascular risk proxies.
Why it matters: Unlike your genome, your epigenome is modifiable. Retesting at six months gives you objective proof your work is paying off — not a guess, not a feeling, a measurement.
TruHealth — functional nutritional & metabolic panel
A complementary blood panel measuring 180+ biomarkers — including 75+ vitamins, antioxidants, amino acids, and fatty acids, plus toxin and heavy metal exposure. Where TruAge tells us how fast you're aging, TruHealth tells us what's driving it at the cellular input level. What's measured:
- Nutrient & vitamin status — the building blocks your cells actually have to work with
- Amino acid and antioxidant levels — capacity for recovery, repair, and oxidative defense
- Metabolic and energy health — the substrates that determine output
- Inflammation and immune function — the systems that either accelerate or slow aging
- Toxin and heavy metal exposure — the inputs most labs never look for
Why it matters: Conventional bloodwork is built to catch disease. TruHealth is built to optimize function — identifying subclinical deficiencies and imbalances long before they become problems. Combined with TruAge, it turns longevity from a guess into a measurable, trackable practice.
How it fits into your membership: The annual TruAge test is included at the Performance tier. Longevity members receive a full TruAge COMPLETE workup at onboarding plus a six-month retest to track intervention response. Results are reviewed during your regular clinician visits and uploaded directly to your patient chart.
The framework
The four horsemen — and how we counter them.
The vast majority of premature death and disability in adults is driven by four interconnected disease categories. Longevity medicine, as we practice it, is the systematic prevention of all four — starting in the decades when prevention still works.
Cardiovascular disease
Still the #1 killer. Lever: aggressive lipid management (ApoB, Lp(a)), blood pressure, training zone 2 and zone 5, body composition.
Metabolic dysfunction
Insulin resistance, fatty liver, type 2 diabetes. Lever: visceral fat, sleep, resistance training, protein, sometimes GLP/GIP therapy.
Neurodegeneration
Alzheimer's and related dementias. Lever: cardiovascular health, sleep architecture, hearing, social engagement, targeted cognitive peptides.
Cancer
Screening discipline (we coordinate with your PCP), metabolic health, body composition, alcohol, training. Early detection is non-negotiable.
Cellular medicine
NAD+, mitochondria, and the engine room.
If the four horsemen are the diseases of aging, mitochondrial decline is the engine that runs underneath them. Our cellular-medicine track focuses on the substrate: the energy production, DNA repair, and signaling that every system in your body depends on.
Why NAD+ matters
NAD+ is a coenzyme present in every cell. It's required for ATP production, DNA repair (via PARP enzymes), and the activity of sirtuins — the proteins central to many of the most studied longevity pathways. NAD+ levels decline measurably with age, and that decline is associated with reduced energy, slower recovery, and accelerated cellular aging.
We use NAD+ supplementation strategically — through IV protocols, subcutaneous injection, and oral precursors — and only when paired with the upstream interventions (sleep, training, nutrition) that determine whether you can actually use it.
Mitochondrial protocols
Beyond NAD+, the cellular-medicine toolkit includes targeted peptides like SS-31 (mitochondria-targeted antioxidant), MOTS-c (mitochondrial-derived metabolic peptide), and methylene blue (cellular energy and neuroprotection). None of these are first-line for everyone — they're tools we deploy when the data, the goals, and the timing align.
The point isn't to take more things. It's to do the few things that move the right metrics, and to know they're working.
Common questions
Performance & longevity FAQ
Is this performance medicine, longevity medicine, or both?
Both — and that's deliberate. The biology is the same. What changes is which targets we emphasize. Most patients start with one center of gravity and gradually shift over time. You don't pick a lane on day one; we let the goals and the data guide the protocol.
Is this just "anti-aging"?
No. Anti-aging is a marketing category. Longevity medicine, as we practice it, is preventive cardiology, metabolic medicine, and neurology applied early — using markers most physicians don't routinely order, paired with interventions chosen for evidence rather than novelty. The goal isn't to look 25 at 60. It's to be functional, sharp, and independent at 85.
Do I need to be sick — or an athlete — to benefit?
Neither. You're a better candidate when you're not sick yet. The window where this work has the most leverage is your 30s, 40s, and 50s — before clinical disease shows up. Plenty of patients are "fine" by their primary care metrics and still have meaningful elevations in ApoB, fasting insulin, or visceral fat that change their decade-out trajectory. And on the performance side, you don't have to be a competitive athlete — you just have to want to operate at the level your biology is actually capable of.
How is this different from my primary care?
Your PCP is screening for disease in a 15-minute visit, in a system that pays them to find existing problems. We're spending an hour interpreting biomarkers your PCP doesn't routinely order, building a multi-year strategy. We are not a replacement for primary care — we coordinate with it. Cancer screening, vaccinations, acute illness, and prescription management for chronic disease should still live with your PCP.
How often do you retest TruAge, and why six months?
Six months is the sweet spot. Four months is rarely enough time to see meaningful, sustained change in your epigenetic data — the noise outweighs the signal. Six months gives interventions long enough to actually move the needle while still being frequent enough to course-correct if something isn't working. Longevity members get a TruAge COMPLETE at onboarding and a retest at month six; Performance members test annually with the option to add a six-month retest at member pricing.
Will my insurance cover any of this?
Some standard labs may be processed through your insurance; the consultation, advanced biomarkers, and any peptide, hormone, or NAD+ protocols are self-pay. We're upfront about what each piece costs before you commit.
Do I need to commit to membership?
No. You can start with a single consult to see whether the approach makes sense for you. Most patients eventually choose membership because the cadence — quarterly strategy visits, lab reviews, messaging access — matches how this work is actually done. But there's no pressure to commit upfront.