Executive Summary

No approved drug has established an aging or lifespan-extension indication in humans. The most credible prescription candidates are approved for defined diseases and are being repurposed around geroscience hypotheses, most prominently rapamycin or sirolimus, metformin, acarbose, SGLT2 inhibitors, GLP-1-based metabolic therapies, and senolytic regimens built around dasatinib plus non-drug flavonoids.

The evidence hierarchy is uneven. Rapamycin, acarbose, and canagliflozin have notable mouse lifespan signals, but human data remain short-duration, biomarker-oriented, disease-specific, or exploratory. Metformin has the broadest historical use and a major aging-focused trial concept, but recent reviews emphasize uncertainty rather than confirmation.

Non-approved compounds occupy a different risk category. NAD+ precursors, spermidine, urolithin A, alpha-ketoglutarate, fisetin, quercetin, and peptide products are generally being evaluated through supplements, early trials, or unapproved research-product channels, with evidence centered on biomarkers, tolerability, muscle or cognitive endpoints, and disease-specific pilot studies rather than survival.

OSK partial reprogramming is the most biologically provocative area, but it is also the area most prone to overstatement. The headline mouse data use remaining lifespan in very old animals, while current clinical translation is beginning in localized disease settings such as optic neuropathy rather than systemic longevity treatment.