When it comes to longevity, most of us want clarity. A plan. A scientific map with a neatly marked route to a longer, sharper, better life. But talk to Dr Neil Paulvin, Manhattan physician to athletes, entrepreneurs and executives looking to “go beyond baseline” and you’ll get something more nuanced. Something more honest.

Take Epitalon. A peptide. A bioregulator. A molecule that may, depending on who you ask, lengthen your telomeres and turn back the cellular clock. To the uninitiated, that might sound like speculative fiction. To Paulvin, it’s just part of the current toolkit.

But there’s a tension, between emerging promise and incomplete proof, running through the whole peptide landscape. Some compounds have solid human data. Many don’t. A few are FDA-approved. Most aren’t. What exists instead is clinical experience, real-world results, and a cohort of patients who’ve stopped waiting for the medical mainstream to catch up. As Paulvin puts it, “Some patients decide they don’t want to go ahead with it. That’s completely fine. Others say, ‘Let’s do this,’ especially when prescription meds aren’t doing anything for them either.”

In this conversation, we ask Dr Paulvin to examine the science, the unknowns and the human hunger that keeps pushing longevity medicine forward, focusing on Epitalon and what it can (and can’t) promise us.

Can you give an overview of Epitalon? 

Sure. Epitalon is one of the first peptides we talk about in the longevity category. It’s technically both a peptide and a peptide bioregulator. Bioregulators are sort of cousins to peptides. They work on gene expression in specific ways and they’re typically derived from animal organs or synthesised versions of that. 

Epitalon’s main claim to fame is that it acts on telomeres – the ends of your chromosomes, kind of like the plastic tip on a shoelace. You want them, in most cases, to be as long as possible. 

Even within professional circles and the conferences I attend, there’s still debate on whether longer is always better. Most people agree longer is generally better, but not universally. Epitalon may also help with circadian rhythm regulation, and possibly with brain health to some extent. 

It definitely has a place, but it’s not something we use continually. It’s typically cycled — once or twice a year. 

Are there any major Epitalon side effect people should be aware of? 

Not really. The main issue is simply that we don’t know enough. We can measure telomere length now, but we still don’t know: how long is too long? So again, that’s why we cycle it. I don’t have patients taking it all the time. 

A lot of these longevity-focused interventions don’t have definitive downside data. It’s all hypothetical – extrapolated from broader correlations in healthspan or ageing research. 

How much actual peer-reviewed data exists on peptides in general?

It really varies. There are a few peptides that are FDA-approved in the U.S. like Thymosin Alpha-1, Tesamorelin, PT-141… I’m probably missing one. But those have gone through the regulatory process. SS-31 also has a good amount of human data now. 

Those are the ones with the most robust clinical research behind them. Another debate within the field is: what level of evidence is sufficient for a doctor or a patient to feel comfortable using something? 

Is it gold-standard human trials? Or early-stage human studies? Or animal studies? Because doing a full, well-run human trial can cost $5–10 million and take 3–10 years. 

Is that realistic? 

It’s not realistic for everything to be tested that way, at least not right now. Maybe that’ll change. With the rise of decentralised funding models – crowdfunding, crypto, DAOs – we might get more real-world studies without waiting for traditional grant funding. That could change things. 

But yes — that’s the million-dollar question I get asked every day. Take BPC-157, which is probably the most popular peptide. It has very few human studies, yet most people feel comfortable using it. It has a great safety profile and broad utility. 

CJC and other growth hormone peptides, with the exception of Tesamorelin, also don’t have much in the way of formal trials. But we know TES is FDA-approved, and we use caution with anything that affects growth hormone. 

For others, like the bioregulators, there are some smaller studies, mainly out of Europe and Russia, where they originated. Hopefully in the next 5–10 years, we’ll have more robust human data. 

A lot of doctors are pushing for that now because we know we need that evidence base to bring this to the next level. And once those studies exist, the hope is that broader access and mainstream recognition will follow. But at this stage – no, it’s not perfect information. 

But hopefully more data is coming? 

That’s kind of where a lot of stuff in the longevity or optimisation space sits right now. That’s why GLP-1s are like the golden child. They have diabetes data, weight loss data and even some emerging longevity data. It’s kind of the perfect combination. They tick all the boxes. 

So we’re getting there with peptides, but there are still some gaps. People have to understand that. I’m very upfront and transparent about it. And some patients decide they don’t want to go ahead with it. That’s completely fine. 

Others say, “Let’s do this,” especially when prescription meds aren’t doing anything for them either and those can have side effects and issues too. So it’s very individual. What’s great now is that patients are far more educated than they were even two or three years ago. 

Unfortunately, or fortunately, I had a patient yesterday who’s really clued up, spends a lot of time doing deep dives, and she said that half the time she’s telling her doctors what to do. Some doctors just aren’t as informed as their patients anymore. So it’s become this interesting reversal, the patient’s often leading the charge, and the physician is more like the tour guide.

For more on Dr Paulvin, visit doctorpaulvin.com. Photography Google Deepmind