Healthy Aging & Longevity
Low Energy & Fatigue — There's Usually a Reason. Let's Find It.
Persistent fatigue, low energy, and changes in how you perform aren't just part of getting older. A licensed provider can evaluate what's driving yours — and connect you to the right next step.
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Energy, fatigue & performance
⚡ When low energy isn't just tiredness
Most people expect to have less energy as they get older. What's less expected — and less accepted — is persistent fatigue that doesn't respond to rest, changes in physical or cognitive performance that seem out of proportion to your lifestyle, or a sense that something is genuinely off even when nothing obvious explains it.
Persistent fatigue often has one or more identifiable contributors. Some of the most common — thyroid dysfunction, anemia, sleep disorders, nutritional deficiencies, mood conditions, metabolic changes, and medication effects — are treatable once identified. That said, an appropriate evaluation doesn't always turn up a single clear explanation, and that's worth knowing going in. The problem is that they're easy to dismiss, attribute to aging, or overlook on a standard check-up if the right questions aren't asked.
The starting point is evaluation, not treatment
The goal of this visit is to understand what's actually driving your fatigue — not to match your symptoms to a predetermined solution. The right next step depends entirely on what the evaluation turns up, and may range from lab work and a referral to a lifestyle recommendation or a prescription when clinically appropriate.
🚨 Call 911 for these symptoms
Call 911 immediately for fatigue accompanied by chest pain, severe shortness of breath, fainting, confusion, sudden one-sided weakness or numbness, sudden vision or speech changes, or severe palpitations. These may indicate a cardiac or neurological emergency.
⚠️ Prompt in-person evaluation (same day or soon)
Seek in-person evaluation promptly — not a scheduled telehealth appointment — for fatigue accompanied by significant unexplained weight loss, night sweats, new swollen lymph nodes, blood in stool or urine, or symptoms that are rapidly worsening. These warrant clinical evaluation that cannot be adequately conducted via telehealth.
What's often behind it
🔍 Common contributors to persistent fatigue and low energy
Fatigue is one of the most common symptoms in medicine — and one of the most nonspecific. It's associated with dozens of conditions. These are the contributors that come up most often and that a focused evaluation is well-positioned to identify as possible contributors and determine which warrant further evaluation.
- 🦋 Thyroid dysfunction An underactive thyroid (hypothyroidism) is among the most common and most overlooked causes of fatigue, weight changes, cold intolerance, brain fog, and low mood — particularly in women over 40. An overactive thyroid (hyperthyroidism) can also cause fatigue, often alongside weight loss, tremor, heat intolerance, anxiety, or palpitations. Both require appropriate testing to identify. → Thyroid & Hormonal Conditions
- 🩸 Anemia Iron-deficiency anemia and anemia from B12 or folate deficiency are common, especially in women, older adults, and vegetarians. Fatigue, weakness, pale skin, shortness of breath on exertion, and rapid heartbeat may all be present. A complete blood count (CBC) can identify anemia, although additional testing is often needed to determine the underlying cause.
- 😴 Sleep disorders Obstructive sleep apnea is significantly underdiagnosed, particularly in people who don't fit the stereotyped profile. Loud snoring, witnessed pauses in breathing, morning headaches, or marked daytime sleepiness warrant sleep evaluation. Insomnia and poor sleep quality also take a significant toll on energy and cognitive performance. → Sleep Disorders & Insomnia
- 😔 Depression & anxiety Both depression and anxiety commonly manifest as physical fatigue — not just low mood. Depression in particular frequently presents as exhaustion, loss of motivation, and changes in concentration or performance, without the patient identifying it as depression. Anxiety can interfere with sleep and sustain a state of physiological depletion.
- ⚖️ Metabolic & blood sugar factors Prediabetes, type 2 diabetes, and insulin resistance commonly produce fatigue, particularly after meals. These conditions are often present for years before diagnosis. → Medical Weight Support
- 🌡️ Hormonal changes In women, perimenopause and menopause frequently cause fatigue through disrupted sleep, night sweats, and hormonal shifts. In men, low testosterone can contribute to low energy, reduced motivation, and changes in physical performance. Although aging influences hormone levels, persistent symptoms deserve evaluation rather than being dismissed as just getting older. → Menopause & Hormonal Health → Men's Energy & Hormonal Health
- 💊 Medication effects Many common medications list fatigue as a side effect — including antihistamines, beta blockers, certain antidepressants, blood pressure medications, statins, sleep medications, muscle relaxants, and opioids. If fatigue began or worsened after starting a new medication, that's an important piece of clinical history worth reviewing.
