Why Am I So Tired? Fatigue and the Transgender Body

I’ve always been someone who pushed limits. Before I transitioned, I spent over a decade as a competitive bodybuilder. I knew what it felt like to be tired—the good kind of tired. The kind that came after lifting heavy, eating clean, and chasing PRs. But something shifted when I began HRT.

Two years into my transition, and I still sometimes wake up wondering why I feel so drained. I’m not talking about sleepy or lazy—I mean the kind of fatigue that sinks into your bones. The kind that doesn’t care if you got 8 hours or if you drank your greens. And I know I’m not alone.

If you’re transgender and feeling exhausted all the time, especially since starting hormone therapy, this article is for you. Let’s walk through it together—from what might be going on inside your body to how you can begin to reclaim your energy, day by day.

Redefining Fatigue: It’s Not Just Being Tired

We all get tired. But fatigue is something deeper. It’s the persistent, nagging kind of exhaustion that doesn’t disappear with rest. It’s sleeping in and still dragging through your day. It’s brain fog that dulls your sparkle and muscles that feel like lead.

Fatigue is a common yet often misunderstood part of transition. And because so many providers are still learning what it means to offer competent trans healthcare, we’re left to do a lot of the heavy lifting ourselves.

What is Chronic Fatigue Syndrome, and How is it Diagnosed?

Chronic Fatigue Syndrome (CFS), also known as myalgic encephalomyelitis (ME), manifests as extreme tiredness that persists for six months or more. Unlike ordinary tiredness, this fatigue isn’t relieved by rest and often worsens with physical or mental exertion.

Recognizing the Symptoms

• Persistent Fatigue: Lasts six months or longer.
• Post-Exertional Malaise: Symptoms exacerbate following physical or mental activity.
• Unrefreshing Sleep: Resting does not alleviate the fatigue.

The Diagnostic Process

Chronic fatigue syndrome is primarily identified by eliminating other possible conditions, making it a “diagnosis of exclusion.” Here’s how healthcare providers tackle it:

• Medical History and Physical Examination: Your doctor will begin with a thorough review of your medical history and conduct a physical examination to observe any evident symptoms or signs.
• Exclusion of Other Conditions: Since there’s no definitive test for CFS, medical professionals usually order blood and urine tests. These aim to rule out other illnesses with similar symptoms, such as thyroid disorders, sleep disorders, or anemia.
• Symptom Evaluation: Doctors will evaluate the symptoms you’ve been experiencing and how they impact your daily life. This helps in crafting a personalized care plan.

Having a clear understanding of what persistent fatigue can signify, and knowing the steps towards a diagnosis, can guide you toward seeking the right medical advice.

Why Hormones Might Be Draining You

HRT is powerful, life-saving, and beautiful—but it is also hard on the body in ways that often go unspoken. Whether you’re taking estrogen or testosterone, your body is undergoing profound changes.

When I began estrogen therapy, the shift was profound. My metabolism slowed. I lost muscle mass. My emotional bandwidth changed. Suddenly, I needed more rest—but my brain didn’t always let me take it.

For trans women and transfeminine folks, lowering testosterone can lead to slower recovery and less stamina, while estrogen—lovely as it is—can increase emotional sensitivity and sleep needs. For trans men, testosterone can give an initial boost in energy and libido, but that high isn’t always sustainable. Some folks crash, especially if their doses aren’t balanced.

Hormones don’t just affect your body—they affect how you sleep, how you process food, how you think, and how your nervous system regulates stress. It’s a whole symphony, and it takes time to tune every instrument.

The Emotional Toll We Don’t Always Talk About

Being transgender in this world is powerful—but it can also be exhausting. Living in a society that questions your existence, your identity, and your right to basic care—it adds up. Emotional stress doesn’t just stay in your head. It floods your body with cortisol, disrupts your sleep, and drains your energy reserves.

Even on good days, there’s emotional labor: explaining yourself, navigating paperwork, correcting pronouns, and absorbing microaggressions. And if you’ve been rejected by family, partners, or jobs along the way? That kind of hurt sinks deep.

Mental health and chronic fatigue go hand in hand. Depression, anxiety, and trauma—they’re heavy backpacks many of us carry. And it’s okay to acknowledge that.

These emotional burdens can be just as draining as physical ones. When feelings of sadness, hopelessness, nervousness, or panic linger, they can sap your energy and contribute to chronic exhaustion. Recognizing these signs is crucial.

It’s important to understand that you don’t have to navigate this alone. Speak with a healthcare provider to explore the resources available to support your mental health. Acknowledging the load you carry is the first step towards lightening it.

What You Eat Matters—Even More Than Before

Let’s talk nutrition. Because if your body is working overtime to adjust to hormones, you need to feed it like you mean it. This was a tough lesson for me to relearn post-bodybuilding. I knew macros and calories—but I had to relearn how to eat for this new body of mine.

Low iron. Vitamin D deficiency. B12 running on empty. These things sneak up on you and masquerade as just “being tired.” But they can derail everything from your focus to your mood to your immune system.

And then there’s food insecurity. Many of us face it, especially during medical transition when work hours might be cut or healthcare costs skyrocket. Disordered eating is also common in the trans community—some of it rooted in dysphoria, some in trauma.

If you’re feeling wiped out, your food (or lack of it) could be playing a bigger role than you think.

