Biological Age Tests

Setting Your Health Baseline: How Old Am I? Biological Age Tests

Biological age tests attempt to determine how old your physical body is, in contrast with your calendar age. Most importantly, they allow you to set your health baseline and then measure your progress to see if treatments actually slow or reverse aging. They offer individuals insights into their potential disease risks, metabolic efficiency, and health trajectory, allowing for proactive and targeted interventions. By analyzing epigenetic markers, inflammation levels, and other key biomarkers, these tests can reveal how lifestyle choices, genetics, and environmental factors impact one’s biological aging process.

The results can motivate meaningful lifestyle modifications, help track the effectiveness of health interventions, and provide a more nuanced understanding of personal health risks. Although not definitive, biological age testing serves as a powerful tool for those committed to preventative health strategies, offering a quantitative way to monitor cellular health, potentially predict longevity, and empower individuals to make informed decisions about diet, exercise, stress management, and other factors that can influence the aging process. By providing a comprehensive, data-driven snapshot of health, these tests transform aging from an inevitable decline into a manageable, optimizable journey.

“We are living in exciting times. Several treatments appear to reverse epigenetic aging.” — Dr. Steve Horvath, leading biological clockmaker

Biological Age Test History

Biological age testing is a young field, with the first epigenetic clock being created in 2009 by Axel Schumacher followed in 2013 by significant advancements to use multiple tissue samples by doctors Gregory Hannum and Steve Horvath. With first-generation DNA methylation-derived epigenetic clocks, it is possible to take cell samples, analyze them using these clocks, and accurately guess the donor’s calendar age within 3.6 years. 

Alternate methods to estimate chronological age using transcriptomic data, saliva or telomere length, have proven less accurate, as there are multiple challenges in biological age testing.

Biological Age Tests — Flaws and Limitations

Many biological age tests ask for your chronological age as part of their determination of your biological age. This should not be necessary and could influence your results if they use it in their formula to determine your biological age.

Most current biological age tests report a single age result per person. In actuality, parts of our body are at different biological ages. For example, If a person has body parts which each measure out as biologically between 30 and 40 years old, yet has a brain which measures at 85, how biologically old are they?

Is it possible to create a credible test to estimate a person’s biological age (or age of each component) within one year? Several research groups are working on the approach.

For a comprehensive biological age test to be truly accurate, it requires a wide range of data including:

1. Biological data from blood, stool, urine and saliva tests, collected over a sufficient range of conditions and time to account for daily fluctuations. Data analysis must include:
   • That typically covered during an advanced annual physical examination.
   • Whole genome genetic and epigenetic data and longevity biomarkers. These can include molecular, cellular, physiological and genetic markers associated with aging, such as telomere length, DNA methylation patterns, inflammatory markers, hormonal levels and oxidative stress markers.
   • Cancer screening.
   • Microbiome testing.
2. Digital data from whole body scans. (skeletal system, musculature, vasculature, organs, body fat percentage, etc.). 
3. Visual data on physical appearance. (Skin health, hair health, etc.)
4. Mental and psychological competency test results including testing your level of stress.
5. Physical capability test results (strength, speed, agility, endurance, stability, etc.) including monitoring data (blood pressure, heart rate, etc.)
6. Sensory system capability test results (vision, hearing, smell, taste, touch)
7. Calendar age at the time of all tests across multiple iterations to create a historical record.
8. A clear standard for what is the individual component biological age associated with various ranges from test data. For example, scores from X to Y in a test of Z indicate association with a gender of age ## for that body element. Biohacker Brian Johnson’s personal measurement site provides an excellent template.
9. Large-scale diverse population data for all of the above matched to the associated biological age standard for each test.

Full comprehensive data and scientific agreement on #8 and #9 do not exist yet. #8 may change dynamically with human healthspan and lifespan increases. There is also no agreement on which biomarkers can be used for longevity clinical trials.

So given the known limitations and major flaws, are biological age tests still worthwhile? Yes, if they influence you to make healthier lifestyle choices or lead to early discovery of treatable disease.

Biological Age Tests — How Fast Am I Aging?

According to Dr. Horvath, “Aging manifests in 30 year olds.” So, if you are at least 30, you should consider taking a biological age test to set your health baseline, then test annually to see how you progress. 

