Rule out the basics — with data

Persistent fatigue has a shortlist of common, measurable causes: thyroid imbalance, iron deficiency, B12 deficiency, blood sugar dysregulation, low testosterone in men, and perimenopausal hormone shifts in women. Sleep apnea deserves consideration for anyone who snores or wakes unrefreshed. A comprehensive lab panel screens most of this in one draw — which is why “tired all the time” should start with data, not guesswork.

The cellular layer

Beneath the lab-visible causes sits cellular energy production itself. NAD+ — the coenzyme your mitochondria use to make energy — declines substantially with age. B-vitamin status, oxidative stress, and declining growth hormone output all feed the same felt experience: less capacity, slower recovery, flatter days.

Treatments such as NAD+ and sermorelin are sometimes used here, but whether they improve energy in people has not been established in well-controlled trials. A provider can tell you what is known, and what isn’t, for your situation.

A sensible order of operations

  • Baseline labs to catch thyroid, iron, B12, metabolic, and hormonal causes
  • Fix what the labs reveal — sometimes that alone resolves it
  • Consider treatments such as NAD+ where a provider finds them appropriate
  • Re-test quarterly so progress is measured, not guessed

A licensed provider reviews your assessment, helps decide whether labs come first, and builds the protocol around what your results actually show.

Protocols

Energy is biology.

NAD+ and peptide protocols, reviewed by a licensed provider. Explore the protocol →