- 🥗 Nutritional deficiencies Vitamin B12, iron, and folate deficiencies contribute to fatigue and can develop gradually without obvious symptoms. B12 deficiency is particularly common in older adults and those who take metformin or proton pump inhibitors. Vitamin D deficiency may also contribute to fatigue, muscle weakness, or bone health concerns in some patients. These are detectable with targeted testing.
- ❤️ Cardiovascular health Unmanaged or inadequately controlled blood pressure and cardiovascular risk factors affect energy and physical performance over time. Fatigue with exertion that seems disproportionate to your activity level may warrant cardiovascular evaluation.
- 🏋️ Deconditioning & lifestyle Reduced physical activity creates a cycle: fatigue leads to less movement, which leads to more fatigue. Deconditioning is itself a contributor to low energy and reduced performance, not just a consequence. Activity-level history matters in the clinical picture.
- 🤰 Pregnancy Pregnancy is a common cause of fatigue, particularly in the first trimester, and may influence which tests and treatments are appropriate. Fatigue in a person who may be pregnant should be evaluated with that possibility in mind, as it affects both the workup and safe management options.
- 🦠 Post-viral fatigue Some people experience prolonged fatigue after viral illnesses, including COVID-19. This post-viral fatigue can persist for weeks or months after the acute illness resolves and may include cognitive symptoms, exercise intolerance, and sleep disruption. Persistent symptoms following any infection should be discussed with a healthcare provider.
Fatigue is usually multifactorial
In many cases, fatigue reflects several interacting contributors rather than one hidden condition. Poor sleep worsens metabolic health. Hormonal changes disrupt sleep. Medication effects compound nutritional deficiencies. The value of evaluation is understanding which combination is most relevant for your specific situation — not finding a single magic explanation.
Lab-guided assessment
🧪 The role of lab work in fatigue evaluation
A focused history and review of symptoms can narrow the field considerably, but lab testing often plays an important role in confirming specific contributors. Depending on your symptom picture and health history, a provider may recommend some or all of the following.
| Test | What it helps identify |
|---|---|
| Complete blood count (CBC) | Anemia (iron-deficiency, B12/folate, or other causes), infections, or other blood abnormalities contributing to fatigue |
| Thyroid panel (TSH, free T4) | Hypothyroidism or hyperthyroidism — among the most commonly missed causes of persistent fatigue |
| Comprehensive metabolic panel (CMP) | Glucose, kidney function, liver function, and electrolytes — all relevant to fatigue; note that glucose on a CMP reflects the value at time of draw, not necessarily fasting glucose |
| Hemoglobin A1C & fasting glucose | Prediabetes or diabetes, which commonly produce fatigue and may be present years before diagnosis |
| Iron studies (serum iron, ferritin, TIBC) | Iron deficiency, even without anemia — ferritin (iron stores) can be low while the blood count is still normal |
| Vitamin B12 & folate | B12 deficiency is common in older adults and in people taking certain medications; causes fatigue and cognitive changes |
| Vitamin D | B12, iron, and folate deficiencies commonly contribute to fatigue; vitamin D deficiency may also be relevant in some patients; other nutritional factors may be considered depending on the clinical picture |
| Lipid panel | Part of overall cardiovascular risk picture; also relevant if fatigue is associated with metabolic factors |
| Testosterone (when clinically indicated) | Low testosterone in men may contribute to fatigue, reduced motivation, and performance changes; evaluation requires clinical context, and testing is generally performed in the morning on more than one occasion when low testosterone is suspected |
We don't currently order labs through our platform — but we can help
MyPhysician360 does not currently offer laboratory ordering through this platform. If lab testing is indicated based on your evaluation, your provider can identify which tests are most relevant for your situation and help you find a lab resource near you. Bringing any recent lab results to your visit can also make the conversation significantly more productive.
Not sure which labs to get or where to start? A provider can help you map it out.