Dr. Horvath’s technology includes PhenoAge and GrimAge from the non-profit Clock Foundation. GrimAge provides epigenetic clock testing for physicians and aging researchers for preclinical and clinical studies. It is considered the best estimation of all-cause mortality as the rate of change in GrimAge shows an increased hazard ratio for predicting death. If the rate of change moves up quickly, you are likely in trouble and should seek medical help.

Created in 2019, GrimAge has received global scientific validation for accuracy in tracking age. GrimAge is 18% more accurate than calendar age and 14% better than previously-described epigenetic biomarkers. In predicting time to coronary heart disease, GrimAge is 61% more accurate than chronological age and 46% better than previously-reported epigenetic biomarkers. Also, GrimAge outperforms in predicting time to cancer and time to menopause. Of note, if patients are sick when taking the GrimAge test, it affects the results because blood health factors show the illness.

In 2022, Dr. Horvath created GrimAge2 which is even more accurate as it factors in whether patients are smokers and examines biomarkers for Hemoglobin A1C and C-reactive protein. According to GrimAge2’s most predictive factors for increased longevity, it is very important to maintain high levels of vegetable intake, good levels of HDL cholesterol and healthy lung function.

Dr. Horvath has found that blood and buccal (cheek swab) cells are the best indicators for testing aging. They are also testing animals such as cats, dogs and even elephants as part of 3rd-generation, pan-mammalian clocks to get a sense for how animals age compared with humans.

Unfortunately, GrimAge and GrimAge2 are not available for direct to consumer testing at this time, however even better models have emerged.

Best Research Comparing Biological Age Tests

At the 2024 Harvard Medical School Biomarkers of Aging conference, Yale scientists led by Albert Higgins-Chen presented DNAm aging biomarkers are responsive: Insights from 51 longevity interventional studies in humans, focused on testing 16 prominent epigenetic clocks that are not focused on any particular aspect of aging. They discovered significant flaws in retest reliability (When to Trust Epigenetic Clocks) and responsiveness in many of these approaches. Generation 2+ reliable biomarkers, particularly DunedinPACE, emerged as leading indicators of biological age response. These papers are a must-read if you are interested in this field.

Blood-Based Biological Age Tests — How Old Am I?

Here are the primarily blood-based biological age tests, none of which are yet fully comprehensive in their data gathering and methodology:

AdaptAge (not publicly available)

• Framework for integrating causal knowledge into epigenetic clock models to adjust for beneficial age-related adaptive changes.
• Created in 2022 by a collaboration of genetics scientists including Steve Horvath and Vadim Gladyshev.

bAge and cAge by Bernabeu et al. (not publicly available)

• Epigenetic clock with chronological (cAge) prediction with a median absolute error equal to 2.3 years.
• bAge predictor was found to slightly outperform GrimAge in terms of the strength of its association to survival.

BioMetrics Age (commercially available from Deep Longevity)

• Uses a combination of 17 blood biomarkers and 4 biometrics to predict biological age.
• Provides personalized health insights and tips for a longer, healthier life.
• Uses outdated and inaccurate measures such as body mass index and waist circumference.

BloodAge (commercially available from Deep Longevity)

• Measures 54 blood-based biomarkers
• 45 are used to calculate your biological age, offering insights into how well your body is aging at a cellular level.
• 9 biomarkers focus on specific organ health scores, helping you understand the functional status of vital organs such as the heart, liver, kidney, etc.
• Provides personalized recommendations for weekly diet plans, customized exercise routines, targeted lifestyle adjustments, and supplements aimed at correcting deficiencies and enhancing both biological and organ health.

CausAge (not publicly available)

• Framework for integrating causal knowledge into epigenetic clock models to adjust for DamAge and AdaptAge changes.
• Performs epigenome-wide Mendelian Randomization on large-scale genetic datasets to identify CpG sites causal to aging-related traits.
• Created in 2022 by a collaboration of genetics scientists including Steve Horvath and Vadim Gladyshev.

ClockBase (Gladyshev Lab, not publicly available)

• A comprehensive platform for biological age profiling in human and mouse.
• Biological age estimates based on multiple aging clock models applied to more than 2,000 DNA methylation datasets and nearly 200,000 samples.

