A standard blood test at your GP tells you whether something is catastrophically wrong. It is not designed to tell you whether you are aging faster than you should be, whether your cardiovascular risk is quietly accumulating, or whether your metabolic health is on a trajectory that will cost you a decade of healthspan. For that, you need a different set of markers.

The 15 biomarkers below are the ones that longevity physicians, including Peter Attia, Rhonda Patrick, and the teams at the world's leading preventive medicine practices, consistently track in patients who want to know not just whether they are sick today, but how they are likely to age over the next 20 to 30 years. Each one is measurable from a standard blood draw. Each one has actionable implications if it falls outside optimal range. And in Bangkok, you can test all 15 for a fraction of what a comparable panel costs in London, New York, or Sydney.

Why standard reference ranges are not enough

Every biomarker below comes with two numbers: a standard reference range and an optimal range. These are not the same thing. Standard reference ranges are designed to catch disease in a general population. They tell you whether you are in the bottom 2.5 percent or top 2.5 percent of a distribution that includes sick, sedentary, and metabolically compromised people.

Optimal ranges are different. They reflect the values consistently observed in people who live longest and healthiest, drawn from centenarian studies, large longitudinal cohorts, and the clinical experience of longevity physicians. Being "within normal range" on a standard panel does not mean you are optimised. It often just means you are average in a population where average is not good enough.

