---
title: "Fatigue & Low Energy"
---
## When You're Tired in a Way That Doesn't Resolve
Most people experience occasional tiredness. Persistent fatigue is something different: the kind that does not improve with a weekend off, that makes basic tasks feel harder than they should, where coffee does not really help anymore but just temporarily masks how exhausted you actually feel.
Most patients we see for fatigue have been managing this for months or years, often having been told it is stress, age, or just how things are now. Sometimes that is accurate; often there is something more identifiable contributing. What we offer is the supportive optimization side of fatigue care, and we are honest that the most important first step is identifying what is actually contributing. For many patients, comprehensive primary care evaluation reveals specific factors, such as thyroid dysfunction, vitamin deficiencies, sleep apnea, or hormonal changes, that can be directly addressed. Our offerings work best alongside that evaluation rather than as a substitute for it.
## Fatigue Has Many Causes
Persistent fatigue is a symptom, not a diagnosis. Causes that often have specific treatments include anemia, thyroid dysfunction, sleep apnea (often undiagnosed and a major contributor), vitamin D deficiency, hormonal imbalances, depression and anxiety, diabetes and prediabetes, chronic infections, autoimmune conditions, medication effects, and post-viral syndromes including long COVID.
Lifestyle and environmental factors include chronic insufficient sleep (the most common modifiable contributor), poor sleep quality, chronic stress, inadequate nutrition, a sedentary lifestyle, and alcohol or substance use. Some conditions, such as ME/CFS and fibromyalgia, have specific clinical considerations. The first step is identifying which categories may be contributing. For patients without prior workup, primary care evaluation typically comes first.
## How PHI Approaches Fatigue and Low Energy
The first step is comprehensive evaluation: a detailed history of your fatigue and how it has progressed, discussion of potential contributors, review of any prior workup, and an honest assessment of whether wellness optimization fits your situation or whether primary care evaluation should come first.
IV therapy delivers nutrients directly into circulation, particularly useful for patients with documented vitamin or nutrient deficits; IV B-complex, B12, and other formulations may produce meaningful improvement when deficits contribute to fatigue. NAD+ therapy delivers a coenzyme involved in cellular energy production that declines with age, with evidence for fatigue we describe as emerging rather than established. Peptide therapy uses specific compounds that may support energy, mitochondrial function, and sleep, discussed individually without listing specific peptides publicly. These are delivered in our clinic setting, and we coordinate with your primary care physician for evaluation and management of underlying contributors.
## When This Page Applies to You
You may benefit from PHI's offerings if you have had primary care evaluation that identified specific contributors being managed but you still have residual fatigue, if your fatigue appears related to high stress or post-illness recovery, if you are in perimenopause, menopause, or andropause with appropriate hormone evaluation underway, or if you want supportive optimization alongside addressing underlying factors.
You are typically better served elsewhere first if you have not had primary care evaluation for persistent fatigue, if you have significant new or progressive fatigue without identified cause, or if you are hoping wellness intervention will substitute for evaluating treatable medical causes.
## Why PHI for Fatigue Optimization
## Frequently Asked Questions
**Q: Should I get a workup before pursuing wellness treatments for fatigue?**
For most patients with persistent fatigue, yes. Primary care evaluation typically includes basic blood work (CBC, comprehensive metabolic panel, thyroid function, B12, vitamin D, ferritin) and discussion of sleep, mood, and lifestyle. Many fatigue cases have specific identifiable causes that respond well to direct treatment. Wellness optimization works better as an addition to addressing underlying factors than as a substitute.
**Q: Will IV therapy fix my fatigue?**
For patients with documented vitamin or nutrient deficits, IV nutrient therapy can produce meaningful improvement. For patients without specific deficits, it may provide more variable benefit. We evaluate whether IV therapy fits your situation rather than offering it as a universal energy boost.
**Q: How effective is NAD+ for energy?**
The mechanistic rationale is sound, since NAD+ is involved in cellular energy production and declines with age. Some patients report meaningful improvement; others experience more limited benefit. We are honest that the clinical evidence is emerging rather than established.
**Q: Could my fatigue be from sleep apnea?**
Possibly. Sleep apnea is one of the most common and under-diagnosed causes of fatigue. If you have loud snoring, witnessed pauses in breathing, morning headaches, or fatigue that does not improve with adequate sleep, sleep apnea evaluation is worth pursuing, and treating it typically resolves fatigue more effectively than wellness interventions can.
**Q: What about long COVID fatigue?**
Post-viral fatigue including long COVID is real and increasingly recognized. Some patients experience improvement with supportive interventions. Long COVID care typically involves coordination with primary care or specialty providers, and PHI's offerings may complement that broader care for selected patients.
**Q: Could my fatigue be related to perimenopause or menopause?**
Yes, often. Hormonal changes commonly include fatigue as a prominent symptom. Hormonal evaluation through your primary care or gynecologist is typically the right first step, and PHI's offerings may complement hormonal management once that is underway.
**Q: What if I have ME/CFS or chronic fatigue syndrome?**
ME/CFS has specific clinical features including post-exertional malaise. Care typically involves specialty providers familiar with the condition. PHI's offerings may complement specialty care for selected patients but are not substitutes for ME/CFS-specific evaluation and management.
**Q: Do you take insurance?**
Insurance coverage and payment options may vary. Please contact our office to discuss your specific plan, available options, and pricing. All pricing is disclosed at consultation.
**Q: Do you accept international patients?**
Yes. PHI regularly treats patients from outside Los Angeles, including Las Vegas, Palm Springs, London, and other international locations.
## Treatments We Offer for Fatigue and Low Energy
PHI offers supportive optimization treatments for fatigue and energy. Your physician will recommend the right options based on your specific situation, prior workup, and suspected contributors.
- IV Therapy, most useful when a nutrient deficit is contributing
- NAD+ Therapy
- Peptide Therapy
> NAD+ metabolism and the control of energy homeostasis. Cell Metabolism.
— [Cantó C, et al.](https://pubmed.ncbi.nlm.nih.gov/26118927/)
> Myalgic encephalomyelitis/chronic fatigue syndrome. Centers for Disease Control and Prevention.
— [Centers for Disease Control and Prevention](https://www.cdc.gov/me-cfs/index.html)
> Anemia of inflammation and chronic disease. NIH National Institute of Diabetes and Digestive and Kidney Diseases.
— [NIH National Institute of Diabetes and Digestive and Kidney Diseases](https://www.niddk.nih.gov/health-information/blood-diseases/anemia-inflammation-chronic-disease)
## Schedule Your Fatigue Consultation
A 60-minute consultation will evaluate your specific fatigue, walk through whether wellness optimization fits your situation or whether primary care evaluation should come first, and recommend treatments that match your situation. Call (310) 856-9488 or book online now.
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