DamAge (not publicly available)

• Framework for integrating causal knowledge into epigenetic clock models to adjust for age-related damaging changes.
• DamAge acceleration is associated with various adverse conditions (e.g., mortality risk).
• DamAge is potentially reversable via cellular reprogramming.
• Created in 2022 by a collaboration of genetics scientists including Steve Horvath and Vadim Gladyshev.

DunedinPACE (available through the TruAge Complete Collection test at TruDiagnostic)

• Tracks the rate at which a person is aging unlike other tests which give a static measurement.
• Developed from the Dunedin Study in New Zealand, which followed 1,000 people from birth, it measures 19 biomarkers to calculate how quickly someone is aging relative to time.
• Can help identify accelerated aging before it leads to chronic disease and can track whether interventions are effectively slowing the aging process.

Epigenetic Age aka DeepM Age (commercially available from Deep Longevity)

• DNA Methylation Age is an epigenetic aging clock with an error margin of 2.77 years.
• This advanced clock is closely associated with age-related conditions such as cancer, dementia, obesity, and other health concerns linked to aging.
• Provides a pace-of-aging report, highlighting recommended lifestyle changes.

Glycan Age ($348 for 1 test. $599 for 2.)

• At-home finger-prick blood test which is mailed back in.
• Glycans are sugar molecules that surround and modify proteins in your body. Glycan Age claims they respond to your lifestyle choices and indicate the inflammatory state of your immune system, which in turn determines your biological age.
• They believe measuring the amount of good and bad glycans can determine biological age.
• Good glycans decrease with age. Bad glycans increase.
• Their accuracy level is unclear. They are trying to benchmark against telomere lengths of a variety of cells.
• Their results have large variations (up to 38 years in one of their examples) against chronological age. They do not have mortality studies.
• Testing a single indicator (glycans) is unlikely to accurately reflect all aspects of biological aging.

iAge by Edifice Health (Not available to the general public yet.)

• Founded by David Furman, PhD and Mark Davis, PhD.
• From a standard blood draw, Inflammatory Age^® predicts multi-morbidity and immune decline and provides actionable items to improving your immune health.
• iAge can be measured once to give a snapshot profile, or tracked over time to give a measurement of longitudinal changes of the effect of interventions.
• The algorithm was created from AI analysis of data from the 1000 Immunomes Project and the Framingham Heart Study.
• Based on the iAge^® test results, Edifice Health claims to have identified over 150 actionable interventions suggested to improve your iAge^® score. These include specific combinations of nutritional supplements, nutraceuticals, medical foods, prescription drugs, and life-style modification. David Furman is writing a book on actionable interventions.
• Since 2020, Edifice has received over $12MM in funding from early venture funds associated with Bayer and Human Longevity.
• iAge was expected to be available in 1H, 2024, however there have been no news updates or blog posts since 2022.

InnerAge 2.0 from InsideTracker ($249)

• Tracks 13 biomarkers for women and 17 for men
• Combination of advanced bloodwork (blood test included) and lifestyle factors
• Provides results as personalized optimal zones based on your age, gender, ethnicity, activity levels and goals. Indicates impact on your biological age from each marker.
• Offers a nutrition database with over 7,500 food items scientifically proven to improve specific biomarker levels. Additionally, receive advice on hundreds of supplements as well as lifestyle and exercise suggestions to help you reach your optimal zones.
• Offer premium “Ultimate” plan with 40+ biomarkers, InnerAge test and annual membership for $588.
• InnerBody Research provides a comprehensive Ultimate Plan review and also provides a 25% discount code.

Knowledge-based deep neural network clock (not publicly available)

• Transcriptomic clock using gene expression data to predict biological age.
• More accurate than RNAAgeClock.
• Findings suggest a link between transcriptomic aging and health disorders, including psychiatric traits.

