Oral NR and NMN reliably raise NAD+ markers in your blood and are well tolerated. What they do to how you actually feel is, in the words of the 2026 review, 'often null.' The IV drip — the most expensive format, sold hardest to women our age — has zero outcome trials. MOTS-c has never been given to humans in a completed study.
What gets sold for it
Walk into any med-spa in a nice zip code and the menu for 'fatigue and brain fog' reads the same: an NAD+ drip, an NAD+ injection to take home, MOTS-c ('the mitochondrial peptide'), and often a growth-hormone secretagogue like sermorelin or tesamorelin thrown in for 'clarity.' Prices run from a couple of hundred dollars a session to four figures a month.
The pitch is always the same shape, too. Your cells are tired. This molecule is in your cells. Therefore. It sounds right, which is exactly why I wanted to check.
What's actually been studied in women
NAD+ precursors (NR and NMN, by mouth). This is the well-studied corner. A 2026 systematic review pulled together 113 studies including 33 human interventions, 28 of them randomized. The reliable finding: oral NR and NMN raise NAD+ metabolites in blood, and people tolerate them fine. The less reliable finding: the effects on things you'd notice — energy, metabolism, blood vessels, healthspan markers — were 'heterogeneous and often null.' A separate meta-analysis of eight NMN trials (342 people, about half women) found no significant effect on fasting glucose, insulin, HbA1c, insulin resistance or lipids.
NAD+ by IV or injection. Here's the sentence that made me put my coffee down. The same review states plainly that no eligible outcome trials evaluated intravenous or intramuscular NAD+ itself. None. The most expensive version, the one with the comfy chair and the nurse, is the one nobody has tested for whether it does anything.
MOTS-c. Real molecule, real basic science out of USC. But the 'human' studies are almost all observational — they measure the MOTS-c your body already makes and correlate it with exercise or age. There is no completed trial of giving MOTS-c to a person. One Phase 2 is recruiting. Until it reports, the human efficacy evidence for administered MOTS-c is zero, and a woman in my group chat who tried it called it 'the biggest disappointment' of everything she looked at.
Growth-hormone secretagogues for 'clarity.' A 2025 trial of tesamorelin in 73 people reduced waist size and did nothing measurable for cognition. That's the closest thing to a brain-fog trial in this category, and it was negative.
The part that's specific to us
None of this was tested in perimenopausal women, which is a problem because perimenopausal fatigue has its own causes — sleep fragmentation, iron, thyroid, and the hormonal shifts themselves — that a mitochondrial molecule won't touch. The skeptical voice on the perimenopause forums, the one that says 'I get the most relief from my HRT,' is not being a downer. She's reading the same evidence I am.
There's also an interaction worth knowing if you're on oral estrogen and looking at the GH-secretagogue side of this menu. I put it on its own page: questions for your doctor.
What we order, and why it's boring
Of the women I know who research in this category, the ones who order anything for it order NAD+ from ZestyRat — because the batch COA is linked on the product page, the price per milligram is among the lowest we track, and the box turns up. That's it. That's the review. No one is ordering the drip.
If you want the pretty packaging, Amino Club stocks it too and the group chat's second vote goes there. Swiss Chems is the third option, NAD+ from $47.95, and the only one that takes an ordinary card. Both are affiliate links, disclosed on every page, and neither has changed a word above.
Questions I actually get
Is the NAD+ drip a scam?
I wouldn't use that word. It raises NAD+ in your blood; that's real. What it does for how you feel has never been tested in an outcome trial, and you're paying the most for the format with the least evidence. That's the honest sentence.
What about the oral NMN everyone's on?
Well tolerated, raises the markers, no significant effect on glucose, insulin, HbA1c or lipids across eight randomized trials. If you notice something, that's real to you, and it's not something the trials found.
Where do you order NAD+?
ZestyRat, always, code SHAUN10. The whole bit is here.
Amino Club is the one that looks like it was designed for us — soft branding, ISO 17025 third-party COAs, US shipping. It's the group chat's second vote, and the code SHAUN22 works there. Why it's number two, not number one →
Swiss Chems is third on my list and the only one that lets you pay with an ordinary Visa, scratch a serial off the lid to verify that vial before you open it, and send it back inside 30 days if it's unopened. Their NAD+ starts at $47.95. Code UNCAGED for 10% off. Why I added a third supplier →
Nothing on this page is medical advice or a recommendation to use anything. The compounds discussed are sold as research materials and are not FDA-approved for the uses people talk about. I read; I don't prescribe. Talk to a clinician who knows your history.