The Ann Arbor Longevity Patient: 5 Profiles I See Every Week

A note before we start: every profile below is a composite. Each one is built from patterns I see repeatedly across many people, deliberately blended so that no individual patient is described or identifiable. Details, ages and specifics have been generalised for exactly that reason.

People arrive at a longevity clinic by very different routes. Some have a symptom that will not resolve. Some have a number on a lab report that worries them. Some feel fine and want to stay that way. What they have in common is that the fifteen-minute appointment model has not served them well.

Below are the five patterns I see most weeks, what a proper workup usually turns up in each, and where I would actually start.

Profile 1: The Woman in Her Forties Whose Labs Are "Normal"

How it presents. Somewhere between 42 and 52. Sleep has become unreliable, often waking at 3am. Mood is flatter or more irritable than it used to be. Words go missing mid-sentence. Periods may still be regular, which is part of why nobody has connected the dots. She has usually been told her thyroid is fine and offered an antidepressant.

What is usually going on. This is very often the menopause transition, and the reason it gets missed is that the classic hot-flash presentation is only part of the picture. Mood fluctuation, disrupted sleep, cognitive changes, altered body composition and metabolic shifts are all recognised features, and as a major BMJ review put it, the link to menopause can be genuinely elusive, while symptoms remain substantially undertreated (DOI: 10.1136/bmj-2022-072612, PMID 37553173). Thyroid also deserves a proper look rather than a glance: subclinical hypothyroidism is common, and middle-aged people with it can have fatigue, low mood and cognitive symptoms (DOI: 10.1001/jama.2019.9052, PMID 31287527). Ferritin is worth checking too; it can sit low enough to cause symptoms while haemoglobin still reads normal.

Where I start. A long history, then labs that actually match the story: full thyroid panel, ferritin and iron studies, B12, metabolic panel, and hormones interpreted against where she is in the transition rather than against a single reference range. The intervention that helps most here is usually not the most expensive one on the menu. More on this pattern in why your labs look normal but you feel terrible.

Profile 2: The Man Who Thinks It Is a Discipline Problem

How it presents. Late forties to sixties. Fifteen or twenty pounds have arrived around the middle over a few years without any obvious change in habits. Gym sessions do not produce what they used to. Motivation, drive and libido have all quietly slipped. He tends to blame himself and frames the whole thing as willpower.

What is usually going on. Frequently it is not willpower. Central weight gain, insulin resistance and declining testosterone reinforce each other in a loop, and untangling which came first matters for treatment. Testosterone in particular needs proper diagnosis rather than a single random draw, and the major society guidelines differ on thresholds and on when to initiate therapy, which is exactly why this deserves a real conversation rather than a quick prescription (DOI: 10.1097/MED.0000000000000581, PMID 33044244). Sleep apnoea is common in this group and commonly missed.

Where I start. Morning testosterone measured correctly and repeated, plus SHBG, LH, prolactin, fasting insulin, HbA1c, lipids and a liver panel. A sleep assessment if there is any snoring or unrefreshing sleep. Then a decision about whether the metabolic side or the hormonal side is the better first lever. Often it is metabolic, and treating that alone moves the hormone numbers.

Profile 3: The High Performer Whose Brain Stopped Cooperating

How it presents. Thirty-five to fifty-five, demanding job, generally does the right things. The complaint is not tiredness exactly; it is that sustained thinking has become effortful. Reading the same paragraph three times. Losing the thread in meetings. Usually there has been a long stretch of high stress, or an illness a few months back that they never fully bounced back from.

What is usually going on. Rarely one thing. Chronic stress load, disrupted sleep architecture, alcohol used as a wind-down, undertreated anxiety, iron or B12 status, and post-viral recovery all show up here, sometimes several at once. This is also the group where cellular energy metabolism is a reasonable part of the conversation, since NAD+ availability declines with age and supports the mitochondrial and repair processes neurons depend on (DOI: 10.1038/s41580-020-00313-x, PMID 33353981). Reasonable, but not first.

Where I start. The unglamorous list: sleep, alcohol, mood, medication review, iron, B12, thyroid, blood sugar. When those are genuinely handled and someone still wants energy support, that is the point at which I would discuss options such as NAD+ IV therapy, with an honest account of what the evidence does and does not support. Doing it the other way round is how people end up spending money and still feeling the same.

Profile 4: The Person Who Wants the Outside to Match the Inside

How it presents. Any age from the late twenties up. They came in for something aesthetic - skin texture, laxity, hair thinning, a face that looks more tired than they feel. Often slightly apologetic about it, as though it is a less legitimate reason to be here.