The 15 biomarkers

01
ApoB
Cardiovascular Risk
ApoB is the single most important cardiovascular biomarker available and the one most consistently missing from standard health checks. Every atherogenic lipoprotein particle in your bloodstream, including LDL, VLDL, and IDL, carries exactly one ApoB protein. This means ApoB gives you a direct count of how many arterial-damage-capable particles are circulating in your blood. Standard LDL cholesterol, by contrast, measures the amount of cholesterol carried in those particles, which is a less accurate predictor of cardiovascular risk. Two people with identical LDL cholesterol can have vastly different ApoB counts and therefore vastly different actual cardiovascular risk. Peter Attia considers ApoB the single best blood marker for long-term heart health and advocates for knowing this number from your 30s onwards.
Standard reference
Below 130 mg/dL
Optimal for longevity
Below 80 mg/dL
02
Lipoprotein(a)
Cardiovascular Risk
Lp(a) is a genetically determined lipoprotein particle that significantly elevates cardiovascular risk when elevated. Unlike most cardiovascular risk factors, Lp(a) is almost entirely determined by genetics and does not change meaningfully with diet or exercise. This makes it something you test once rather than repeatedly. But that one result matters enormously. Approximately 20 percent of the population carries Lp(a) levels high enough to significantly elevate their lifetime cardiovascular risk. If you are in that group, it should fundamentally alter your approach to everything else on this list, particularly ApoB, since lowering ApoB becomes even more important as a compensating strategy.
Standard reference
Below 75 nmol/L
Optimal for longevity
Below 30 nmol/L
03
High-Sensitivity CRP (hs-CRP)
Inflammation
High-sensitivity CRP is the primary blood marker of systemic inflammation. Chronic low-grade inflammation, sometimes called "inflammaging," is one of the hallmarks of biological aging and a driver of virtually every major age-related disease including cardiovascular disease, Alzheimer's, cancer, and type 2 diabetes. Standard CRP tests are designed to detect acute inflammation from infection or injury. The high-sensitivity version picks up the subtle, chronic inflammatory state that standard tests miss. An hs-CRP above 3.0 mg/L in the absence of acute illness is a clear signal that something is driving inflammatory activity in your body and that the root cause needs identifying, whether that is poor sleep, metabolic dysfunction, visceral fat, chronic stress, or poor diet.
Standard reference
Below 3.0 mg/L
Optimal for longevity
Below 1.0 mg/L
04
Fasting Insulin
Metabolic Health
Fasting insulin is arguably the earliest detectable sign of metabolic dysfunction, appearing years or even decades before blood glucose becomes abnormal. When cells start becoming resistant to insulin, the pancreas compensates by producing more of it. Fasting glucose stays normal because the extra insulin is still doing its job. But the elevated insulin itself causes damage: it drives fat storage, promotes inflammation, accelerates arterial plaque development, and suppresses fat burning. Most standard health checks measure fasting glucose but not fasting insulin, missing the problem entirely until it is far advanced. A fasting insulin test takes one additional blood draw and costs very little. Knowing your HOMA-IR score, calculated from fasting insulin and fasting glucose, gives you a precise measure of insulin resistance.
Standard reference
2 to 25 mIU/L
Optimal for longevity
Below 6 mIU/L (HOMA-IR below 1.0)
05
HbA1c
Metabolic Health
HbA1c measures the percentage of haemoglobin that has been glycated, providing a 3-month average of blood glucose levels. It is a more reliable indicator of blood sugar management than a single fasting glucose reading because it reflects chronic exposure rather than a snapshot. Centenarian studies consistently show HbA1c levels below 5.5 percent throughout life. Every incremental rise above the optimal range is associated with accelerated protein glycation, which ages tissues faster than their chronological counterparts. An HbA1c of 5.8 percent may fall within the "normal" reference range, but it represents a meaningfully different metabolic trajectory than one of 4.9 percent.
Standard reference
Below 5.7% (non-diabetic)
Optimal for longevity
4.8 to 5.2%
06
Triglycerides
Metabolic Health
Triglycerides are fats circulating in the bloodstream, and their level is one of the most direct reflections of dietary carbohydrate intake and metabolic efficiency. Elevated triglycerides are closely associated with insulin resistance, elevated ApoB burden, and non-alcoholic fatty liver disease. The triglyceride to HDL ratio is a particularly powerful and underused predictor of insulin resistance: a ratio above 3.0 strongly suggests insulin resistance even when fasting glucose and HbA1c look normal. Reducing carbohydrate intake consistently lowers triglycerides faster than almost any other dietary intervention.
Standard reference
Below 150 mg/dL
Optimal for longevity
Below 80 mg/dL (ratio to HDL below 2.0)
07
Homocysteine
Inflammation / Cardiovascular
Homocysteine is an amino acid produced during protein metabolism. When it accumulates at elevated levels in the blood, it damages the lining of blood vessels, drives oxidative stress, and significantly increases the risk of both cardiovascular disease and neurodegenerative conditions including Alzheimer's. Elevated homocysteine is often caused by deficiencies in B vitamins, particularly folate, B6, and B12, making it one of the most actionable markers on this list: in many cases, supplementing with methylated B vitamins brings it back to optimal range within weeks. Peter Attia targets homocysteine below 9 micromol/L in his patients, noting that supplementation with methyl folate and methyl B12 is often sufficient to achieve this.
Standard reference
Below 15 micromol/L
Optimal for longevity
Below 9 micromol/L
08
Vitamin D (25-OH)
Immune & Hormonal Health
Vitamin D functions less like a vitamin and more like a hormone, with receptors in virtually every tissue in the body. It regulates immune function, bone density, cardiovascular health, mood, and cognitive function. Deficiency is extraordinarily common, particularly in people who spend significant time indoors or who live in northern latitudes, and it is consistently associated with increased all-cause mortality, higher cancer risk, and faster cognitive decline. Despite living in Thailand where sunlight is abundant year-round, many Westerners who work indoors remain deficient. Testing is cheap, supplementation is inexpensive, and the benefits of correcting a deficiency are among the most well-supported in the nutrition literature.
