Always feeling tired and sleepy

12 Reasons You’re Always Tired (and What to Do About It)

If you’re feeling overly tired or have little energy, you’re not alone.

Fatigue may be caused by simple factors like a lack of sleep or coming down with a cold or the flu. However, it can also be caused by underlying health conditions.

Even though everyone feels tired from time to time, chronic fatigue can harm your quality of life and prevent you from doing things you enjoy.

In most cases, fatigue can be remedied by lifestyle or dietary modifications, correcting a nutrient deficiency, or treating an underlying medical condition. Still, to improve fatigue, you need to get to the bottom of what’s causing it.

Here are 12 potential reasons why you’re always tired.

Getting enough sleep is essential for overall health. Unfortunately, many of us don’t get enough, which may lead to fatigue.

During sleep, your body performs a number of critical processes, including releasing important growth hormones and repairing and regenerating cells. This is why most people wake up feeling refreshed, alert, and energized after a night of high quality sleep (1, 2, 3).

Importantly, sleep should be restful and uninterrupted to allow your brain to go through three stages of non-rapid eye movement (NREM) sleep and one stage of rapid eye movement (REM) sleep — the stage in which you dream (1).

Even though sleep time should be individualized, the American Academy of Sleep Medicine and Sleep Research Society recommends that adults get at least 7 hours of sleep per night for optimal health (2, 3).

Even though you may know the importance of getting enough sleep, falling and staying asleep can be a struggle.

Insomnia is a term for any condition that causes difficulty falling or staying asleep. It can be caused by several factors, including menopause, medical conditions, psychological stress, poor sleeping environments, and excessive mental stimulation (1, 4).

Insomnia is very common. In fact, one review noted that up to 40% of adults in the United States experience insomnia at some point in a given year (5).

Short-term insomnia, which lasts less than 3 months, is more common and affects 9.5% of the U.S. population. Yet, 1 in 5 cases of short-term insomnia turns into chronic insomnia, which occurs 3 or more times per week and lasts longer than 3 months (5).

If you’re experiencing insomnia, treatments like natural supplements, medications, and the management of underlying medical conditions may help. Visit your doctor to get the appropriate care and treatment.

Summary
Inadequate or poor quality sleep is a common cause of fatigue. Stress, medical conditions, and poor sleeping environments may negatively affect sleep and trigger insomnia. If you’re experiencing insomnia, consult your doctor for advice.

Nutrient deficiencies may lead you to feel exhausted on a daily basis, even if you’re getting more than 7 hours of sleep.

Deficiencies in the following nutrients have been linked to fatigue (6, 7):

iron
riboflavin (vitamin B2)
niacin (vitamin B3)
pantothenic acid (vitamin B5)
pyridoxine (vitamin B6)
folate (vitamin B9)
vitamin B12
vitamin D
vitamin C
magnesium

Deficiencies in many of these nutrients are quite common.

Anemia affects 25% of the world’s population. Iron deficiency anemia is the most common type, responsible for 50% of all anemia. Fatigue is one of the most common symptoms of this condition, but it typically improves once iron stores are restored (8).

Furthermore, studies suggest that up to 20% of people in the United States and United Kingdom ages 60 and over are deficient in vitamin B12. This deficiency is especially common in older adults because the body’s ability to absorb B12 declines with age (9).

B12 is critical for oxygen delivery and energy production, so low levels can cause extreme fatigue.

Additionally, a vitamin D deficiency may cause fatigue. Over half of the world’s population has inadequate vitamin D levels (10).

Because these deficiencies are quite common, it’s important to have your levels tested if you’re experiencing unexplained fatigue.

Typically, fatigue related to a deficiency in one or more nutrients improves once your nutrient levels normalize.

Summary
Deficiencies in certain nutrients — such as iron and vitamins B12 and D — may cause fatigue. Your doctor can test for nutrient deficiencies and suggest appropriate treatment.

Although some stress is normal, chronic stress is linked to fatigue (11, 12, 13).

In fact, chronic stress may lead to stress-related exhaustion disorder (ED), a medical condition characterized by psychological and physical symptoms of exhaustion (14).

Furthermore, chronic stress may cause structural and functional changes in your brain and lead to chronic inflammation, which may contribute to symptoms like fatigue (14, 15).

While you may be unable to avoid stressful situations, especially those related to work or family obligations, managing your stress may help prevent complete exhaustion.

