This wikipaedia article CD38 claims that the ultimate cause of age related CD38 elevation (and hence NAD depletion) are believed to be senescent immune cells that accumulate in visceral fat:
Macrophages are believed to be primarily responsible for the age-related increase in CD38 expression and NAD+ decline.[56] Cellular senescence of macrophages increases CD38 expression.[56] Macrophages accumulate in visceral fat and other tissues with age, leading to chronic inflammation.[57] The inflammatory transcription factor NF-ÎşB and CD38 are mutually activating.[56] Secretions from senescent cells induce high levels of expression of CD38 on macrophages, which becomes the major cause of NAD+ depletion with age.[58]
Based on that using a senolytic like Fisetin might also be effective in suppressing CD38 and raising NAD. So I plan to order the 4-pack of NAD tests from Jinfinity (they offer a 10% discount of you order 4 tests) and test the effectiveness of Fisetin and Apigenin sequentially (along with ruling out any effect of alpha17-estradiol):
Mar 10: First NAD test : 24.3 uM
Mar 10 : Start 3 days of Fisetin 1.5g/day (Renue 150mg Liposomal Fisetin x 10 + LEF Senolytic Activator 3 capsules), around 20mg/kg of body weight of bioavailable Fisetin per day, equivalent to around 4g/day of regular Fisetin with 40% bioavailability. Split in 2 equal doses at 6am and 6pm.
Mar 13: Second NAD test (to see if Fisetin had any effect on NAD) + LEF blood test panel with estradiol (regular and sensitive), T, DHT, IGF1, LH+FSH (to monitor status before starting 17alpha-E2) : NAD= 28.1 uM, IGF1= 138 ng/ml, Total T= 579 ng/dL, Free T= 6.7 pg/ml, DHT = 18 ng/dL (ref=30-85), Estradiol(ECLIA)= 26.9 pg/ml, Estradiol (LC/MS/MS)= 26 pg/ml, LH= 16.4 mIU/ml (ref=1.7-8.6), FSH= 51.5 mIU/ml (ref= 1.5-12.4).
Mar 13: Start dermal 17alpha-E2 0.25mg, 2x/day (10am, 10pm) expected to absorb around 50ug/day. Also 1g DoNotAge Apigenin + 70mg Renue Lipo Apigenin, 3x/day (6am, 2pm, 10pm).
Apr 7-10 : 3 days of Lipo Fisetin 1.5g/day.
Apr 10 : Third NAD test to see if Apigenin (+ 17alpha-E2) had any effect on NAD over and above Fisetin. Will also take a panel of LEF blood tests including T+E2(sens)+DHT+FSH+LH+IGF1 to monitor effect of 17alpha-E2.
After getting results of 3rd NAD test, if NAD level is adequate (40-50 uM) see if Apigenin can be dialed back to reduce cost (or discontinued if it had no effect). If NAD is still low will consider adding Lipo NMN 250mg/day.
May 5-7 : 3 days of Fisetin 1.5g/day
May 8 : Fourth NAD test
Update 3/14/2023 : Raised my dosage of Apigenin to 1g every 8 hours and changed my schedule a bit so Fisetin is used half way between my every other week Rapamycin (20mg) to minimize interference.
Update 3/22/2023 : Added blood test results from 3/10/2023. Summary: 3 days of 1.5g/day of Lipo Fisetin raised NAD+ from 24.3uM to 28.1uM. Normal NAD+ for 20-40 year olds are 40-50uM.