Why am I cold when everyone else is comfortable?

That mismatch is the definition of cold intolerance. It usually means your body makes less heat (low thyroid hormone, low body weight) or delivers less warm blood to the skin (anemia, narrowed vessels). A doctor can sort out which with a short set of blood tests.

Can anxiety or stress make me feel cold?

Stress can trigger a Raynaud's attack, because stress signals narrow the small blood vessels in the hands and feet. It does not lower core body temperature on its own. If you are cold all day and not only during stressful moments, look for a physical cause first.

Does feeling cold mean I have a slow metabolism?

Sometimes. Thyroid hormone sets the pace of metabolism, and low levels slow heat production. Very low body weight has a similar effect because there is little fat for insulation and less muscle to generate heat. A TSH test and a look at your weight history answer this quickly.

Will iron pills make my cold hands go away?

If iron deficiency is the cause, yes, but slowly. NHLBI says it often takes three to six months of oral iron to restore iron stores. Do not start iron without a ferritin test, because too much iron causes its own problems and the bleeding source still needs to be found.

Is it normal to feel colder as I get older?

It is common. Older adults lose body heat faster and more often have thyroid disease, diabetes, and poor circulation. The National Institute on Aging recommends keeping indoor heat at 68°F or higher, because homes at 60 to 65°F can lead to hypothermia in older people.

Why Am I Always Cold? Thyroid, Anemia, and 8 Other Causes

The short answer: Feeling cold all the time usually has a physical cause. The most common ones are an underactive thyroid, iron-deficiency anemia, low body weight, and circulation problems such as Raynaud's phenomenon. Some medicines, diabetes nerve damage, low vitamin B12, and normal aging also lower your tolerance for cold. A few blood tests (TSH, a complete blood count, ferritin, and B12) find most causes.

Is always being cold a real medical symptom?

Yes. Doctors call it cold intolerance. MedlinePlus defines it as "an abnormal sensitivity to a cold environment or cold temperatures." The key sign: you feel cold when the people around you do not. MedlinePlus lists the main causes as anemia, anorexia nervosa, blood vessel problems such as Raynaud phenomenon, chronic severe illness, a problem with the hypothalamus (the brain's thermostat), and underactive thyroid.

The causes fall into two groups. Some lower heat production (low thyroid hormone, too few calories, little muscle). Others limit warm blood reaching the skin (anemia, narrowed vessels).

Could my thyroid be the reason I am always cold?

It is the first thing most doctors check. The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) lists "trouble tolerating cold" as a common symptom of hypothyroidism, alongside fatigue, weight gain, dry skin, joint pain, and a slowed heart rate. NIDDK says nearly 5 out of 100 Americans ages 12 and older have hypothyroidism, although most cases are mild. Women are much more likely than men to develop it, and it is more common after age 60.

The American Thyroid Association (ATA) explains why. Thyroid hormone "helps the body use energy, control metabolism, stay warm." When levels are low, the body slows down and you "feel cold" and "feel tired." Hashimoto's disease, an autoimmune attack on the thyroid, is the most common cause. Thyroid surgery, radioactive iodine, and medicines such as lithium and amiodarone can also cause it.

ATA says "a blood test is the only way to know for sure." Treatment is a daily levothyroxine pill, with a recheck 6 to 8 weeks after any dose change. If you already take thyroid medicine and still feel cold, ATA notes that "too little" medicine can leave you tired, cold, or constipated. Ask about your dose. For more on thyroid testing and treatment, see thyroid.md.

Can low iron or low B12 make me feel cold?

Yes, through anemia. Red blood cells carry oxygen and warm blood to the skin. When you have too few of them, the body pulls blood toward vital organs and your hands and feet go cold first. The National Heart, Lung, and Blood Institute (NHLBI) lists "cold hands and feet" as a symptom of iron-deficiency anemia, together with fatigue, dizziness, pale skin, and shortness of breath. NHLBI calls it the most common type of anemia.