For example, you can set aside time to decompress by taking a bath, meditating, or going for a walk (16).

A therapist may also help you develop strategies to reduce stress. Many health insurance plans cover mental health counseling, and virtual therapy is also an option.

Summary
Excessive stress may cause fatigue and reduce your quality of life. Prioritizing time for yourself and going to therapy may help you manage stress.

If you’re experiencing unexplained, chronic fatigue, you should visit your doctor and discuss your symptoms.

They may recommend testing to rule out certain health conditions that cause fatigue, such as sleep apnea, hypothyroidism, cancer, chronic fatigue syndrome, multiple sclerosis, anxiety disorders, kidney disease, depression, diabetes, and fibromyalgia (17, 18, 19).

It’s important to know that it’s abnormal to feel exhausted all the time. If you experience frequent fatigue, there’s likely one or more causes.

Getting proper treatment for an underlying medical condition can help you feel better and improve other areas of health as well.

Summary
Numerous medical conditions are linked to fatigue. If you’re chronically tired, it’s important to visit your healthcare professional to undergo appropriate testing.

Your diet significantly affects the way you feel.

To maintain energy and get the nutrients your body needs to perform critical processes, it’s important to consume a balanced diet high in nutrient-dense foods.

Undereating — or eating ultra-processed foods low in essential nutrients — may lead to calorie and nutrient deficiencies, which can cause exhaustion.

When you don’t obtain enough calories and nutrients like protein, your body starts breaking down fat and muscle to meet energy demands. This leads to a loss of body fat and muscle mass, which may trigger fatigue (20).

Older adults are especially at risk of malnutrition and nutrient deficiencies due to factors like age-related changes in appetite and reductions in physical activity (20).

Additionally, diets high in ultra-processed foods impair energy levels. For example, a diet high in added sugar may harm sleep and lead to chronically high blood sugar and insulin levels, which can result in fatigue (20).

In a 28-day study in 82 people, a diet high in refined sugars and highly processed grains resulted in 38% and 26% higher scores for depressive symptoms and fatigue, respectively, than a low glycemic load diet high in whole grains and legumes but low in added sugar (21).

What’s more, a review including over 53,000 postmenopausal women associated diets high in added sugars and refined grains with a greater risk of insomnia — and diets high in fruits, vegetables, and whole grains with a lower risk of insomnia (22).

Following a diet low in ultra-processed food and added sugar but rich in nutrient-dense foods like fruits, veggies, legumes, and protein sources like fish and eggs may help reduce fatigue and support healthy sleep while providing your body with optimal nutrition.

Summary
A diet high in ultra-processed foods may hamper your energy levels, so transitioning to a nutrient-dense diet loaded with whole, nourishing foods like fruits, vegetables, and legumes may reduce fatigue.

Although caffeinated beverages like coffee and energy drinks give you a temporary boost of energy, over-reliance on them may make you more tired the next day. That’s because too much caffeine can harm sleep, which may cause fatigue.

Research shows that feeling tired in the morning leads people to consume large amounts of caffeine, which impairs your sleep cycle. In turn, you may overuse coffee or other caffeinated drinks for energy, which continues the cycle of poor sleep followed by too much caffeine (23).

Drinking too much caffeine is linked to increased nighttime worrying, sleeplessness, increased nighttime awakenings, decreased total sleep time, and daytime sleepiness (24).

A study in 462 women linked high calorie coffee and energy drink intake to poor sleep quality and sleep disturbance. Those who didn’t drink these beverages reported better sleep quality (25).

Still, caffeine tolerance varies, and some people are more sensitive to caffeine’s effects on sleep than others (26).

While coffee and caffeinated beverages like green tea may benefit health when consumed in moderation, energy drinks are extremely high in stimulants and added sugar. Thus, you should avoid them whenever possible (27).

If you’re currently experiencing sleep issues and frequently drink caffeinated beverages, try cutting back to see whether it helps improve your sleep and energy levels.

Summary
Relying too heavily on caffeinated beverages may harm your sleep cycle and lead to fatigue. Therefore, cutting back on caffeine may help restore your sleep and energy levels.

Staying well hydrated is important for maintaining energy levels. The many biochemical reactions that take place in your body every day result in a loss of water that needs to be replaced.

