By Dr. Steven Long, DO, MHA, CPT
Beyond Health | Precision Medicine for High-Performance Living
Like many treatments that straddle the line between medicine and wellness, hyperbaric oxygen therapy (HBOT) has found new life in the age of biohacking. Clinics now market it as a fix for everything from fatigue and brain fog to aging itself. At $250–$500 per session, it's not cheap—but it’s gaining traction among health-optimizers, athletes, and a few high-profile tech entrepreneurs. Most of you readers wouldn’t know but I was a physician administering HBOT for 5+ years and have seen a lot of its successes, some failures, and a lot of complications. So, is HBOT a legitimate therapy with underappreciated benefits, or just another overpriced tool in the “wellness” toolkit?
What Is HBOT and What’s the Mechanism?
HBOT involves breathing 100% oxygen at pressures greater than atmospheric pressure, usually 1.5 to 3.0 ATA (atmospheres absolute). The theory is straightforward: increased pressure allows more oxygen to dissolve in the plasma, improving oxygen delivery to hypoxic tissues.
The FDA currently approves HBOT for 14 indications, including carbon monoxide poisoning, non-healing diabetic wounds, radiation necrosis, air embolism, and osteomyelitis refractory to standard treatment. So yes—it’s a legitimate medical intervention. But the broader claims being made today, especially in longevity medicine, are mostly off-label and unproven.
Claimed Benefits: What the Evidence Says
1. Cognitive Function and Neurological Recovery
A 2020 study in Aging gained a lot of attention after it reported that HBOT in healthy older adults led to cognitive improvements and telomere lengthening (Hachmo et al., 2020). Sounds great—until you read the fine print. The study was small (n=35), lacked a placebo group, and used endpoints that are far from universally accepted as clinically meaningful. The idea that you can reverse aging by sitting in a pressurized tank a few times a week is…ambitious at best.
2. Post-Concussion Syndrome and TBI
Some small trials and case series suggest HBOT might improve symptoms of chronic traumatic brain injury (Boussi-Gross et al., 2013). But again, the data are mixed and confounded by poor study design and variable protocols. A Cochrane review concluded there’s insufficient evidence to recommend HBOT for TBI (Bennett et al., 2012).
3. Muscle Recovery and Athletic Performance
There’s interest in using HBOT to speed recovery post-exercise. One randomized trial found marginal improvements in muscle fatigue recovery after strenuous exercise (Ishii et al., 2005). But the effects were small, and the same benefits could probably be achieved with a few hours of rest, hydration, and decent nutrition.
4. Anti-Aging and Telomeres
Telomere length and senescent cell burden are trendy surrogate markers for aging. HBOT has been shown to modestly impact both in limited human studies (Hachmo et al., 2020). But surrogate markers are not outcomes, and no one has lived longer because of slightly longer telomeres in a Petri dish. Let’s not confuse mechanistic plausibility with clinical benefit.
Risks, Costs, and Other Inconvenient Details
- Safety Profile
While generally safe when properly administered, HBOT isn’t risk-free. Barotrauma (ear, sinus, or lung), oxygen toxicity, and temporary myopia are well-documented side effects. It’s not something you want to do in your friend’s garage chamber they bought on Craigslist. - Cost and Accessibility
The price tag is substantial—routinely over $10,000 for a recommended 40-session protocol. If you're not treating a chronic wound or radiation injury, you're likely paying out-of-pocket for a benefit that’s, at best, theoretical. - Clinical Ambiguity
Longevity centers will cite "rejuvenation" and "mitochondrial health" as reasons to dive in. But as of now, there’s no convincing data that HBOT extends healthspan or lifespan in humans. If it did, we’d be using it in hospitals daily for chronic disease management, and insurers would be all over it. They’re not.
Bottom Line: Proceed with Caution—and Realistic Expectations
HBOT is not a scam. It has clear utility in a handful of well-established conditions. But as an anti-aging tool or performance enhancer? The evidence just isn’t there—at least not yet. If your patient has cash to burn and wants to try it for mild cognitive fog, sure, it's likely safe in the right hands. But don’t expect miracles. And don’t let anecdotal success stories convince you otherwise without data.
In the world of high-cost, low-evidence interventions, HBOT joins a crowded field. Like most things in medicine, the answer is rarely black and white—but when the grayscale leans this heavily toward hype, a healthy dose of skepticism is the best medicine of all.
References
- Hachmo, Y., et al. (2020). Hyperbaric oxygen therapy increases telomere length and decreases immunosenescence in isolated blood cells: A prospective trial. Aging, 12(22), 22445–22456.
- Boussi-Gross, R., et al. (2013). Hyperbaric oxygen therapy can improve post concussion syndrome years after mild traumatic brain injury–randomized prospective trial. PLoS ONE, 8(11), e79995.
- Bennett, M. H., et al. (2012). Hyperbaric oxygen therapy for traumatic brain injury. Cochrane Database of Systematic Reviews, Issue 12. Art. No.: CD004609.
- Ishii, Y., et al. (2005). Effects of hyperbaric oxygen on muscle fatigue following intermittent tetanic contraction in rat skeletal muscle. Clinical and Experimental Pharmacology and Physiology, 32(10), 776–781.
