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Tesamorelin is a well-studied alternative with a stronger clinical evidence base from formal trials

The clearest indicator for starting with NAD+ is the patient who describes waking up tired despite sleeping a full night, experiencing mental sluggishness that does not resolve with caffeine, and feeling like their body takes longer to bounce back from physical exertion than it used to

According to Dr Tushar Tayal, Associate Director- Internal Medicine, CK Birla Hospital, Gurugram, the body does not store most B vitamins in large amounts, so excess is usually excreted through urine

In the first 4 weeks, pain and inflammation decrease and mobility improves

The one human trial that will measure tolerability directly has not started reporting it is only recruiting (planned 2026), studies a topical gel on small standardized wounds , and lists safety as a secondary, not primary, outcome (NCT07437586)