What is usually going on. It is a completely legitimate reason to be here, and it is frequently a useful doorway. Skin and hair are visible readouts of things happening underneath: thyroid function, iron and ferritin, protein intake, blood sugar, hormone shifts, sleep, sun exposure and stress. A meaningful proportion of people who come in for a treatment leave with a lab finding they did not expect.

Where I start. Treat what they came for, honestly and with realistic expectations about what any single treatment achieves, and run the basic internal workup alongside it. Where regenerative options come up, I am clear about their status. Exosome preparations, for example, are used topically only, never injected, remain investigational and Phase 2 research preparations, and are not a cure for anything. Patients deserve that framing rather than the marketing version.

Profile 5: The Optimiser Who Wants a Plan, Not a Stack

How it presents. Feels good. Wearable data, a supplement cupboard, possibly a direct-to-consumer biological age test, and a list of questions. They are not sick and are not looking to be treated. They want to know what is worth doing and what is theatre.

What is usually going on. Usually an accumulation of individually reasonable decisions that nobody has ever looked at as a whole. Supplements duplicating each other, a couple that interact with a prescription, a great deal of money spent on the tier of intervention with the least evidence, and the highest-yield basics somewhat neglected.

Where I start. Baseline labs, a full review of everything they are taking, and a frank ranking: what has strong evidence, what is plausible and reasonable to trial, and what I would not spend money on. That conversation frequently ends with them doing fewer things rather than more. If oral NAD+ precursors are in the cupboard, we go through how NMN and NR actually compare rather than guessing.

What All Five Have in Common

Every one of these people had been told, in some form, that their results were normal. In most cases that was accurate and also unhelpful. "Normal" means your result sits inside a population reference range. It does not mean optimal for you, it does not account for your trajectory over time, and it does not explain your symptoms.

The other thing they share: none of them was best served by starting with the treatment. Starting with the workup is slower, less exciting, and considerably more likely to find the answer.

Frequently Asked Questions

Are these real patients?

No. Each profile is a composite drawn from patterns across many visits and deliberately generalised so that no individual is identifiable. No patient details are shared here.

What if I do not fit any of these?

Plenty of people do not, and that is fine. These are the most common shapes, not an exhaustive list. The starting point is the same either way: history first, then the tests that match your story.

What happens at a first visit?

Mostly conversation. Your symptoms, your timeline, your previous labs, what you have already tried and what you actually want to be different. We then order testing that fits, rather than a fixed panel for everyone. You can read more in what happens at the $35 consultation.

Do I need to know what I want before I come in?

No. Quite a few people arrive with a symptom and no theory, which is a perfectly good place to begin.

What does the first visit cost?

The first-visit consultation is $35, and that fee applies toward your care if you go ahead.

If One of These Sounds Familiar

The useful next step is a conversation, not a treatment decision. Call or text (734) 436-3357 to book.

Arbour Longevity, 2217 Packard St #15, Ann Arbor, MI 48104. Open Thursday through Monday, 10:00 to 19:00, closed Tuesday and Wednesday. Parking is free and directly outside, with no meters and no structure. Suite 15 is down a flight of stairs, so please call ahead if stairs are difficult for you.

Related reading: fatigue after 40, brain fog is not normal, and who actually needs IV nutrient therapy. Persistent brain fog and low energy are common threads across these patterns, and our brain fog and fatigue program looks at them directly.

References

1. Duralde ER, Sobel TH, Manson JE. Management of perimenopausal and menopausal symptoms. BMJ. 2023;382:e072612. PMID 37553173. DOI: 10.1136/bmj-2022-072612
2. Biondi B, Cappola AR, Cooper DS. Subclinical hypothyroidism: a review. JAMA. 2019;322(2):153-160. PMID 31287527. DOI: 10.1001/jama.2019.9052
3. Pelzman DL, Hwang K. Testosterone therapy: where do the latest guidelines agree and differ? Curr Opin Endocrinol Diabetes Obes. 2020;27(6):397-403. PMID 33044244. DOI: 10.1097/MED.0000000000000581
4. Covarrubias AJ, Perrone R, Grozio A, Verdin E. NAD+ metabolism and its roles in cellular processes during ageing. Nat Rev Mol Cell Biol. 2021;22(2):119-141. PMID 33353981. DOI: 10.1038/s41580-020-00313-x

Citations verified against PubMed. All patient profiles are composites and non-identifying. This article is educational and does not replace individualized medical advice.