Levine Phenotypic Age (free)

• A downloadable spreadsheet to enter 9 factors from blood work results
• Developed from studies on over 11,000 adults
• Calculates your phenotypic age and expected mortality
• Here’s one person’s experience using this test: What’s My Age Again? Reviewing Three Online Biological Age Testing Tools

LifeLength — HealthTAV telomere length testing ($610)

• Blood test for short telomeres associated with many age-related illnesses and declining health.
• Compares your number of short telomeres with those in their database of similar calendar age.
• Telomere length is not accurate for predicting mortality.

myDNAge — Blood and urine tests ($299 each) based on the first generation version of the Horvath Clock

• Company is not affiliated with Dr. Horvath.
• Claims to be the Most Accurate Biological Clock, but provides no evidence.
• Target over 2,000 CpG sites, much fewer than competitors.
• Offer a Dog Age Test kit ($299), although free with other purchase.

OmicMAge — (available through the TruAge Complete Collection test at TruDiagnostic)

• Developed at Harvard in partnership with TruDiagnostic.
• Provides novel insights into the reasons why someone is experiencing advanced aging.
• Includes:
  • Your Risk of Death
  • Your Risk of Stroke, Cancer, Congenital Heart Disease, COPD, Depression, and Type II Diabetes
  • Your Methylation Risk Scores for Various Proteins
  • Your Methylation Risk Scores for Various Metabolites
  • Your Methylation Risk Scores for Clinical Biomarkers

SystemsAge aka SymphonyAge — (available through the TruAge Complete Collection test at TruDiagnostic)

• Created by from Raghav Sehgal and Albert Higgins-Chen at Yale, to capture aging in distinct physiological systems.
• Includes 11 system-specific epigenetic reports: Heart, Lung, Kidney, Liver, Brain, Immune, Inflammatory, Blood, Musculoskeletal, Hormone, and Metabolic.

TallyAge from Tally Health ($249 per age test or $129 / month for health membership services including regular 6 month age testing)

• Founded by David Sinclair and led by CEO Melanie Goldey.
• Epigenetic aging clock based on DNA methylation analysis, analyzing around 850,000 DNA methylation sites for biomarkers of healthy aging.
• Using a proprietary machine learning model, this data is used to determine a person’s TallyAge, which may be younger or older than their chronological age.
• 8,000 diverse beta testers to establish initial result metrics.
• Provide personalized insights, lifestyle recommendations and longevity supplements designed to help lower your TallyAge.
• Competitor TruDiagnostic penned an insightful Open Letter questioning some of TallyAge’s methodology.

TruDiagnostic ($499 for a single TruAge Test or $998 for 4 quarterly tests)

• Aggregates results from three separate leading-edge methylation tests
  • SystemsAge aka SymphonyAge, licensed from Raghav Sehgal and Albert Higgins-Chen at Yale, to capture aging in distinct physiological systems.
  • Includes DunedinPACE scoring.
  • Includes OmicMAge, developed at Harvard to provide novel insights into the reasons why someone is experiencing advanced aging.
• Provides 11 system-specific epigenetic reports: Heart, Lung, Kidney, Liver, Brain, Immune, Inflammatory, Blood, Musculoskeletal, Hormone, and Metabolic.
• Includes:
  • Your Risk of Death
  • Your Risk of Stroke, Cancer, Congenital Heart Disease, COPD, Depression, and Type II Diabetes
  • Your Methylation Risk Scores for Various Proteins
  • Your Methylation Risk Scores for Various Metabolites
  • Your Methylation Risk Scores for Clinical Biomarkers
• Used by 16+ anti-aging clinical trials including from Harvard, Cornell and OneSkin.
• Raw data available for personal download
• Here’s how their lab works.

Cell-Based Biological Age Test

Multiple researchers are working on a CellAgeClock to track aging in single in-vitro cells for the purpose of testing new anti-aging drugs. 

Lipid-Based Biological Age Test

LipidAge (not publicly available)

• Based on serum lipidome of pancreatic ductal adenocarcinoma.
• Can determine age of a healthy person with a mean absolute error of 4.6 years.
• Identifies parallels between cancer and aging dynamics.

Metabolomic-Based Biological Age Tests

Metabolomics is the study of metabolites, the small molecules that result from the body’s breakdown of food, drugs, chemicals, and tissue. It involves analyzing metabolites in cells, tissues, and biofluids to understand how biological systems change over time. Researchers have created MetaboHealth and MetaboAge tests.