Dehydration occurs when you don’t drink enough liquid to replace the water lost in your urine, stools, sweat, and breath. Several studies show that being dehydrated leads to lower energy levels and a decreased ability to concentrate (28, 29).

In fact, dehydration affects your entire body, including your sleep cycles.

A study in over 26,000 Chinese and American adults associated inadequate hydration with shorter sleep times (30).

Being dehydrated may also make you feel more fatigued during exercise and negatively affect exercise endurance (31).

Although you may have heard that you should drink eight, 8-ounce (240-mL) glasses of water daily, hydration needs depend on several factors, including your weight, age, sex, and activity levels.

The key is drinking enough to maintain good hydration. Common symptoms of dehydration include thirst, fatigue, dizziness, and headaches (28).

Summary
Even mild dehydration may reduce energy levels and alertness. Make sure to drink enough to replace fluids lost during the day.

Maintaining a healthy body weight is essential to overall health.

Not only is obesity significantly linked to a greater risk of many chronic illnesses like type 2 diabetes, heart disease, and certain cancers, but it may also increase your risk of chronic fatigue (32).

Obesity greatly increases your risk of obstructive sleep apnea, which is a common cause of daytime fatigue. It’s also linked to increased daytime sleepiness regardless of sleep apnea, suggesting that obesity directly affects the sleep cycle (33, 34, 35, 36).

What’s more, people with obesity have a higher risk of conditions associated with fatigue, including depression and type 2 diabetes (37, 38, 39).

Plus, poor sleep quality and sleep restriction may cause weight gain or obesity (40).

Maintaining a healthy body weight may support good sleep and energy levels, while getting high quality sleep may help prevent weight gain and reduce fatigue.

Summary
Obesity has been linked to poor sleep quality and conditions associated with fatigue like obstructive sleep apnea.

Many other conditions may lead to tiredness. It’s important to understand that several factors may be contributing to your exhaustion.

Here are a few other common reasons why you may feel tired:

Drug and alcohol dependence. Research shows that people who are dependent on drugs or alcohol are more likely to experience fatigue (41).
Shift work. Shift work causes sleep disruption and may result in fatigue. Sleep experts estimate that 2–5% of all shift workers have a sleep disorder characterized by excessive sleepiness or disrupted sleep over a period of 1 or more months (42, 43).
A sedentary lifestyle. Leading a sedentary lifestyle may lead to tiredness during the day. Studies show that exercising more may improve symptoms of fatigue in some people, including those with medical conditions like multiple sclerosis (MS) (44, 45, 46).
Certain medications. Some drugs, including steroids, blood pressure medications, and antidepressants, are linked to side effects like insomnia and increased tiredness (47, 48).

Help for drug or alcohol dependence

If you need help overcoming your addiction contact the Substance Abuse and Mental Health Services Administration (SAMHSA) National Helpline at 1-800-662-HELP (4357).

It may be difficult or impossible to identify the factor(s) behind your fatigue on your own, which is why it’s important to work with a doctor you trust. They can help you find the cause and suggest possible treatments.

Summary
Medications, drug or alcohol dependence, a sedentary lifestyle, and shift work may all contribute to fatigue.

Even though everyone has days when they feel exhausted, constantly feeling run down and tired isn’t normal.

Many possible factors cause chronic fatigue, such as underlying medical conditions, nutrient deficiencies, sleep disturbances, caffeine intake, and chronic stress.

If you’re experiencing unexplained fatigue, it’s important to talk with your doctor to find the cause.

In many cases, your fatigue should improve once you identify the underlying cause(s) and make appropriate lifestyle and dietary adjustments — or get the right treatment for medical conditions.

For more sleep support, check out our sleep shop.

Just one thing

Try this today: When I started to feel extremely tired during the day, I knew that something was off. I ended up being diagnosed with Hashimoto’s disease after many months of visiting different doctors.

You know your body best and know when something isn’t right. If you’re feeling chronically exhausted even when you get adequate rest, there may be a medical condition contributing to your fatigue.

Work with a doctor you trust to get the right testing to rule out common health conditions that may be contributing to your fatigue.

Read this article in Spanish

Always Tired? Your Thyroid May Be to Blame

The thyroid is a small gland with a big job. Here's what you need to know about it.

Written by Colleen Oakley

In today's you-can-do-it-all culture, it's hard to find a woman who doesn't feel tired. But it might not be a side effect of multitasking.

