"Signs of Hormonal Imbalance: Fatigue and Reduced Energy Levels"

If you constantly feel like it’s a drag to get through an entire waking day or totally wiped out even if you’ve been sleeping well, you know the struggle. Fatigue is not uncommon. In fact, Americans report feeling sleepy on an average of three days a week, with many noting that it negatively affects their day-to-day life, according to research by the National Sleep Foundation. What’s even more intriguing: Women are the group that report feeling the most sleepy—3.4 days a week on average compared to men who report feeling sleepy 2.7 days a week.

Why are women more tired than men? That’s a loaded question, but we can start to address it by looking at one of the key differences between men and women: hormones, or chemical messengers that help one part of our body communicate with another. 

Several hormones play vital roles in maintaining energy levels and preventing fatigue: thyroid, cortisol, and gonadal hormones (estrogen and testosterone). These hormones are integral to the body’s energy regulation system, and disruptions in their balance can lead to chronic fatigue and other health issues, explains Caroline Messer, M.D., an endocrinologist at Fifth Avenue Endocrinology and Founder of Well by Messer.

Tiny but mighty hormones your thyroid gland produces—triiodothyronine (T3) and thyroxine (T4)—act like conductors in your metabolic orchestra, regulating how efficiently your body converts food into usable energy. When your thyroid is functioning optimally, you experience consistent energy throughout the day, explains Dr. Messer. However, an imbalance in these hormones can throw the whole system off-kilter, leading to significant energy issues. “For instance, hypothyroidism, characterized by low levels of T3 and T4, often results in fatigue and sluggishness, while hyperthyroidism also causes tiredness because the body is essentially in overdrive, which can eventually lead to exhaustion,” she says.

Cortisol, often referred to as the stress hormone, is produced by the adrenal glands and plays a pivotal role in the body’s stress response, giving you that extra energy to deal with demanding situations. Here's where things get interesting: cortisol has a sweet spot. “When it's working optimally, [cortisol] ensures you have enough energy (glucose) in your bloodstream to conquer daily tasks and manage stress effectively,” says Dr. Messer. “But, like a sugar rush that crashes later, chronically high cortisol levels can backfire, leaving you feeling drained and fatigued.” On the other hand, insufficient cortisol can lead to a condition called adrenal insufficiency, resulting in constant tiredness.

Insulin, produced by the pancreas, controls blood glucose levels by facilitating glucose uptake into cells for energy production, explains Sunjya Schweig, M.D., integrative family physician and Founder of California Center for Functional Medicine. “When blood glucose levels rise, insulin is released to help cells absorb glucose, reducing blood sugar levels and providing energy,” he says. “Insulin dysregulation, such as in diabetes, can lead to significant energy imbalances and fatigue.”

Estrogen plays a crucial role in women's health in regulating the menstrual cycle, maintaining bone density and promoting cardiovascular well-being, explains Dr. Messer. “During menopause, when estrogen levels drop, many women experience fatigue and a decrease in energy,” she says. Estrogen is also a precursor to neurotransmitters like serotonin, which can influence our mood and motivation. In other words, higher serotonin levels might give us an energy boost, and lower levels may do the opposite. 

While often associated with men, testosterone is also crucial for women, supporting muscle mass, bone density, and overall vitality, notes Dr. Messer. Like in men, testosterone in women may contribute to increased energy levels by helping to regulate metabolic rate, which can influence energy production. Dr. Messer notes that it also helps maintain muscle mass, which can contribute to a higher basal metabolic rate and potentially more energy throughout the day. 

Several hormones play a key role in whether or not we feel unnecessarily fatigued. Here’s how imbalances in their levels can leave you feeling drained and unmotivated.  

According to Dr. Messer, endocrine or hormonal disorders often present with nonspecific symptoms, including fatigue. It’s important to think about your sleep, activity, and nutrition habits, as they can influence your levels of fatigue. When fatigue is persistent or unexplained, it's critical to consider the possibility of an endocrine disorder. “In patients with known endocrine conditions, the onset of fatigue may signal the development of a related disorder or complication, so it’s important to seek medical advice from an endocrinologist if you find yourself in this position,” she says.