Standard reference
30 to 100 ng/mL
Optimal for longevity
50 to 80 ng/mL
09
Testosterone (Total and Free)
Hormonal Health
Testosterone is the primary anabolic hormone in men and plays significant roles in women as well. In men, it declines at approximately 1 to 2 percent per year from the mid-30s onwards. This decline is associated with reduced muscle mass, increased fat mass, impaired cognitive function, lower energy, reduced libido, and elevated cardiovascular risk. Total testosterone tells you how much is in circulation overall. Free testosterone, the portion not bound to proteins and therefore biologically active, is often a more clinically relevant number. Many men with "normal" total testosterone have low free testosterone due to elevated sex hormone-binding globulin. Both numbers together give a complete picture. In women, testosterone deficiency is frequently underdiagnosed but equally consequential for energy, muscle maintenance, and cognitive clarity.
Standard reference (men)
300 to 1000 ng/dL total
Optimal for longevity (men)
600 to 900 ng/dL total, free T in upper quartile
10
Thyroid-Stimulating Hormone (TSH)
Hormonal Health
TSH is the pituitary signal that tells the thyroid gland how much thyroid hormone to produce. When TSH is high, it means the pituitary is working harder than it should to stimulate an underperforming thyroid. When it is low, the thyroid may be overactive. Subclinical hypothyroidism, where TSH is elevated but thyroid hormone levels are still technically normal, is associated with fatigue, cognitive slowing, weight gain, and cardiovascular risk. A complete thyroid picture requires not just TSH but free T3 and free T4, since TSH can look normal while downstream hormone levels are suboptimal. This is particularly relevant for anyone experiencing symptoms of thyroid dysfunction despite a normal TSH result.
Standard reference
0.4 to 4.0 mIU/L
Optimal for longevity
0.5 to 2.0 mIU/L
11
ALT (Alanine Aminotransferase)
Liver Health
ALT is the primary liver enzyme used to assess hepatic health. The liver is the central metabolic organ in the body, responsible for processing nutrients, detoxifying compounds, producing proteins, and regulating cholesterol and glucose. Elevated ALT, even within the upper end of the "normal" range, can indicate early non-alcoholic fatty liver disease or hepatic inflammation before symptoms or imaging abnormalities appear. Peter Attia uses a tighter ALT target than standard ranges suggest, targeting below 25 U/L for men and below 20 U/L for women, noting that values in the upper normal range often reflect a degree of metabolic stress that is worth addressing proactively.
Standard reference
7 to 56 U/L
Optimal for longevity
Below 25 U/L (men), below 20 U/L (women)
12
eGFR (Kidney Function)
Organ Health
Estimated glomerular filtration rate measures how efficiently the kidneys are filtering blood. Kidney function declines with age, but the rate of decline varies enormously and is significantly influenced by metabolic health, blood pressure control, and hydration habits. Chronic kidney disease is one of the most underdiagnosed conditions in otherwise healthy adults, partly because early stages produce no symptoms and partly because many standard health checks only measure creatinine, which can appear normal until kidney function has already declined significantly. eGFR is a more sensitive calculation that accounts for age, sex, and muscle mass. An eGFR above 90 is considered normal; below 60 indicates moderate kidney impairment even in the absence of symptoms.
Standard reference
Above 60 mL/min/1.73m2
Optimal for longevity
Above 90 mL/min/1.73m2
13
Complete Blood Count (CBC)
General Health
The CBC is one of the foundational panels in medicine and contains more information than most people realise. Beyond identifying anaemia, it provides data on immune cell populations, platelet function, and red blood cell characteristics. Red cell distribution width (RDW), a measure of variability in red blood cell size, is consistently associated with all-cause mortality in large population studies and is one of the nine biomarkers used in the PhenoAge biological age calculation. Mean corpuscular volume (MCV) provides insight into B12 and folate status. Lymphocyte and neutrophil counts reflect immune function and inflammatory status. A CBC is included in virtually every health check package in Bangkok and takes minutes to process.
Key marker: RDW
Standard: 11.5 to 14.5%
Optimal for longevity
Below 12.5% (lower is better)
14
IGF-1 (Insulin-Like Growth Factor-1)
Hormonal Health / Longevity
IGF-1 is produced by the liver in response to growth hormone and drives cellular growth and proliferation throughout the body. The relationship between IGF-1 and longevity is genuinely complex. Too low, and you lose muscle mass, bone density, and metabolic drive. Too high, and you may be accelerating the proliferative processes associated with cancer risk. The longevity research literature generally suggests that the middle-to-lower end of the normal range is associated with the best longevity outcomes in older adults, reflecting the evolutionary argument that slightly lower growth hormone signalling in middle age reduces cancer risk without imposing the penalties of outright deficiency. This is one marker where the optimal range depends heavily on age.
Standard reference (adults)
88 to 246 ng/mL
Optimal for longevity (40-60)
120 to 180 ng/mL (mid-lower range)
15
Albumin
Protein Status / Longevity
Albumin is a protein produced by the liver that transports hormones, fatty acids, and other substances through the bloodstream while maintaining fluid balance. It is one of the nine biomarkers in the PhenoAge biological age calculation, included because albumin levels decline with chronic inflammation, malnutrition, and progressive organ dysfunction. A study in BMC Geriatrics found that many centenarians maintain healthy albumin levels well into their later years, suggesting that preserved albumin reflects a combination of good liver function, adequate protein intake, and controlled inflammation. Low-normal albumin in otherwise healthy adults is worth investigating as an early signal of cumulative biological stress.
Standard reference
3.5 to 5.0 g/dL
Optimal for longevity
Above 4.5 g/dL