An estimated 20 million Americans have some kind of thyroid disease, and women are five to eight times more likely than men to have a thyroid problem. Even more surprising? Sixty percent of those with an issue go undiagnosed for years.

"Women especially have such busy lives and often think it's normal to be tired all the time. It's hard for them to know when it's a real problem," says Nancy Simpkins, MD, a board-certified internist.

Here's what you need to know.

Your thyroid is the mastermind of your body. This relatively small hormone-producing gland in the middle of your lower neck has a really big job. "It controls all of your bodily functions by sending messages to every organ in the body," Simpkins says.

"If your thyroid isn't functioning well, it can throw your whole system off."

Hypothyroidism or hyperthyroidism? "The first means your thyroid gland is not producing enough thyroid hormone. Hyperthyroidism happens when your thyroid gland produces too much," says Melanie Goldfarb, MD, an endocrine surgeon. "Hypothyroidism is by far the most common."

Hypothyroidism feels a lot like jet lag. If you're walking around every day feeling like you just got off a transatlantic flight, you probably should get your thyroid checked, Simpkins says.

"Most patients say they just feel sluggish or as if they're walking around in a trance," she says.

Other symptoms include weight gain, chronic constipation, and hair loss.

Thyroid disease is often mistaken for depression. "People with underactive thyroid often can't seem to get moving -- and it can feel a lot like depression," Simpkins says. Talk to your doctor. If you take antidepressants, they may need to be switched out for thyroid medication.

Should I be screened for thyroid disease? You and your doctor can decide when a test makes sense for you. Also, make sure your doctor is aware of all the medications you take. Some can affect thyroid test results.

Can you feel for any changes in my thyroid? Your doctor should touch your neck every year to look for changes. Thyroid disease -- and thyroid cancer -- will often change the size, shape, and contour of the gland.

Could the underlying cause of my symptoms be my thyroid? If you have any unexplained symptoms such as fatigue, depression, or infertility, mention them if your doctor doesn't ask.

What are my treatment options? If you do have thyroid disease, discuss next steps -- whether you need an ultrasound, if you need to see a specialist, what medications could help, and how long it will take to get the disease under control.

Find more articles, browse back issues, and read the current issue of "WebMD Magazine."

Strong constant fatigue and weakness, what to do if there is not enough strength?

Everyone knows the feeling of tiredness and lack of energy, especially during periods of bad weather or outbreaks of viral infections. Normally, this problem is solved with the help of proper rest and sleep. But when such a state drags on and significantly reduces the quality of life, this is a signal that the time has come to think about the state of health of the nervous system.

Fatigue is a functional state of the body with a significant decrease in energy, performance and motivation, which affects both the physical and mental well-being of a person. As a rule, constant fatigue is a symptom, not a separate condition. In most cases, it is caused by a combination of lifestyle, health characteristics and social problems. nine0003

Constant feeling of fatigue can cause a variety of physical, mental and emotional symptoms:

Headache, dizziness
Reduced immunity, frequent infectious diseases
Lack of feeling of proper rest after sleep in the morning
Muscle weakness, body aches
Ringing in the ears
Slow reaction time, problems with coordination
Constant lethargy, inertia, apathy, laziness, lack of motivation
Deterioration of thinking processes: decrease in attention, concentration and ingenuity, which means deterioration in educational and work activities
Loss of appetite
Problems with short-term and long-term memory
Exacerbations of allergic reactions
Enlargement of lymph nodes

Symptoms tend to get worse after exercise.

Clinically significant is the feeling of fatigue with accompanying signs for two or more weeks.

Certain symptoms may predominate depending on the type of fatigue. There are two of them:

Physical fatigue: Normally, muscle fatigue gradually accumulates during exercise and disappears after rest. Pathological cases are associated with lack or lack of sleep and health problems. It becomes difficult for a person to perform ordinary physical actions that he easily coped with before. For example, a patient who used to go to the gym regularly and with pleasure, completely quits training due to lack of strength. The problem can also affect completely routine matters: climbing the stairs to the second floor, walking to the nearest store. Muscle weakness will be a mandatory symptom. nine0003

Mental fatigue: it is difficult for the patient to maintain not only physical, but also mental activity. Memory, concentration, learning ability are impaired. Eternal fatigue and drowsiness do not allow even light mental work to be done. This condition affects the reaction and attention of the driver. According to statistics, sleepy people at the wheel get into car accidents three times more often than others. This is comparable to the risks that are associated with the state of intoxication.