Plasma Proteomic Organ-Specific Biological Age Tests

Trained on organ-specific proteins, organ-specific biological age tests will significantly improve this field. Instead of generating a single aging score for the whole body, they measure distinct scores for bladder, stomach, lymph nodes, prostate, ovaries, uterus, pancreas, breast, brain, colon, rectum, skin, thyroid, liver, heart, kidney, lung and intestinal tract. These scores appear to be able to identify onset of disease. Further validation is ongoing.

Conventional plasma proteomic biological age test methodologies include those from: Tanaka (2018), Lehallier (2019), Sathyan (2020), Oh (2023) and Wang (2024).

Saliva-Based Biological Age Tests

Index by Elysium ($299)

• At-home saliva-based epigenetic test kit developed by Professor Morgan Levine, Ph.D., at Yale School of Medicine and former employee in Horvath’s lab.
• Analysis of 100,000-150,000 biomarkers using an Illumina chip, an upgrade on her work creating PhenoAge (considered the second clock) in Dr. Horvath’s laboratory.
• Epigenetics involves changes in your biology caused by modifications in gene expression rather than the underlying genetic code itself. Factors that can influence your epigenetics include your diet, exercise habits, alcohol consumption, and stressors like sleepless nights.
• Provides biological age plus Cumulative Rate of Aging, the pace at which your body has aged for every year you’ve been alive.
• For a bit more on one person’s experience with Index, see the AARP article: The DNA Test That Tells You Your “Real” Age.

Tru Me Labs (TruAge $110)

• At-home mail-in DNA-based saliva epigenetic test kit.
• Use methylation on only a tiny fraction of the billions of nucleotides in your DNA. Claim an unproven statistical error of approximately 4.75 years.
• Only provides your calculated biological age as a result. Lack rigor and transparency in their methodology.
• Results can show huge and unlikely differences in chronological vs biological ages.

Survey-Based Biological Age Tests

Survey-based biological age test questionnaires were the original method to gather health and lifestyle data for the purpose of calculating a health age score representative of an average person’s abilities at a given age. The surveys are limited by the questions they ask, their answer-scoring methods and their algorithms. There is much room for improvement in this space.

Actual Age (free) by Longevity Playbook

• Created in 2023 by Dr. Michael Roizen, Chief Wellness Officer Emeritus of the Cleveland Clinic.
• 10-15 minute, 35 question survey to answer questions about your health and lifestyle.
• Questions include: How old are you? What is your fasting blood sugar level, LDL level, blood pressure and resting heart rate. Know these before taking the test.
• The result is only a single number called your “real age.” It appears overly optimistic towards youthfulness.
  • A 55 year old received a real-age of 18 and, although flattered, clearly isn’t still a teenager.
  • An 81 year-old received a real-age of 66, yet has physical limitations much closer to 81.
• The survey and algorithm don’t appear to properly measure declines in speed, endurance, fragility, memory, hair and skin quality, and physical appearance.

MindAge — (commercially available from Deep Longevity)

• Gathers data from user-submitted Excel questionnaire. Responses are scored from 1-7.
• Uses multiple deep-learning models.
• Provides personalized recommendations that are aimed to increase one’s mental health, resilience and longevity potential.
• Ongoing surveys and wellness tracking empower individuals to monitor their progress and pinpoint areas for improvement. This consistent feedback helps maintain motivation and encourages lasting changes that enhance well-being.
• See 27 minute demo. Sample questions appear here in the video.
• 20-25% of adults report having at least one mental health issue with the majority originating from toxic workplace environments.

Real Age by ShareCare (free) online questionnaire and results

• Created in 1999 by Dr. Michael Roizen, Chief Wellness Officer of the Cleveland Clinic.
• Currently owned by Sharecare, a health and wellness platform.
• 15-20 minutes to answer questions about your health and lifestyle.
• 29 million people have taken it.
• Provides your “real age” and tips to improve your health.
• Of note, they still recommend daily aspirin. See Keep Health’s article for the risks.
• Here’s one person’s experience using this test: What’s My Age Again? Reviewing Three Online Biological Age Testing Tools

Tissue-Based Biological Age Tests

AltumAge by Shift Bioscience (not publicly available)

• Neural network improves on prior linear regression epigenetic clocks for people older than 59 by factoring in dangerous conditions.
• Developed based on 142 publicly available data sets from several human tissues. Not designed for testing bloodwork.
• Predicts higher age acceleration for those prone to tumors, for cells that exhibit age-related changes in vitro, such as immune and mitochondrial dysfunction, and for samples from patients with multiple sclerosis, type 2 diabetes, and HIV, among other conditions.

