If you are comparing longevity treatments, therapeutic plasma exchange has the strongest published case for measurable biological age reduction among the options on this list. NAD+ IV therapy is broader, less aggressive, and far less expensive, which makes it a sensible entry point for many patients. Ozone therapy is better framed as a support tool for inflammation and recovery, not a replacement for plasma exchange. Stem cells, exosomes, and peptides can be useful in the right context, but the evidence quality varies more than most marketing suggests. And if you have never checked baseline inflammatory markers, start there first.
| Treatment | Mechanism | Best Evidence For | Cost Per Session | Session Time | Frequency | Best Candidate Profile |
|---|---|---|---|---|---|---|
| Therapeutic Plasma Exchange | Removes plasma, inflammatory proteins, and circulating cellular waste, then replaces plasma with albumin | Biological age marker reduction, inflammatory burden, high-touch longevity protocols | $6,000-$15,000 per session | 2-3 hours | 3-6 session initial series, then maintenance as indicated | Adults 50+, elevated inflammation, already disciplined with sleep, diet, and exercise |
| NAD+ IV Therapy | Repletes a coenzyme involved in cellular energy metabolism, mitochondrial function, and sirtuin signaling | Energy support, cognitive support, broader wellness and longevity programs | $200-$600 per session | 1.5-4 hours | Weekly to monthly | Patients seeking a lower-cost starting point for energy, focus, and recovery |
| Ozone Therapy | Uses controlled ozone exposure to trigger oxidative signaling with anti-inflammatory and oxygenation effects | Localized inflammation, pain, immune support, selected autoimmune cases | $100-$300 per session | 30-60 minutes | Often weekly in short blocks, then adjusted | Patients with inflammatory complaints, pain, or recovery issues who need a supportive therapy |
| Stem Cells / Exosomes | Attempts tissue repair and signaling through regenerative cells or cell-derived factors | Orthopedic and targeted regenerative applications more than systemic anti-aging | $1,000-$10,000+ per treatment | 45-120 minutes | Usually procedure-based, not weekly drip style | Patients with specific orthopedic or regenerative goals who understand product variability |
| Peptide Therapy | Uses signaling peptides to influence growth hormone release, tissue repair, metabolism, and recovery | Recovery support, sleep support, metabolic support, hormone-adjacent optimization | $200-$600 per month | Ongoing home protocol or office-guided plan | Daily or cyclical, depending on protocol | Patients building a layered protocol who want incremental support rather than a single anchor treatment |
Cost ranges are approximate and based on published clinic pricing and industry benchmarks as of 2026. TPE pricing at Liondale is discussed at consultation. See our NYC TPE cost guide for a full breakdown including comparison of local providers.
TPE is the most aggressive option on this list, which is why it gets attention. During treatment, plasma is removed and replaced with albumin, which allows the procedure to clear out inflammatory proteins and circulating waste products rather than simply adding something into the bloodstream (that distinction matters). It is a medical procedure, not an upgraded IV.
The strongest human data we have right now comes from Fuentealba et al., published in Aging Cell in May 2025. In that randomized, placebo-controlled trial of 42 adults age 50 and older, the TPE plus IVIG arm showed an average 2.61-year reduction in biological age markers, while TPE alone showed a 1.32-year reduction. That should get your attention. It should not switch off your judgment. For a deeper breakdown, read our review of the 2025 TPE clinical trial evidence.
This is the option I point to when a patient says, "I want the treatment with the clearest signal, even if it is the most involved." Best candidates are usually adults over 50 with elevated inflammation, slower recovery, persistent fatigue, or a sense that the basics are already dialed in and they want a more serious intervention. But it is not for patients with active bleeding disorders, significant clotting issues, or albumin allergy. And it should be approached carefully if you take anticoagulants or have a complex medical history.
At Liondale, TPE is run with pre- and post-session lab tracking every time, physician oversight by Dr. Bissoon, and a Circulate-informed protocol that connects to the evidence base behind the 2025 trial. We are not asking you to spend TPE-level money and then guess whether anything moved. Most patients start with a three- to six-session initial series, then spacing is adjusted based on response and labs.
NAD+ IV therapy is easier to understand once you stop treating it like a miracle product. NAD+ is a coenzyme involved in cellular energy metabolism, mitochondrial function, and sirtuin activity tied to DNA repair pathways. Levels decline with age. IV delivery bypasses the gut, which is one reason clinics use it in higher-dose longevity programs (whether every person needs IV dosing is a separate question).
The human evidence here is more modest than TPE. There is strong mechanistic rationale, strong animal data, and a lot of clinical interest around energy, mental clarity, recovery, and cognitive support. But there is no large randomized controlled trial comparable to the 2025 TPE study showing biological age reduction of the same kind. That does not make NAD+ weak. It makes it different, and often a better first step for patients who want broader support without starting with the most intensive procedure on day one.
This is what I tell patients who ask this question directly: NAD+ is a very reasonable entry point if budget matters, if your main complaints are energy and focus, or if you want to build toward a bigger protocol gradually. It can also layer well with TPE. We often use NAD+ IV therapy weekly or monthly between more intensive treatments, especially when the goal is to keep energy and recovery moving in the right direction.
Ozone therapy tends to get explained badly, either oversold as a cure-all or dismissed too quickly. The cleaner way to say it is this: medical ozone uses controlled ozone exposure to trigger oxidative signaling cascades that may support oxygen utilization, inflammation control, and recovery pathways (in experienced hands, context is everything). That mechanism is not the same as clearing old plasma out of the body.
The evidence is strongest in wound care, some pain conditions, and selected inflammatory or immune-related problems. It is much less convincing when someone tries to sell it as a standalone answer to systemic aging. But for the right person, it can be useful. Patients with localized inflammation, pain, immune support needs, or certain autoimmune patterns often view ozone as a practical add-on rather than the centerpiece.