It happens that a person sleeps enough every day, eats normally and leads an orderly life, but constant weakness and fatigue do not go away. Feeling exhausted can make it impossible to manage even the necessary daily activities. This means that the condition requires professional diagnosis and possibly treatment. nine0003

Causes of fatigue

Fatigue can be conditionally divided into physiological (normal) and pathological.

With physiological fatigue of the body, the causes are usually the following:

Active recreation
Emotional outburst, overexcitement
Sports training
hard work
Biorhythm shift due to travel or flights

Pathological causes of fatigue:

Mental and psychological problems: mental overload, chronic stress, anxiety disorder, depression, alcohol or drug abuse
Medications: Incorrect dosage, abrupt withdrawal and incorrect use of certain drugs are a common reason why constant fatigue, weakness and loss of energy do not go away
Insomnia: if a person does not get enough sleep, then the body becomes exhausted and chronic fatigue sets in
Avitaminosis: vitamins and minerals are involved in the activity of the nervous system and are responsible for mental work
Chronic diseases: the presence of heart failure, arrhythmia, hepatitis, COPD, rheumatoid arthritis, hormonal imbalance, cancer, infectious diseases and other diseases are common causes of weakness and fatigue
Chronic pain: such patients often wake up at night and are in a state of permanent tension, which may be associated with constant fatigue
Viral infections and subsequent rehabilitation period
Lack of physical activity

Separately, it is worth talking about such a reason as chronic fatigue syndrome (CFS, myalgic encephalomyelitis). This is no longer just a symptom, but a separate disease, which is characterized by a high degree of fatigue without a somatic disorder corresponding to the state. Such patients may wonder why they are tired and apathetic all the time, almost constantly, since they are hypersensitive to even light exertion. nine0003

Patients with chronic fatigue syndrome are able to conduct some kind of relatively productive activity for only a few hours a day, or even less. It's not about hard work, creative projects, or intense workouts - such people are exhausted even by talking about abstract topics or going to the nearest store. They have to spend most of their time trying to rest and recover.

For persistent weakness and fatigue, the causes in this case include viral infections, primarily the Epstein-Barr virus, and problems with the immune system. The etiology of this disease is still being studied. Risk factors are age over 40, female gender, and stress. nine0003

The main symptom of CFS is severe fatigue that lasts at least six months and is not relieved by rest. Post-exercise weakness is characteristic, which persists for at least 24 hours.

Constant companions of chronic fatigue syndrome are various sleep disorders, cognitive disorders, muscle and joint pain, orthostatic hypotension, painful lymph nodes and frequent colds. With constant fatigue, the reasons for the decline in the quality of life lie not only in poor health, but in the fact that it becomes almost impossible to lead a full-fledged lifestyle: there is no strength for previous hobbies and even work, self-development and learning new things stop. It becomes difficult to maintain daily contact with people up to social isolation. nine0003

Symptoms of the disorder may wax and wane, which can create a false sense of well-being. But, unfortunately, in the pathological state of severe fatigue, the causes are rarely eliminated without specialized treatment. Therefore, despite temporary remissions, the old problems return with a vengeance.

It is always important to understand why you feel tired. If the condition lasts for a considerable time and it’s not just a too busy day, then you need to consult a specialist, because this not only interferes with life, but can also be a symptom of a serious mental or somatic disorder. nine0003

What to do with constant fatigue

If you are sure that your condition is caused by a natural cause and is a normal reaction of the body, then you should give yourself a rest. In cases where the cause is unknown or pathological, only a specialist can tell you what to do if you constantly feel tired.

Since fatigue is often associated with insomnia and disruption of the nervous system, it is necessary to consult a psychiatrist-psychotherapist and a neurologist. Depending on the situation, the help of a therapist, psychologist and other specialists may be needed. nine0003

There are no diagnostic tests that can pinpoint the exact reason why the patient constantly feels tired. This difficult-to-diagnose condition that can mimic other health problems requires ruling out a number of other disorders and identifying the underlying cause.

