Why You're Still Tired — And Why Your Doctor Can't Figure It Out

You're not depressed. You're sick.

Your doctor ran a CBC and a TSH. Everything came back "normal." They suggested you might be depressed. Maybe stressed. Offered an SSRI. Told you to sleep more.

If you're searching for a chronic fatigue doctor near you who treats this as the medical problem it is, that's exactly what I do. You're already sleeping eight hours a night. You're eating well. You're not sad. You're exhausted. There's a difference.

You feel like you're running on 40% battery all the time. Brain fog so thick you forget what you walked into the kitchen for. Can't recover from exercise the way you used to. Some days, getting through a full workday feels like climbing a mountain.

And every doctor you've seen has told you the same thing: your labs are fine. Nothing's wrong. Maybe it's just life in your thirties.

Here's the thing: chronic fatigue is not a mystery. It's one of the most solvable problems I deal with. You just have to actually look for the cause instead of managing the symptom.

The Problem With "Normal" Labs

The typical pattern: you go to your doctor, you say "I'm exhausted all the time," and they run a basic panel. CBC, metabolic panel, maybe a TSH. Everything comes back in range. Doctor says you're fine. Maybe it's stress. Maybe you need more exercise. Here's a referral to a therapist.

The problem? Those labs are not even close to adequate for figuring out why someone is chronically fatigued. They're screening tools. They're designed to catch catastrophic disease, not functional dysfunction. And there is a massive gap between "you don't have a disease" and "you're actually healthy."

A TSH that's technically "normal" might not be optimal for you. And if all we checked was TSH, we're missing the whole picture. I need free T3, free T4, reverse T3, and thyroid antibodies before I'm willing to say your thyroid is fine.

Does that make sense? Your doctor isn't wrong that the TSH is "in range." They're wrong that it doesn't matter.

Where I Actually Start

When a patient comes to me with chronic fatigue, I have a system. I'm not guessing. I'm working through a clinical framework, and we start at the foundation — the things that are most commonly broken and most likely to explain why you feel like garbage.

​First: thyroid. Full panel, not just TSH. I just explained why. If your body isn't producing enough active thyroid hormone — or worse, if it's converting your T4 into reverse T3 instead of free T3 — your metabolism is literally being downregulated. So what's happening is your body is pumping the brakes on energy production at the cellular level. You're going to be tired. Period, end of story.

​Second: metabolic health. I want fasting insulin with fasting glucose so I can calculate insulin resistance. Here's why this matters for fatigue: when your cells are resistant to insulin, they're not efficiently taking up glucose for energy. You've got fuel in the bloodstream, but your cells can't use it properly. That's like having a full gas tank and a clogged fuel line. You're going to feel it.

I see a lot of patients — especially women in their thirties and forties — where the fatigue, the brain fog, the afternoon crashes, the inability to lose weight… it's all insulin resistance. And nobody has ever checked their insulin. Ever. Because the standard approach is to check fasting glucose, see that it's in range, and call it normal. Meanwhile their insulin is elevated and their cells are screaming.

​Third: chronic viral reactivation. This is where it gets interesting, and this is a big one in my practice.

The Virus That Never Left

A huge number of the chronically fatigued patients I see in Central Texas have something going on with Epstein-Barr virus — EBV. Most people have been exposed to EBV at some point. It's the virus that causes mono. And for most people, the immune system handles it and life goes on.

But here's what happens in some patients. The virus doesn't fully go away. It goes dormant — it hides. And then something comes along and reactivates it. Could be a major stress event, a surgery, another infection, sometimes a vaccine reaction. And now you've got this chronic, low-grade viral reactivation that your immune system is constantly fighting. You're not sick enough to be in bed, but you're never not fighting something. That's exhausting. Literally.

I check comprehensive viral panels on almost every chronically fatigued patient. I'm looking at patterns that tell me whether this is old exposure or active reactivation. And when we find it — which we do, a lot — that changes the whole treatment approach.

In my clinic, when I identify chronic viral reactivation, I use targeted antiviral and immune-modulating protocols that have solid research backing. The specific treatment depends entirely on what we're seeing in labs and how the patient responds. For patients dealing with chronic fatigue from viral reactivation, these interventions can be a game-changer.

The same approach applies to a lot of my long COVID patients and people dealing with post-vaccine fatigue. The mechanism is similar — persistent immune activation, chronic inflammation, and in many cases, viral reactivation layered on top.

The Stress Response Nobody Checks

Fourth on my list: the HPA axis — which is your body's central stress management system. Hypothalamic-pituitary-adrenal axis, if you want the full name. Basically, it controls your cortisol.

The pattern I see constantly: someone's been running on stress and caffeine for years. Their body has been pumping out cortisol nonstop. And at some point, the system just… gives out. Cortisol production drops. And now instead of being wired, they're wired AND tired. Or just flat-out exhausted.

This doesn't show up on standard labs. You have to look for it specifically — cortisol patterns, specialized testing to see what's happening throughout the day. A single morning cortisol from a blood draw is almost useless for this.

And this is where I bring up what I call the pillars of health — sleep, diet, movement, environment, community, mental health. All of these feed into your HPA axis. If you're sleeping five hours, eating garbage, never seeing sunlight, and your marriage is falling apart — your cortisol is going to reflect that. Those aren't soft questions. They're metabolic questions.

But — and this is important — some patients are so depleted by the time they get to me that telling them to "fix their sleep hygiene" is almost insulting. They can barely get through the day. So sometimes we have to jump above the pillars. We intervene medically first — address the thyroid, address the insulin resistance, address the viral reactivation — and get them functional enough that they can actually make lifestyle changes. You have to meet people where they are.

Going Deeper

If we've addressed the foundation and someone's still not where they need to be, we keep digging.

​Gut health and inflammation. Your gut is directly connected to your immune system, your energy production, and your neurotransmitter balance. If you've got dysbiosis, leaky gut, chronic low-grade inflammation from food sensitivities — that's a constant energy drain. I see patients whose fatigue is being driven almost entirely by gut dysfunction, and once we clean that up, the energy comes back.

​Environmental toxins and mold. This one is huge and wildly underdiagnosed. Mold exposure in particular can cause a chronic inflammatory response that absolutely destroys energy levels. If a patient has been fatigued for years and we've ruled out the usual suspects, environmental exposures are high on my list. It's not rare. It's just rarely looked for.

Why Your Doctor Can't Figure It Out

I don't say this to bash other doctors. Most of them are doing what they were trained to do. But the training has gaps. Medical school teaches you to diagnose disease. It doesn't teach you to optimize function. And when your labs don't show a disease, you get told you're fine — even when you clearly aren't.

The difference in my practice is that I'm not looking for a diagnosis to check a box. I'm looking at the whole system — metabolic health, thyroid function, immune status, stress response, gut health, environmental exposures — and I'm filtering all of that through your actual symptoms. We take your labs, we take your symptoms, and we filter everything through each other. That's how you actually figure this stuff out.

Chronic fatigue is one of the most fixable problems I deal with. Not because there's one magic answer, but because there's almost always an answer if you're willing to look hard enough. The patients who come to me exhausted and leave feeling like themselves again — that's why I do this.

If This Sounds Like You

If you've been tired for months, if you've been told your labs are normal, if you've been handed an antidepressant when what you needed was someone to actually investigate — that's exactly what we do at Rooted Health Clinic. We dig until we find the answer.

Give us a call at 254-780-0023 or visit rootedhealthclinic.com to schedule a consultation.

Rooted Health Clinic — 1401 N Stagecoach Rd, Salado, TX 76571