Symptom
Why am I always tired?
Persistent tiredness is a symptom, not a diagnosis. It is usually multifactorial, and can involve medical, hormonal, metabolic, sleep, psychological or lifestyle contributors. Targeted testing helps identify the ones that can be treated.
In short
Constant tiredness most often comes from iron or vitamin B12 deficiency, thyroid disease, poor sleep quality or sleep apnoea, blood sugar and insulin problems, hormonal change such as perimenopause or low testosterone, chronic stress and recovery failure, gut problems affecting absorption, or the effects of certain medicines. Many people have more than one contributor. A structured assessment with targeted blood tests can identify contributors that are treatable, although not every case has a single measurable cause.
Medically reviewed by Dr Arnav Kapur, MBBCh Cum Laude
The approach
Understand first. Then treat.
Being told that bloods are normal while still feeling exhausted is common. Sometimes relevant tests were not included, and sometimes results within a wide reference range were not interpreted alongside symptoms. In other cases the explanation lies with sleep, workload, mood or recovery rather than a blood test.
We work through the likely contributors systematically rather than treating fatigue as a single condition, then address what we find.
Causes we look for
- Iron deficiency, low ferritin, vitamin B12 and vitamin D deficiency
- Thyroid disease, including underactive thyroid and autoimmune thyroiditis
- Insulin resistance, unstable blood sugar and prediabetes
- Perimenopause, menopause, low testosterone and other hormonal change
- Sleep apnoea and poor sleep quality
- Chronic stress, cortisol rhythm disruption and burnout
- Gut problems affecting digestion and absorption
- Inflammation, post viral fatigue, anaemia and medication effects
Why one blood test is rarely enough
A basic panel may not include ferritin, full thyroid function, insulin, inflammatory markers or nutrient status. Testing is selected according to your history rather than ordered exhaustively, and results are interpreted alongside your symptoms.
Sleep is assessed, not assumed
Snoring, unrefreshing sleep, early waking and daytime sleepiness point towards sleep disordered breathing, which is common and frequently undiagnosed. Where indicated, we arrange appropriate sleep investigation.
Stress physiology and recovery
Sustained demand without recovery affects sleep, appetite, mood, hormones and blood sugar. We assess the whole pattern, including cortisol rhythm where clinically appropriate, and build a realistic recovery plan.
What happens after the results
We explain what each finding means, treat the contributors we can treat, and follow up to confirm improvement. Where a condition sits with another specialty, we refer appropriately.
Common questions
Answers before you book.
When should tiredness be investigated?
When it lasts more than a few weeks, is not explained by an obvious short term cause, or comes with weight change, hair loss, low mood, breathlessness, snoring or reduced libido. Unexplained weight loss, fever, night sweats, bleeding or a new lump should be assessed promptly.
My doctor said my bloods were normal. What now?
Normal often means within a wide reference range on a limited panel. Appropriate additional testing, correct timing and interpretation against your symptoms can identify contributors that were not assessed, although it may also confirm that no measurable abnormality is present.
Could this be hormonal?
It can be. Thyroid disease, perimenopause, menopause and low testosterone can all contribute to fatigue and can be tested for, but fatigue is frequently multifactorial and hormones are only one possible contributor.
This page is general health information and is not medical advice. Investigation and treatment follow individual clinical assessment.
Ready to start properly?
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Centre of Advanced Medicine, 13 Scott St, Waverley, Johannesburg
Monday to Friday, 07:40 to 17:00
011 440 8721