Sleep: The Most Underrated Medicine

While there’s no one-size-fits-all fix, many transgender individuals (myself included) have found relief using a mix of carefully chosen tools and over-the-counter support. If you’re looking for a few well-reviewed, top-selling options on Amazon, here are some to consider:

• Nature Made Vitamin D3 5000 IU – Especially helpful if your lab results show low D. A lack of vitamin D is one of the most common contributors to chronic tiredness.
• Garden of Life Vitamin B Complex – High in B12 and designed for energy metabolism, this plant-based blend supports nervous system health and mental clarity.
• Magnesium Glycinate by Nested Naturals – Gentle on the stomach and excellent for muscle relaxation, deep sleep, and reducing stress.
• Iron Supplement with Vitamin C by MegaFood – Ideal if you’re low on iron, especially for trans women who may be prone to anemia after starting estrogen.
• Liquid I.V. Hydration Multiplier – A great electrolyte booster for those days when plain water just doesn’t cut it.

These are not medical recommendations—always check with a healthcare provider before starting any new supplement, especially if you’re already on prescription medication. But if you’re like me, having a few trusted tools on hand can be a real energy-saver.

I used to treat sleep like a luxury. Post-transition, I’ve learned it’s a necessity. Hormones affect your circadian rhythm—estrogen can make you sleepier but reduce deep sleep; testosterone can lead to restlessness or even sleep apnea.

And then there’s the mental side: racing thoughts, nightmares, and insomnia from gender-related anxiety. We need better sleep—and we need to fight for it like we fight for everything else.

But how exactly does poor sleep quality contribute to chronic fatigue? It’s simple yet profound: sleep isn’t just restorative; it’s essential. In our fast-paced “rise and grind” culture, we often overlook that getting between 6-9 hours of quality sleep isn’t a luxury but a biological requirement.

When we skimp on sleep, the repercussions are clear: our bodies fail to rejuvenate, leading to persistent tiredness that compounds into chronic fatigue. Without those essential hours of rest and deep sleep cycles, we risk falling into a cycle of exhaustion that affects every aspect of our lives.

So, while balancing hormones and managing anxiety are crucial, ensuring we prioritize and protect our sleep is fundamental. Let’s redefine sleep as the non-negotiable foundation of our well-being.

Start small:

• Shut down screens an hour before bed.
• Create a calming wind-down ritual (meditation, lavender tea, or writing).
• Keep a consistent sleep schedule if possible.

It’s not always easy. But a rested trans body is a revolutionary one.

Understanding Obstructive Sleep Apnea and Its Link to Fatigue

Obstructive Sleep Apnea (OSA) is a condition where breathing temporarily stops during sleep, often due to an obstruction in the airway. This disruption can cause frequent awakenings throughout the night, preventing deep and restorative sleep.

How It Affects You

• Intermittent Breathing: OSA results in reduced or halted airflow, which means your brain and body may not get enough oxygen.
• Sleep Interruptions: The constant start-and-stop breathing can cause you to wake up multiple times, often without even realizing it.

Connection to Fatigue

• Reduced Sleep Quality: Without the deep sleep stages, you experience less recuperation, leading to persistent tiredness.
• Daytime Drowsiness: The lack of sufficient restful sleep can make you feel sleepy and lethargic during the day.
• Impact on Daily Life: Such fatigue can affect concentration, increase irritability, and reduce overall productivity.

OSA can also exacerbate other health conditions like hypertension and diabetes, which might indirectly contribute to fatigue. With interventions like CPAP therapy or lifestyle changes, many find relief and improved energy levels.

Sometimes It’s Not “Just HRT”

This is important. Fatigue can be a warning sign. While hormones explain a lot, don’t let a dismissive provider tell you “it’s just transition.” Get checked out.

Ask about:

• Full thyroid panel
• CBC (complete blood count)
• Iron, ferritin, B12, Vitamin D
• Blood sugar and insulin sensitivity
• Hormone levels (including estradiol or testosterone)

Push for answers. You deserve providers who see you, not just a checklist.

Fatigue Isn’t Laziness: It’s a Signal

One thing I’ve had to unlearn from my bodybuilding days is that rest isn’t failure. Fatigue isn’t weakness. It’s a message from your body that it needs support, not shame.

So here’s what I tell myself now:

• You are not broken.
• You are not alone.
• And you don’t have to push through this without help.

Sometimes that help looks like supplements or better sleep. Sometimes it looks like therapy. Sometimes it looks like saying no to that thing you should do and saying yes to your own damn peace.

Gentle movement helps. Stretch. Breathe. Go for a walk without a goal. Move your body because it’s yours, not because you have to prove anything with it.

And track how you feel—write it down. Your patterns are your power. Knowing what drains you (and what refills you) gives you back control.

The Bottom Line

I still get tired. Some days, it frustrates me. But I also see how far I’ve come. Transition gave me my life back, but it also gave me a deeper relationship with my body than I ever had as a bodybuilder.

Now I move slower—but I move with intention. I rest more—but I rest with grace. And when I do feel energized, it feels earned.

So if you’re reading this and dragging through another morning, please know you are not lazy. You are not weak. You are navigating a transformation most people can’t imagine.

Your fatigue is valid. But it doesn’t have to define you. Give yourself permission to rest. To ask questions. To advocate for your health like it matters—because it does.

Stay soft. Stay strong. And know that tired doesn’t mean defeated.

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