‘Equity in longevity is the entire ballgame’

Ahead of The Longevity Show, Poonam Desai discusses sex-specific medicine, preventive care and the risk of longevity becoming a luxury.

The longevity sector has become rather fond of the word “personalized”; biomarker dashboards, bespoke supplementation stacks and AI-assisted diagnostics now arrive wrapped in the language of precision medicine. Yet for all the sophistication, many of the frameworks underpinning modern healthcare still derive from a model that treated male biology as standard and female biology as deviation – a historical quirk that is increasingly difficult to defend in an era supposedly defined by individualized care.

Those tensions sit at the center of an upcoming session at The Longevity Show, which takes place in London this July. In a panel exploring the gender gap in longevity, Dr Poonam Desai will join Professor Mike Kirby, Dr Helen O’Neill and Siobhan Mitchell to examine how research bias, diagnostic gaps and unequal access continue to shape health outcomes for both women and men across the lifespan. Desai – a double board-certified physician in Lifestyle and Precision Medicine and founder of Longevity Place and HER Longevity – has become an increasingly prominent voice in the preventive-health space, particularly around women’s healthspan and the clinical blind spots that continue to surround it.

Longevity.Technology: Longevity medicine has spent years talking about personalization – but as this discussion at The Longevity Show makes clear, personalization is a fairly hollow concept if the underlying system still treats male biology as the default setting and female biology as a variation on the theme. The reality is rather less futuristic than the marketing decks might suggest; many of the clinical frameworks underpinning modern healthcare were built on research that excluded women altogether, while men have often fared poorly under cultural assumptions that discourage preventive care or reduce health conversations to stoicism with better tailoring. The result is a peculiar kind of equality in dysfunction – different blind spots, different outcomes, same systemic problem. In this context, Dr Poonam Desai’s observations land with particular force; longevity is not simply about extending lifespan through ever more sophisticated diagnostics and interventions, but about interrogating who those interventions were designed for in the first place. As the field matures – and edges uneasily from elite optimization culture toward something resembling mainstream medicine – questions around menopause, andropause, sex-specific risk and equitable access begin to look far less niche and far more foundational. After all, a healthcare system cannot realistically claim to be advancing longevity for everyone while large parts of the population are still being assessed against reference points that were never built with them in mind.

Rebuilding the protocol

For Desai, the issue begins with the architecture of medicine itself. “We’ve historically used the ‘average man’ as the default biological subject,” she says, arguing that the term itself masks a century of methodological convenience rather than scientific rigor.

“We rewrite them by acknowledging that the ‘average man’ was never average to begin with – he was just convenient.”

Until 1993, women were largely excluded from clinical trials in the United States, meaning many dosing protocols, biomarker ranges and treatment assumptions were calibrated using male physiology. Desai argues that the consequences continue to reverberate through clinical practice today.

Desai argues that correcting this imbalance requires more than symbolic inclusion. “Practically speaking, rewriting these protocols means demanding sex-disaggregated data in every study we cite, recalibrating reference ranges for things like ferritin, TSH, and testosterone to reflect what is optimal for women rather than just statistically common, and integrating the menstrual cycle, perimenopause and menopause as physiological variables that change how we interpret labs, prescribe medications and structure interventions.”

“It also means training the next generation of clinicians to stop treating women as small men with complicated hormones,” she adds.

The critique is particularly resonant within longevity medicine, where prevention depends heavily on biomarker interpretation and risk stratification; reference ranges are not merely administrative details, but the framework through which future disease is anticipated – or missed.

The paradox of longer lives

Women, statistically, live longer than men. Yet they also spend more years in poor health – a contradiction that Desai believes is too often framed as biological inevitability rather than the cumulative effect of delayed diagnosis and neglected research.

“It is both, and pretending it is one or the other is how we got here in the first place.”

She points to cardiovascular disease, which frequently presents differently in women and is still missed in emergency settings, as well as autoimmune conditions that disproportionately affect women and can take years to diagnose. Perimenopause, despite affecting every woman who lives long enough, remains conspicuously underrepresented in medical education.

“So yes, it is diagnostic failure. But it is also biological nuance we have ignored, because hormones are not a footnote to female physiology, they are the operating system, and we have been treating them like a quarterly software update.”

There is a subtle but important shift happening here. Discussions around menopause are increasingly moving out of the lifestyle margins and into mainstream longevity science – not simply as a quality-of-life concern, but as a pivotal transition affecting cardiovascular, metabolic, musculoskeletal and cognitive aging trajectories.

“Women are not living sicker because their biology is more complicated,” Desai says. “They are living sicker because their biology has been less prioritized.”

Personalization and its limits

Desai is similarly skeptical of longevity medicine’s tendency to conflate personalization with exclusivity. The science of extending healthspan may be accelerating rapidly, she says, but the systems needed to deliver those interventions equitably are lagging behind.

“Longevity medicine will either be the most democratizing force in healthcare or the most stratifying, and which one it becomes is being decided right now, by us, in rooms exactly like this one.”

For Desai, equity in longevity is not a secondary ethical consideration, but a defining structural question for the field itself. “The science of extending healthspan is advancing faster than the infrastructure to deliver it equitably, and if we do not actively build access into the foundation, we will end up with a two-tiered system where the wealthy live healthier into their nineties and everyone else inherits the chronic disease burden we already have, just with better marketing.”

The concern lands at a moment when many of the most sophisticated preventive-health services remain concentrated within concierge clinics and premium subscription models – accessible primarily to affluent patients able to spend heavily on diagnostics, continuous monitoring and individualized optimization.

“If your longevity medicine only works for people who can afford a concierge clinic, you are not practicing longevity medicine, you are selling a luxury good.”

It is a deliberately sharp formulation, although one increasingly echoed across public health and policy circles. As healthcare systems confront the economic realities of aging populations, prevention is beginning to look less like a consumer aspiration and more like infrastructure.

A different protocol

When discussion turns to personalized medicine itself, Desai returns repeatedly to one central point; sex-specific biology changes not only how aging manifests, but how interventions should be structured in response.

“It changes everything, because aging is not a gender-neutral process and pretending it is has cost women decades of healthspan.”

Women, she explains, experience “a relatively abrupt hormonal cliff at menopause that accelerates bone loss, cardiovascular risk, cognitive vulnerability, and metabolic shift in ways that men simply do not experience on the same timeline.”

That biological divergence, she argues, should alter everything from screening timelines to therapeutic priorities. “That means the interventions that matter, when we screen, what we measure, how we dose, and which therapies we prioritize, all need to be recalibrated around female physiology rather than retrofitted from male data.”

“Personalized health for women is not a pink version of the male protocol, it is a different protocol.”

The implications extend beyond menopause alone. Desai advocates earlier cardiovascular screening in women, greater attention to perimenopausal symptoms as indicators of long-term risk and a more expansive understanding of hormone therapy within longevity medicine.

“Personalized medicine that ignores sex is not personalized,” she says. “It is just a smaller cage.”