Start a VisitWhat we can do
💻 Our role in your fatigue evaluation
A telehealth visit is well suited to the initial evaluation of fatigue and low energy. Here's what that looks like in practice — and where in-person or specialist care takes over.
| What a telehealth visit can do | What may require in-person or specialist care |
|---|---|
| Conduct a focused clinical evaluation of your fatigue — onset, pattern, associated symptoms, and functional impact | Physical examination findings (heart, lungs, abdomen, lymph nodes) that require in-person assessment |
| Review medications for fatigue-contributing side effects | Sleep study for suspected obstructive sleep apnea — requires in-person or at-home sleep testing |
| Identify which lab tests are most relevant and help you find a lab resource near you | Complex cardiac, pulmonary, or oncologic causes of fatigue — specialist referral when indicated |
| Review available lab results and discuss what they mean for your clinical picture | Fatigue with red-flag symptoms (unexplained weight loss, night sweats, swollen glands, blood in stool) — prompt in-person evaluation |
| Discuss lifestyle factors — sleep, activity, nutrition, stress — and their specific role in your fatigue | Eating disorders or significant undernutrition — require specialist management |
| Prescribe treatment or recommend supplementation when a treatable cause has been identified and is appropriate — including thyroid medication, nutritional supplementation, or treatment for mood-related contributors | Endocrinology, sleep medicine, cardiology, or other specialist care when complexity requires it |
| Discuss injectable NAD+ as a compounded wellness option when clinically appropriate and legally available — see our Men's Energy & Hormonal Health page for full details on this option | NAD+ is a compounded medication not FDA-approved for wellness uses; evidence in humans is limited and should be discussed honestly with your provider before proceeding |
| Refer to the appropriate specialist or condition-specific page when the evaluation points in that direction |
Your visit
🗓️ What to expect in a fatigue evaluation
The more specific you can be about what you're experiencing, the more useful the visit. Here's how the evaluation typically unfolds.
|
1
Describe your fatigue specifically
When it started, whether it's constant or comes and goes, how it compares to your previous baseline, what makes it better or worse, and whether it's physical, mental, or both. Mention if you've had recent illness, life changes, or new medications. |
2
Share your health picture
Current medications and supplements, sleep patterns (including snoring or partner observations), mood, diet, activity level, weight changes, and any prior lab work. These all factor into identifying likely contributors. |
3
Discuss with your provider
Your provider reviews your intake, asks focused follow-up questions, and works through the most likely contributors based on your clinical picture. They'll be direct about what can and can't be assessed through telehealth. |
4
Leave with a clear plan
Whether that's a lab recommendation and where to get it, a prescription for a treatable condition, a lifestyle recommendation, a referral to a specialist, or a link to a more specific condition page — you leave with a direction, not just a conversation. |
Bring recent labs if you have them
If you've had bloodwork done recently — even from a routine physical — bring those results to your visit. Your provider can review them in context of your symptoms and advise whether additional testing is needed, which specific markers are relevant, and where to get them. This often saves time and avoids duplicate testing.
How we can help
🏪 Evaluation, guidance, and the right next step
A provider can evaluate your fatigue, identify the most likely contributors, and help you understand what to do next. When prescription treatment is appropriate — for thyroid conditions, mood, nutritional deficiencies, or other identifiable causes — it may be sent electronically to your pharmacy. When the right path is a specialist or further testing, we'll tell you clearly and help you get there. We don't currently order labs through our platform, but we can help you identify what to get and where.
- ✓Focused clinical evaluation of fatigue, energy, and performance changes
- ✓Medication review — identifying contributing side effects
- ✓Lab guidance — what to test for and help finding a lab resource near you
- ✓Prescriptions when appropriate, sent electronically to your pharmacy
- ✓Clear referral when specialist or in-person evaluation is the right next step
- ✓No required membership to access our telehealth services
- ✓Visits may be HSA/FSA eligible — check with your plan administrator
- ✓If we cannot help you through telehealth, you will not be charged
Frequently asked questions
❓ Your questions answered
Is fatigue just a normal part of getting older?
Some changes in stamina and recovery time are a normal part of aging. But persistent fatigue that interferes with daily function, doesn't respond to rest, or represents a noticeable change from your previous baseline is worth evaluating — not just accepting. Many of the most common causes of fatigue in middle-aged and older adults are identifiable and treatable. Attribution to aging often delays a useful workup.
What labs should I get for fatigue?
The right panel depends on your specific symptoms and history. A basic fatigue workup commonly includes a complete blood count, thyroid panel, comprehensive metabolic panel, fasting glucose or A1C, iron studies, vitamin B12, and vitamin D. A provider can help you determine which are most relevant for your situation and identify a lab near you. If you've had recent bloodwork, bring it to your visit — it may already answer some of the questions.
