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To keep himself healthy into his eighth decade, David Sandler recently decided to go beyond his regular workouts and try something experimental: taking rapamycin, an unproven but increasingly popular drug to promote longevity.

The medication has gained a large following thanks to longevity researchers and celebrity doctors who, citing animal studies, contend that rapamycin could be a game changer in the quest to fend off age-related diseases. The drug is going mainstream as an anti-aging treatment, even though rapamycin’s <a href="https://www.accessdata.fda.gov/drugsatfda_docs/label/2017/021083s059,021110s076lbl.pdf" target=_blank>regulatory approval</a> is for treating transplant patients. There is no evidence that it can extend human life.

Sandler initially dismissed the idea of rapamycin as a longevity drug, but as he read up online, he decided there might be something to it and ordered a year’s supply for about $200 from a supplier in India.

“If I was younger, I would hold off,” said Sandler, a 77-year-old retired accountant who lives in Bergen County, N.J. “But at this age, I’m making myself part of the experiment,” he said.

Researchers have found that rapamycin can modify a kind of cellular communications system that gives cells certain directions — to grow when the body has plenty of food and to slow down when nutrients are scarce. The drug can dial down the signal to grow, causing cells to clear out accumulated junk and allowing them to run more efficiently.

Despite the buzz surrounding the drug, it is unlikely that the Food and Drug Administration will ever approve it for longevity. The agency doesn’t consider aging to be a disease, and rapamycin’s generic status means there’s little financial incentive to run expensive clinical trials to test it on age-related afflictions. So doctors and entrepreneurs are increasingly marketing rapamycin beyond the scope of its regulatory label, believing a potentially life-extending drug is effectively hiding in plain sight.

Melanie Landsman

More than two dozen medical practices prescribe rapamycin as an anti-aging treatment, according to a Washington Post review, and telehealth companies are bringing it to thousands of patients nationally. Prices vary widely, but some online purveyors offer a typical dose for about $10 a week or less. Alan Green, a physician in Little Neck, N.Y., says he has personally treated nearly 1,500 patients with rapamycin since 2017 and has <a href="https://rapamycintherapy.com/" target=_blank>called it</a> “the most important drug in the history of medicine.”

Rapamycin’s promise as a longevity drug, however, remains divisive among scientists and longevity influencers.

The enthusiasm for the drug’s anti-aging properties comes from studies that repeatedly have shown benefits in animals <a href="https://www.nature.com/articles/s43587-023-00416-y" target=_blank>across multiple species</a>, including yeast, worms and mice. Some physicians and researchers believe that if taken intermittently and in low doses, rapamycin can increase human life span the way it has in animal trials. But doctors also caution that no one knows what the optimal dose might be for humans, and taking certain quantities of rapamycin can lead to <a href="https://www.sciencedirect.com/science/article/pii/S1600613522226197" target=_blank>reproductive harm</a> and <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3324089/" target=_blank>insulin resistance</a> as well as making the body more <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5427056/" target=_blank>susceptible to infection</a>.

“Mice may be a little different from humans when it comes to drug tolerance, diseases and reactions,” said Elena Volpi, a professor and longevity expert at the University of Texas Health Science Center at San Antonio.

“It is a drug that I think can be taken safely under certain conditions but has enough of a side effect profile that I’m not interested in taking it for sake of increasing life span at this time,” Andrew Huberman, a neuroscientist with a large social media following, said on a podcast in October.

Brad Rosen, a doctor in Los Angeles, says he believes rapamycin’s potential is compelling enough for him to try.

“At 60, I don’t have the luxury of expecting studies to be completed that can validate the benefits of a longevity drug prior to my own steeper decline,” said Rosen, who also has prescribed the drug to about 250 patients. The promising animal studies, combined with rapamycin’s long history as an immune-suppressing drug, he said, makes it “one of few agents where taking a calculated risk can absolutely make sense.”

Rapamycin’s growing popularity mirrors the rise of longevity medicine. Altos Labs, which <a href="https://www.prnewswire.com/news-releases/altos-labs-launches-with-the-goal-to-transform-medicine-through-cellular-rejuvenation-programming-301463541.html" target="_blank">raised $3 billion</a>, is aiming to reverse diseases of aging by rejuvenating cells — inspired by research that won the <a href="https://www.nobelprize.org/prizes/medicine/2012/press-release/" target="_blank">2012 Nobel Prize</a>. The Saudi-based <a href="https://hevolution.com/en/web/guest/w/igniting-a-new-era-in-global-health-hevolution-foundation-announces" target="_blank">Hevolution Foundation</a> is pledging to spend up to $1 billion a year to accelerate research on aging. Longevity medicine practitioners like Peter Attia have amassed large followings on social media — and kindled excitement about rapamycin.

Rapamycin was <a href="https://www.nature.com/articles/ncb3624" target=_blank>collected</a> by a scientific expedition in the 1960s from the soil of Easter Island, also known as Rapa Nui, one of the most remote inhabited places on earth. The FDA approved it in 1999 to help transplant patients tolerate their new organs. But scientists kept exploring how the drug worked and ultimately set the field of longevity medicine abuzz.

Esteban Felix

“It was uncanny,” Attia writes in his best-selling book, “Outlive: The Science and Art of Longevity.” “This exotic molecule, found only on an isolated scrap of land in the middle of the ocean, acts almost like a switch that inhibits a very specific cellular mechanism that exists in nearly everything that lives.” He added that “this fact still blows my mind every time I think about it.”

A <a href="https://www.nature.com/articles/nature08221" target=_blank>bombshell study</a> in 2009 found that rapamycin extended the lives of elderly mice by as much as 14 percent, the first time a drug had been shown to help a mammal live longer. Then in 2014, researchers had a <a href="https://www.science.org/doi/10.1126/scitranslmed.3009892" target=_blank>revelation</a>: Older adults who took a rapamycin-like drug had a more robust response to the flu vaccine, upending the widely held notion that rapamycin weakened the immune system.