Where to test all 15 in Bangkok

All 15 biomarkers above are available through Bangkok's major hospital health check packages. The question is which package covers everything you need and at what price point.

Bangkok Hospital's comprehensive health check packages are the most transparent on pricing and the most detailed on what is included. Their Prestige packages for 40 to 50 year olds cover CBC, HbA1c, full lipid profile, kidney function, liver enzymes, thyroid function (TSH), and tumour markers, at 15,900 to 25,000 THB depending on gender and whether EST is included. Their Signature and Longevity packages add free T3, free T4, bone density, and sarcopenia assessment. You would need to request ApoB, Lp(a), fasting insulin, homocysteine, and IGF-1 as add-ons, as these are not standard inclusions in most packages.

Bumrungrad International's health screening centre offers similar coverage with slightly higher price points and an exceptionally experienced international patient services team. Their comprehensive packages are well-suited to first-time visitors who want the most seamless clinical experience alongside their panel.

BDMS Wellness Clinic is the right destination for anyone whose results suggest hormonal or metabolic issues requiring specialist interpretation. Their Prevention and Wellness Clinic is Bangkok's most sophisticated longevity medicine facility and has the clinical depth to interpret complex panels and design interventions.

Panel Coverage Bangkok (THB) Bangkok (USD approx.) London / New York equiv.
Standard health check (CBC, glucose, lipids, liver, kidney, TSH) 5,500 to 13,500 ~$157 to $386 £600 to £1,200
Comprehensive panel (all standard + thyroid, hormones, tumour markers) 15,900 to 28,000 ~$455 to $800 £1,500 to £2,500
Full longevity panel (all 15 biomarkers including ApoB, Lp(a), fasting insulin, homocysteine, IGF-1) 22,000 to 35,000 est. ~$630 to $1,000 £3,000 to £5,000+
Which markers to prioritise if testing incrementally

If you are new to longevity biomarker tracking and want to start with the highest-impact tests, prioritise in this order: ApoB and hs-CRP first (highest actionability for cardiovascular risk), then fasting insulin and HbA1c together (metabolic health picture), then homocysteine and vitamin D (highly actionable if abnormal), then testosterone and thyroid panel, then Lp(a) once as a one-time genetic screen. The remaining markers will be captured in any comprehensive health check package.

How often should you test

For most health-conscious adults in their 40s and 50s, a comprehensive panel twice per year is the right cadence. The first panel establishes your baseline. The second, 6 months later, tells you whether interventions are working and whether any markers are trending in the wrong direction.