Could my fatigue be thyroid-related?
Thyroid conditions — especially hypothyroidism — are among the most frequently missed causes of persistent fatigue, particularly in women. Other symptoms may include weight gain, cold intolerance, constipation, hair thinning, and brain fog, but many people have fatigue as their primary or only noticeable symptom. A TSH and free T4 are the commonly used initial screening tests for thyroid dysfunction. See our Thyroid & Hormonal Conditions page for more.
Could it be hormonal — menopause or low testosterone?
Yes, both are worth considering. In women, perimenopause and menopause frequently disrupt sleep through night sweats, and declining estrogen directly affects energy and mood. In men, low testosterone can cause fatigue, low motivation, and changes in physical performance. Both can contribute to fatigue in some individuals and may warrant evaluation when symptoms and clinical history suggest they are relevant. See our Menopause & Hormonal Health or Men's Energy & Hormonal Health pages for more focused evaluation.
Could sleep apnea be causing my fatigue?
Quite possibly. Obstructive sleep apnea is substantially underdiagnosed and doesn't always follow the stereotyped pattern of overweight, older men. Women, thinner adults, and younger people can have it too. Key signals include loud snoring, witnessed breathing pauses, waking with headaches, or being persistently exhausted despite what seems like adequate sleep time. Diagnosis requires sleep testing. See our Sleep Disorders page for more.
What is NAD+ and is it something that can help with fatigue?
NAD+ (nicotinamide adenine dinucleotide) is a coenzyme involved in cellular energy metabolism and DNA repair. NAD+ levels appear to decline with aging, and injectable NAD+ is sometimes discussed as a cellular energy support option. The underlying biology is well established, but evidence that compounded injectable NAD+ meaningfully improves energy or fatigue in humans is still limited and does not come from large controlled trials. It is a compounded medication, not FDA-approved for wellness uses, and is not appropriate as a substitute for identifying and treating underlying causes of fatigue. A licensed provider can discuss whether it may be worth considering for your situation after a proper evaluation. Full details, including safety information and prescribing considerations, are on our Men's Energy & Hormonal Health page — though this option is available for evaluation by any patient, not only men.
Can fatigue be treated through telehealth?
The evaluation of fatigue is well suited to telehealth, and many causes — thyroid conditions, nutritional deficiencies, mood-related contributors, and others — can be evaluated and managed through a telehealth visit once identified. Physical examination, sleep testing, and specialist evaluation for more complex causes require in-person care. Your provider will be clear about which category your situation falls into and what the right next step is.
Is this visit HSA or FSA eligible?
Visits may be eligible — check with your plan administrator to confirm based on your specific plan.
Tired of being tired? Let's find out why.
Persistent low energy usually has a reason. A licensed provider can evaluate what's driving yours, identify the right tests, and help you get to the right next step — whether that's a prescription, a referral, or a lab to visit near you.
HSA & FSA eligible — check with your plan administrator | No required membership | No charge if we can't help
Medical disclaimer: The information on this page is for general educational purposes only and does not constitute medical advice. Persistent fatigue has many possible causes, some of which require in-person evaluation, physical examination, laboratory testing, or specialist assessment that cannot be conducted through telehealth. Call 911 immediately for fatigue with chest pain, severe shortness of breath, fainting, confusion, or sudden neurological symptoms. Seek prompt in-person evaluation for fatigue alongside unexplained weight loss, night sweats, swollen lymph nodes, or blood in stool or urine — these require clinical assessment that cannot be conducted via telehealth. MyPhysician360 does not currently offer laboratory ordering through this platform; if testing is indicated, providers can help identify a lab resource near you. Injectable NAD+ is a compounded medication not FDA-approved for wellness or energy uses; evidence supporting its use for these purposes in humans is limited; it is not appropriate as a substitute for evaluation and treatment of underlying medical conditions. Whether any specific treatment is appropriate depends on individual health history and a licensed provider's clinical judgment; nothing on this page constitutes a guarantee of any prescription, diagnosis, or specific treatment. MyPhysician360's ability to provide care depends on the patient's physical location and applicable licensure rules. A licensed MyPhysician360 provider will review your complete health history before making any clinical recommendations. Services are not currently available in Mississippi or Alaska.