What we will not prescribe
On omission as a clinical standard. Tier 3 interventions, and the discipline of waiting.
Most of the disagreement in longevity medicine is not about the Tier 1 levers. It is about how, and how quickly, to adopt the Tier 3 ones.
Our position is conservative by construction. A Tier 3 intervention is mechanistically plausible and provisionally supported. It is not yet a recommendation. We sequence Tier 1 first, Tier 2 second, and consider Tier 3 only when the earlier tiers are saturated and the patient has named — explicitly — what they are willing to accept.
The absence of a recommendation is itself a recommendation. This is the part of the practice that the literature does not always reward, and that patients sometimes hear as restraint. It is restraint. It is also the medicine.
Signal Longevity · Trajectory Medicine