I would not position ozone as a substitute for TPE. I would position it as a lower-cost support treatment that can sit beside TPE or NAD+, especially when inflammation or recovery is part of the clinical picture. Liondale offers medical ozone therapy for exactly that reason. Cost also stays accessible at roughly $100-$300 per session, which changes the entry calculus for many patients.
Stem cells and exosomes are where patients need the most skepticism, not because the category is useless, but because the claims vary wildly from clinic to clinic. The basic idea is regenerative signaling and tissue repair. In orthopedic medicine and some targeted regenerative settings, that can be compelling. In the much broader world of "systemic age reversal" (a phrase I would treat carefully), the evidence is thinner than the marketing copy usually admits.
If a clinic is telling you stem cells will reverse whole-body aging, improve every biomarker, and do it with one treatment, ask for the trial data. Seriously. Product quality varies. Source material varies. Regulatory status varies. What is legally offered in one setting may not be the same in another, and patients often do not realize how big that spread is until they start asking better questions.
That said, there is a place for this category. If the goal is targeted regenerative support, joint concerns, or a more specific tissue repair question, the evidence is stronger and the discussion becomes more concrete. Liondale's regenerative medicine program fits best in that lane. Cost can range from $1,000 to well above $10,000 depending on the source, route, and clinical goal, so the burden of proof should rise with the price.
Peptide therapy sits in the middle ground between mainstream longevity medicine and the faster-moving compounding world. Peptides are signaling molecules, and protocols may target growth hormone secretion, tissue repair, sleep, metabolism, or recovery depending on the compound used (CJC-1295 and Ipamorelin are discussed very differently than BPC-157 for a reason). That breadth is part of the appeal and part of the problem.
The evidence base is mixed. There is strong community use, clear clinician interest, and a lot of patient-reported benefit around sleep, recovery, body composition, and training resilience. But large human randomized trials are limited, and some peptides sit in a regulatory gray area when compounded. So I do not frame peptides as the anchor treatment for someone chasing the strongest proof. I frame them as tools that may sharpen a larger plan.
For the right patient, peptides can layer well with TPE or NAD+, especially when the goal is growth hormone optimization, recovery support, or better sleep continuity. Cost usually lands around $200-$600 per month for compounded protocols, which makes them more manageable than a procedure-heavy plan. But they still deserve real supervision, not a casual online checkout flow.
Here is the decision framework I use most often in consults (plain language first, medicine second).
There is no prize for picking the most expensive protocol first. There is also no point doing the cheapest option forever if your data are clearly pointing somewhere else.
Many patients who are serious about longevity medicine do not pick one treatment and stop. The sequencing Dr. Bissoon sees most often: TPE as the anchor intervention, with NAD+ used between sessions for energy and recovery support, and ozone added when inflammation or immune issues are part of the clinical picture. That combination is a patient-specific choice, not a default stack.
TPE handles the mechanical plasma clearing. NAD+ addresses cellular energy and mitochondrial function. Ozone can support inflammation and recovery in patients where that is part of the picture. Peptides or regenerative treatments may come later, once the baseline is clearer and the data suggests a specific gap.
And this is where good consults matter. The right mix depends on your labs, age, medications, tolerance for procedure time, and how aggressive you actually want to be. Some patients want the strongest protocol the evidence can justify. Others want a smarter on-ramp.
If the question is which treatment has the stronger published evidence for measurable biological age reduction, TPE wins right now. If the question is which treatment is easier to start, lower cost, and useful for energy or cognitive support, NAD+ may be the better first move. They are not direct substitutes, even if patients often compare them that way.
Yes, and that is a common approach at Liondale. TPE can serve as the anchor treatment while NAD+ IV therapy is used between sessions for energy and recovery support (timing still matters). The sequence should be based on your labs, goals, and how you tolerate treatment.
For many patients, NAD+ IV therapy or ozone therapy is the most accessible starting point. They cost far less than TPE and can still provide useful clinical information about how your body responds. But I still recommend baseline lab work first because a cheaper treatment is only a bargain if it fits the problem you are trying to solve.
They may have value in specific regenerative or orthopedic contexts, but the evidence for broad systemic anti-aging claims is much weaker than many clinics imply. Product quality and regulatory status also vary significantly. If a provider is promising whole-body age reversal, ask to see the human trial data before you commit.
Start with labs and a real consultation. If you want the most intensive evidence-led option and your workup supports it, TPE is the clear candidate. If you want a lower-cost starting point, NAD+ or ozone can make sense first. This is not a treatment category where guessing is efficient.
Some patients report changes in energy, clarity, recovery, or pain within days to weeks, depending on the treatment. Biomarker movement may take longer and should be checked rather than assumed (subjective improvement can be real, but it is not the whole story). TPE protocols, in particular, are best judged across an initial series rather than after a single session.
TPE has the strongest controlled human evidence on this list for biological age marker reduction, based on the 2025 randomized trial in adults over 50. That does not mean the evidence is complete. It means it is currently the clearest signal among popular longevity interventions in this category.
It depends on the labs and the patient's appetite for intensity, but many new patients are guided toward one of two paths. Either TPE as the anchor treatment with NAD+ and ozone layered around it, or NAD+ as the starting point with TPE added later if the clinical picture supports it. The goal is not to sell every therapy. The goal is to match the plan to the patient.
This article was written and reviewed by Lionel Bissoon, D.O., founder of Liondale Medical. Dr. Bissoon is a board-certified osteopathic physician specializing in anti-aging and concierge medicine on the Upper West Side of Manhattan.
This content is for educational purposes only and does not constitute medical advice. Individual results may vary. Consult a qualified physician before beginning any new treatment.