A decade later, a low, intermittent dose used in the 2014 study — 5 milligrams a week — has remained popular for people taking rapamycin for longevity.

In a <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10187519/" target=_blank>recent survey</a> of 333 people who used rapamycin off-label, researchers found that they generally reported better quality of life since starting the drug. Compared with a cohort that didn’t take the drug, the only side effect among rapamycin users that was statistically different was mouth sores.

“I would say that rapamycin is the current best-in-class for a longevity drug that we have,” said Matt Kaeberlein, a professor the University of Washington who has researched rapamycin for two decades and is studying its anti-aging effects <a href="https://dogagingproject.org/project-details" target=_blank>in dogs</a>. In his own experience, he credited rapamycin’s anti-inflammatory properties with healing his persistent shoulder pain.

Joan Mannick is aware of what she calls “a gold rush” in longevity medicine. As the researcher who led the 2014 study, she doesn’t exactly embrace how her work has become the basis for rapamycin dosing in people.

“I don’t know yet what’s the right dose, what’s the right duration, what are the risks, what are the benefits,” said Mannick. Now chief executive of Tornado Therapeutics, she is aiming to develop a <a href="https://www.tornado-tx.com/science" target=_blank>rapamycin-like compound</a> that could be even more effective — and patentable. “I think we’ll be able to get there, but we aren’t there yet.”

Others are not inclined to wait. “Get Rapamycin online,” AgelessRx, a longevity-focused telehealth firm, advertises on Google.

Healthspan, a telehealth service whose main offering is rapamycin, markets it predominantly for longevity but also cosmetic use, touting “the only skin cream scientifically proven to reverse skin aging at the molecular level.” On Tuesday, the company announced a new rapamycin product to stimulate hair growth.

Daniel Tawfik launched Healthspan — a term that refers to the portion of life when people are healthy — in 2022 after trying to help his wife battle cancer and observing a “chasm between what’s happening in the research community and the clinical world.” Tawfik said more than 2,000 patients have subscribed to its rapamycin service, which includes the drug and regular testing (Healthspan doesn’t prescribe the drug to between 15 and 20 percent of prospective patients, he said).

Mark Abramson

For longevity dosing, Healthspan relies on studies <a href="https://www.science.org/doi/10.1126/scitranslmed.3009892" target=_blank>led</a> <a href="https://www.science.org/doi/10.1126/scitranslmed.aaq1564" target=_blank>by</a> <a href="https://www.thelancet.com/journals/lanhl/article/PIIS2666-7568(21)00062-3/fulltext" target=_blank>Mannick</a> as well as research <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5411365/" target=_blank>on dogs</a>. For its skin cream, Tawfik cited a small <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6925069/" target=_blank>study</a> by Drexel University researchers and a rapamycin-like gel approved by the FDA in 2022 to treat <a href="https://www.prnewswire.com/news-releases/fda-approves-nobelpharmas-hyftor-sirolimus-topical-gel-0-2-301516272.html" target=_blank>benign facial tumors</a>. For the hair treatment, the company highlighted a 2019 study <a href="https://www.cell.com/cell-reports/fulltext/S2211-1247(19)30699-0" target=_blank>on mice</a>.

“The potential is enormous for patients to be able to extend their health span and quality of life as they age,” Tawfik said, adding that his firm’s experience “shows that rapamycin can be prescribed safely” with few side effects.

Attia, who has a medical practice focused on helping people live longer and healthier, dedicates a chapter of his 2023 book to rapamycin and has said he takes the drug himself. With more than 600,000 subscribers to his <a href="https://www.youtube.com/@PeterAttiaMD" target=_blank>YouTube channel</a>, Attia has become one of the most influential voices in longevity medicine, and many doctors say patients learn about rapamycin from him.

Bryan Johnson, who founded and sold mobile-payments firm Braintree, has also emerged as a high-profile user of rapamycin in his current project: developing a <a href="https://protocol.bryanjohnson.com/Home" target=_blank>protocol</a> to reverse the aging process.

Mike Coppola

After his team surveyed scientific literature on what can improve longevity and ranked various strategies, Johnson said rapamycin — in combination with diabetes drug metformin — “is the 10th best-performing of all time.” Johnson — whose <a href="https://www.youtube.com/channel/UCnRVL1-HJnXWB_Xi2dAoTcg" target=_blank>videos</a> of his extensive regimen have been viewed millions of times — sees his exploration of longevity on a grand historical scale, like Magellan circumnavigating the globe. He’s actively adjusting his dose of rapamycin.

“I don’t think we have any conclusive observations yet,” he said.

Eric Verdin, chief executive of the Buck Institute on Aging, says there’s a strong case to be made for rapamycin as an anti-aging drug but hastens to add: “We should not as a field recommend use on people.” He and many other doctors say rapamycin is no substitute for exercise and a healthy diet.

“People going on it, using it as a substitute for a healthy lifestyle, it’s a bridge too far for me,” Verdin said. Then he offered a disclosure: He takes rapamycin.

“I’m doing everything I can to try to maximize my longevity,” said Verdin, who is 66. Of rapamycin, he said, “I haven’t felt any difference one way or the other.”

University of Chicago, BA in International Studies

Daniel Gilbert joined The Washington Post in 2022 and writes about the business of medicine. He previously spent seven years as an investigative reporter for the Seattle Times, and before that covered business and energy for the Wall Street Journal.

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How a drug for transplant patients became known for anti-aging effect

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How a cheap, generic drug became a darling of longevity enthusiasts