NAD+ (Nicotinamide riboside)
NAD+ is a core “helper molecule” found in every cell and is central to energy metabolism (mitochondrial function) and cellular maintenance. Because NAD+ levels tend to decline with age and stress, many people try to raise NAD+ via supplements such as NMN (nicotinamide mononucleotide) or NR (nicotinamide riboside), or via clinic-based NAD+ injections/IV infusions. The general goal is to support cellular energy, fatigue resilience, and “brain function,” but real-world responses are mixed and products vary widely in dose and quality. (nature.com)
In PFS/PSSD/PAS discussions, NAD+ comes up because it sits upstream of several big systems people suspect are unstable in these syndromes: mitochondrial energy, DNA repair, and cell-signaling/epigenetic regulation through NAD+-dependent enzymes (notably sirtuins and PARPs) and NAD+ consumers like CD38. That’s a plausible overlap on paper, but it does not mean NAD+ reliably improves PFS/PSSD/PAS symptoms in practice.
Crash Anecdotes (Community Reports):
https://www.reddit.com/r/PSSD/comments/1j9d7sf/experiences_with_nad/
https://www.reddit.com/r/FinasterideSyndrome/comments/1gcfqu6/nicotinamide_riboside/
How to Interpret This Page
This page summarizes anecdotal reports and community observations, not medical evidence. “Risk” here refers to how frequently severe or prolonged symptom worsening is reported, not to proven causation or population-wide probability. Individual responses vary widely, and absence of issues in some users does not rule out significant reactions in others.
Risk Signal Based on User Reports
Community Reports: Mixed Outcomes & Variable Risk Signal
Across PFS/PSSD communities, NAD+ boosters (especially NMN/NR) are most often described as “doesn’t move the needle much”—some report mild energy/mood changes, many report no meaningful change, and a subset describe feeling noticeably worse (a “crash” or flare). There are scattered reports of strong negative reactions after NAD+ precursors (including NMN) in the PSSD community, which is why many people treat NAD+ experiments as variable-response rather than “safe by default.”
Practical caution signal (route matters): people tend to report more immediate side effects with IV NAD+ than with typical oral precursors—things like flushing, nausea, chest pressure, anxiety, or feeling “wired/off,” especially if infused quickly. That doesn’t prove long-term harm, but it supports a cautious framing: not a targeted treatment for these syndromes, and not worth aggressive dosing/clinic infusions for most people who are already sensitized. There are reports of crashing taking this substance.
Evidence basis: general NAD+ biology and safety literature; anecdotal reports (online forums/self-reports). No controlled studies establishing benefit for PFS/PSSD/PAS-specific outcomes.