Advocates of “personalized” genomic medicine maintain that it is revolutionary not just in what it can reveal to us, but in how it will enable us to take control of our health. But we should not assume that patient empowerment always yields positive outcomes. To assess the social impact of personalized medicine, we must anticipate how the virtue might go awry in practice.

In 2002, the Women’s Health Initiative, a large-scale study of the safety of hormone replacement therapy (HRT) for women conducted in the United States, released results suggesting that use of postmenopausal HRT increased women’s risks of stroke and breast cancer. In the years that followed, as rates of HRT prescription fell, another hormonal therapy rose in its wake: bioidentical hormone replacement therapy (BHRT). Anti-aging clinicians, the primary prescribers of BHRT, tout it as a safe and effective alternative to treat menopausal symptoms and, moreover, as a preventative therapy for age-related diseases and ailments. Through in-depth interviews with 31 U.S.-based anti-aging clinicians and 25 female anti-aging patients, we analyze attitudes towards BHRT. We illustrate how these attitudes reveal broader contemporary values, discourses, and discomforts with menopause, aging, and biomedicine. The attraction to and promise of BHRT is rooted in the idea that it is a “natural” therapy. BHRT is given both biomedical and embodied legitimacy by clinicians and patients because of its purported ability to become part of the body’s “natural” processes. The normative assumption that “natural” is inherently “good” not only places BHRT beyond reproach, but transforms its use into a health benefit. The clinical approach of anti-aging providers also plays a role by validating patients’ embodied experiences and offering a “holistic” solution to their symptoms, which anti-aging patients see as a striking contrast to their experiences with conventional biomedical health care. The perceived virtues of BHRT shed light on the rhetoric of anti-aging medicine and a deeply complicated relationship between conventional biomedicine, hormonal technologies, and women’s bodies.

Anti-aging practitioners' adoption of the rhetoric of successful aging reflects the success of successful aging models in shaping popular conceptions of what aging is and an ethos of management and control over the aging process. The overlap between anti-aging and successful aging rhetoric also highlights some of the most problematic social, cultural, and economic consequences of efforts made to reconceptualize old age.

The rise of anti-ageing medicine is emblematic of the current conditions of American biomedicine. Through in-depth interviews with 31 anti-ageing practitioners, we examine how practitioners strive for—and justify—a model of care that runs counter to what they see as the ‘assembly line’ insurance-managed industry of healthcare. Their motivation, however, is not merely a reaction to conventional medicine. It is derived from what they see as a set of core beliefs about the role of the physician, the nature of the physician-patient relationship, and the function of biomedicine. We analyse this ideology to underscore how anti-ageing medicine is built on a ‘technology of the self’, a self in need of constant surveillance, intervention, and maintenance. The ultimate goal is to create an optimal self, not just a self free of illness. A fundamental irony is that, despite their self-presentation and the perception of the public, anti-ageing providers do not use practices that are especially ‘high-tech’ or unconventional. Instead, the management of ageing bodies rests on providers’ perceived knowledge of their patients, tailored treatments, and a collaborative pact between the provider and patient.

This paper infuses a new perspective into scholarship on anti-aging science: the experiences of individual scientists as they entered and navigate this controversial field. We draw on in-depth interviews with 43 prominent biogerontologists to accomplish three objectives. First, we highlight key factors that draw scientists into biogerontology-especially the unique and complex puzzles posed by aging. Second, we examine how biogerontologists define themselves and their research in relation to "anti-aging" science-particularly how scientists distance themselves from the tarnished history of the field and employ powerful language to distinguish legitimate from illegitimate scholarship, and science from industry. Finally, we explore how individual scientists manage any social, religious, and ethical objections to conducting "anti-aging" research-and the repertoire of responses they use to simultaneously dismantle objections and reinforce the legitimacy of their science. The analyses reveal how much is ultimately at stake for these individual scientists on the front line.Other manuscripts in this special issue (e.g., Fishman, Binstock, & Lambrix; Vincent, Tulle, & Bond) and elsewhere (e.g., Gruman, 2003;Hall, 2003;Juengst, Binstock, Mehlman, & Post, 2003;Olshansky & Carnes, 2001;Post & Binstock, 2004) have charted the turbulent history of anti-aging science as a field. These accounts point especially to the controversial nature of the field; to its marginal scientific status even (or especially) within biomedicine; and to its continued struggle for legitimacy. For example, anti-aging science has been undermined by its association, real or imagined, with charlatanic medical practices and with profit-seeking practitioners and entrepreneurs. These associations also foster the perception that the field seeks "forbidden" knowledge and lacks scientific rigor and innovation (Fishman et al., this issue). Similarly, scientific and medical efforts to control human aging prompt vehement public