RNAAgeCalc (not publicly available)

• Multi-tissue transcriptomic clock using gene expression data to predict biological age.
• Less accurate than knowledge-based deep neural network clock.
• Findings suggest a link between transcriptomic aging and health disorders, including psychiatric traits.

Additionally, Alexander Tyshkovskiy, Vadim Gladyshev and colleagues have been researching Transcriptomic Hallmarks of Mortality Reveal Universal and Specific Mechanisms of Aging, Chronic Disease, and Rejuvenation, making deep inroads into the aging mechanisms of tissues. They have developed robust multi-tissue transcriptomic biomarkers of mortality, capable of quantifying aging and change in lifespan in both short-lived and long-lived rodent models. These tools were further extended to single-cell and human data, demonstrating common mechanisms of molecular aging across cell types and species.

Of particular interest, human plasma levels of Cdkn1a and Lgals3 demonstrated a strong association with all-cause mortality, disease incidence and risk factors, such as obesity and hypertension. It will be interesting to see if potential medical treatments are initiated and how they progress through clinical trials.

Visual Biological Age Tests

PhotoAgeClock (not publicly available)

• Based on left and right eye photos of over 8000 people.
• Mean-Average Error rate within 2.3 years. Varies by age of participant.
• Not considered official because it doesn’t use cellular biomarkers. 

There are websites and apps where you can upload a photo and they’ll attempt to show you what you will look like at various ages. Here are a few you can try out:

Extrapolate (website. $9 for 10 images) — did not test this out.

Media.IO Age Filter (website. free) — questionable results. Allows scrolling back and forward in time.

Novos FaceAge (website. free) — Did not work during our testing. Hopefully they’ll fix it soon.

YouCam Makeup (phone app. $2.50 / month, 7 day free trial offer.) — Just an aged snapshot at 70, however seems like it could be fairly accurate.

Obsolete Biological Age Tests

Aging.ai from Insilico

Young.ai iPhone app from Hong Kong–based Deep Longevity and Dr. Polina Mamoshina

• Tracked multiple biological clocks, using biomarkers that show the rate of aging at the molecular, cellular, tissue, organ, and system level. 
• Users uploaded their data from photos, surveys, biological samples, and activity trackers into an AI system which provides a personalized to-do list to promote healthier aging.
• Believed their AI method will be more powerful than Horvath’s models for detecting aging.
• 5 most important predictors; (Albumen) liver function, metabolic function (glucose), urea (renal), erythrocytes (respiratory), hemoglobin. (Side note: Dr. Horvath — agrees with Dr. Polina on these targets.) Facial features, microbial taxa can be factored in too.
• Smoking under the age of 40 has much more impact on human aging than after that.
• Accuracy between 6-7 years. Expected to improve rapidly with more datasets.

Databases of Genes which Impact Aging

For the curious, here are two public databases maintaining the known list of genes which impact aging. 

GenAge — database of genes which impact aging, maintained at Human Ageing Genomic Resources.

SynergyAge — a curated database to examine the combination of multiple genes on lifespan, seeking to identify synergistic and antagonistic interactions of longevity- associated genes via BioRxiv.org (BioArchive). Run by Gabriela Bunu, PHD student at the Romanian Academy. 

Conclusion

This concludes our article comparing biological age tests. As your reward for reading and to satisfy your curiosity, we recommend you consider TruDiagnostic or InnerAge. You can pursue the title of best biohacker and create your equivalent of Brian Johnson’s personal measurement site.

If you curious for what you might look like as you age into the future, play around with the free 7 day trial of YouCam Makeup and its AI Aging and skin diagnostic functions. Try a few different photos of yourself to see how results vary. In our case, it prompted us to re-read our skin care page! Very few of us want to look that old!