The elimination of this pathological condition requires special knowledge and experience from the specialist, since there is no standard treatment regimen. The use of one drug is not enough; correction of prescriptions in the course of therapy is often required. Therefore, with constant fatigue and weakness, only a highly qualified specialist can determine what to do to ensure that the result is as effective and lasting as possible. nine0003

This condition affects many organs and systems. With general fatigue of the body, what to do can be decided only after the examination. It may include laboratory testing, exercise tests, instrumental methods, and mandatory psychiatric diagnosis.

Treatment should primarily relieve symptoms. It may include:

Medications. They are prescribed depending on the patient's complaints. These can be painkillers, antidepressants, sleeping pills, antihistamines. With constant fatigue, what to do needs to be decided not only with new drugs, but also to correct the previous treatment of other disorders, if any. In this case, there is no universal drug - therapy is prescribed based on individual needs. nine0010
Psychotherapy: autogenic training and cognitive-behavioral therapy are used, aimed at normalizing the psycho-emotional background, relaxation and restoring the dynamic balance of the body.
Advice for normalizing lifestyle: The patient should receive advice on rest regimen, dietary therapy, and restoration of physical activity.

If you caught yourself on such questions as “I am constantly tired, what should I do? Why can't I rest and pull myself together? How to stop this?” — don’t expect everything to go away by itself. Contact a competent specialist, because it is not known what is hidden behind these symptoms. Chronic fatigue develops differently for everyone: it happens that it is enough to normalize the lifestyle and eliminate beriberi, but sometimes complex complex therapy is required. Remember that fatigue quickly depletes the body, reduces immunity and prevents you from leading an active life. nine0003

Chronic fatigue syndrome | Family Doctor

Loss of strength, weakness, lethargy, fatigue, impotence, “woke up and was already tired”, drowsiness, “I don’t feel rested after a good sleep”, decreased concentration, memory impairment, etc. A significant proportion of people who consult an endocrinologist or other doctors experience these or similar symptoms. The latter are not specific, because they can be with a variety of diseases and conditions. nine0003

Let's figure out what common endocrine diseases can cause symptoms of chronic fatigue.

With a decrease in thyroid function (hypothyroidism):

a breakdown is often combined with dry skin, hair loss, swelling of the face, hands and lower extremities, constipation, chilliness, memory impairment; in women - with a violation of the menstrual cycle.

With an excess of thyroid hormones in the blood (thyrotoxicosis):

weakness and fatigue are accompanied by constant heart palpitations, increased excitability and sweating, trembling of the hands and / or body, sleep disturbances, weight loss with increased appetite, in some cases with protrusion, pain and redness of the eyeballs.

For high blood glucose (type 1 diabetes):

patients complain of thirst, frequent urination, dry mouth, itchy skin, changes in visual acuity, weight loss with increased appetite. In type 2 diabetes, such symptoms occur much less frequently, since they develop only with severe decompensation of carbohydrate metabolism several years after the onset of the disease. With a moderate increase in blood glucose, in most cases there are no symptoms. nine0003

Phosphorus-calcium metabolism disorders

It is possible to suspect violations of phosphorus-calcium metabolism in persons with general and muscle weakness, bone pain, depressed mood, with complaints of thirst, frequent urination, vomiting and diarrhea (not due to other causes), urolithiasis, frequent recurrence of gastric ulcer and duodenal ulcer, low-traumatic (occurring with minimal trauma) fractures, muscle cramps, chronic kidney disease, long-term use of glucocorticosteroids, with low or no insolation, including people who completely cover themselves with clothes for religious or national reasons or do not leave the house. nine0003

Testosterone deficiency

Testosterone deficiency in men is also often accompanied by fatigue, mood lability with a tendency to depression, decreased sex drive, memory impairment, hot flashes, excessive sweating, palpitations, decreased muscle mass, and sleep disorders.

Adrenal insufficiency

In adrenal insufficiency, asthenia is always accompanied by weight loss, loss of appetite, and orthostatic hypotension (darkening of the eyes and/or dizziness when standing up). In addition, cravings for salty foods and darkening of skin folds and postoperative sutures may appear. nine0003

Hypercortisolism

Hypercortisolism (excess production of cortisol by the adrenal glands) is characterized by muscle weakness in the arms and legs, weight gain with predominant deposition of fat on the trunk with relatively thin limbs, the appearance of bright purple, wide (usually more than 1 cm wide) stretch marks on the skin, increased blood pressure , carbohydrate metabolism disorders (impaired carbohydrate tolerance or type 2 diabetes), sexual dysfunction, decreased body resistance to infections.