Markers like Lp(a) and genetic risk factors only need to be tested once, as they do not change. Metabolic markers like fasting insulin, HbA1c, and triglycerides respond to lifestyle changes within weeks to months and benefit from more frequent tracking if you are actively working to improve them. Hormonal markers including testosterone and thyroid typically need 6 to 12 months to assess the full effect of any intervention.

The single most important thing is not which panel you choose or how often you test. It is establishing a baseline. You cannot track improvement in something you have never measured. A comprehensive Bangkok health check at the start of a longevity visit gives you the map. Everything else on your protocol, whether that is HBOT, NAD+ IV therapy, hormonal optimisation, or a supplement stack, becomes more targeted and more effective when it is informed by your actual data.

Frequently asked questions

Do I need to fast before getting these tests?

Yes, for most of the metabolic markers on this list. Fasting insulin, HbA1c, fasting glucose, triglycerides, and the full lipid panel all require an 8 to 12 hour fast before the blood draw for accurate results. ApoB, hs-CRP, homocysteine, vitamin D, thyroid markers, testosterone, IGF-1, albumin, and kidney and liver function markers do not strictly require fasting, but most comprehensive panels are drawn fasted for consistency. Bangkok hospital health checks are typically scheduled first thing in the morning for this reason. Drink water freely before and during your fast as dehydration can artificially alter some results.

Which of these biomarkers is most important for someone in their 40s?

For someone in their 40s without known health conditions, the three highest-impact markers to know are ApoB, fasting insulin, and hs-CRP. ApoB because cardiovascular risk accumulates silently for decades and the 40s is when early intervention has the greatest lifetime impact. Fasting insulin because metabolic dysfunction almost always begins with insulin resistance long before glucose becomes abnormal, and the 40s are when this process typically accelerates. And hs-CRP because chronic inflammation is the underlying driver of almost every age-related disease and it is both measurable and often addressable through lifestyle changes. Knowing these three gives you the most actionable picture of your longevity trajectory at 40.

Can I get ApoB and Lp(a) tested at Bangkok Hospital?

Yes. Both are available at Bangkok Hospital, Bumrungrad, and Samitivej as add-on tests to standard packages. They are not typically included in the published package prices, so you will need to request them specifically when booking or during your consultation. ApoB is a straightforward add-on that most hospitals can process within the same visit. Lp(a) is slightly less commonly ordered and may take a day or two longer to process. When booking your health check in Bangkok, specifically mention that you want ApoB, Lp(a), fasting insulin, and homocysteine added to your panel and confirm the hospital can include them before your appointment.

What should I do if a result comes back outside the optimal range?

First, interpret it in context rather than in isolation. A single marker outside optimal range is a signal worth investigating, not a diagnosis. Most longevity physicians look at the pattern across multiple markers rather than any single result in isolation. Elevated ApoB alongside high triglycerides and elevated fasting insulin tells a coherent metabolic story that points toward specific interventions. Elevated homocysteine in isolation may simply indicate a B vitamin deficiency. The most productive next step after receiving results is a consultation with a physician who understands longevity medicine and can help you interpret the full picture. At Biovala, we include a physician consultation as part of our Discovery package specifically to help clients interpret their Bangkok panel results and design a protocol based on the data.

How do Bangkok blood test prices compare to the UK and US?

The savings are substantial. A comprehensive longevity panel covering all 15 biomarkers from a private clinic in London typically costs between £2,000 and £5,000. The equivalent panel at Bangkok Hospital or Bumrungrad, including all the add-on markers, sits between 22,000 and 35,000 THB, which is approximately $630 to $1,000 USD. You receive the same quality of analysis from internationally accredited laboratories, with English-speaking physicians and same-day results for most markers. For many clients, the cost of a comprehensive Bangkok blood panel is covered by what they save on a single other treatment compared to Western pricing.