Low iron usually comes from blood loss or poor absorption. NHLBI names heavy menstrual periods, bleeding in the gut from ulcers or colon cancer, regular aspirin or NSAID use, celiac disease, Crohn's disease, weight-loss surgery, and endurance sports. Iron pills usually take three to six months to restore iron stores. Some people need intravenous iron.

Vitamin B12 deficiency causes a different anemia with the same early symptoms. NHLBI lists fatigue, paleness, shortness of breath, and dizziness first. Untreated, nerve symptoms follow: tingling, trouble walking, memory problems, and mood changes. Older adults, people with pernicious anemia, heavy drinkers, and people who take metformin or heartburn medicines are at higher risk. If you have tingling with the cold, read our guide to numbness and tingling causes.

Why are only my hands and feet cold?

Cold that stays in the fingers and toes points to blood flow, not metabolism. The most common pattern is Raynaud's phenomenon. The National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) describes attacks in which small blood vessels in the hands and feet narrow quickly and stay narrowed. The skin turns white, then blue, then red as blood returns. Cold, stress, and smoking are the main triggers. Even holding a glass of ice water can set off an attack.

Primary Raynaud's has no known cause. It affects women more than men, usually starts before age 30, and runs in families. Secondary Raynaud's comes with another disease, most often lupus, scleroderma, rheumatoid arthritis, or Sjögren's disease, and NIAMS says it "tends to be more serious."

In older adults and smokers, one cold foot can mean peripheral artery disease (PAD). NHLBI lists "one foot may feel colder than the other" among PAD symptoms, along with leg cramping when walking that stops with rest, pale or blue skin, and foot sores that do not heal. About 1 in 5 people with PAD report no symptoms at all.

Diabetes adds a third pathway. The NIDDK says up to one-half of people with diabetes have peripheral neuropathy. Damaged nerves misreport temperature, so feet can feel cold, burning, or numb even when they are warm to the touch.

What about body weight, medicines, and age?

Low body weight. Fat is insulation, and muscle makes heat. MedlinePlus notes that "some people (often thin older women) do not tolerate cold temperatures because they have very little body fat to help keep them warm." It also lists anorexia nervosa as a direct cause. The National Institute of Mental Health (NIMH) lists mild anemia, low blood pressure, and slowed pulse among its physical effects. Each makes cold worse. Cold intolerance with unplanned weight loss needs a prompt visit; see our article on unintentional weight loss.

Beta blockers. These heart and blood pressure medicines slow the heart and narrow small vessels in the limbs. The FDA label for metoprolol on DailyMed lists "cold extremities; arterial insufficiency, usually of the Raynaud type" among reported adverse reactions. Do not stop a heart medicine on your own. Ask your prescriber about alternatives.

Age. The National Institute on Aging (NIA) says older adults often have conditions that make staying warm harder: diabetes that limits blood flow, thyroid problems, and poor circulation. NIA advises setting home heat to at least 68°F, because "even mildly cool homes with temperatures from 60 to 65°F can lead to hypothermia in older adults." Alcohol also makes you lose body heat.

What tests will my doctor order, and when is cold a red flag?

The workup is short. MedlinePlus lists the standard tests for cold intolerance: a complete blood count (CBC), a comprehensive metabolic panel, serum TSH, and thyroid hormone levels (T3, T4). Your doctor will likely add a ferritin test and a vitamin B12 level.

TSH. MedlinePlus explains that when thyroid hormone is low, the pituitary makes more TSH to push the thyroid harder. A high TSH means hypothyroidism. ATA adds that a free T4 test shows the usable hormone in your blood.
CBC and ferritin. The CBC shows hemoglobin and red cell size. Ferritin measures stored iron and can catch a deficiency before anemia develops.
Vitamin B12. A low level explains anemia plus tingling or memory changes.
Fasting glucose or A1C. Screens for diabetes when feet feel cold or numb.

Expect questions too: Have you always been cold, or is this new? What is your diet like? Bring a list of your medicines.

Some patterns should not wait. Call your doctor promptly if cold intolerance comes with unplanned weight loss, heavy periods, black or bloody stools, fingers or toes that turn white or blue, a foot sore that will not heal, or new numbness. Call 911 for signs of hypothermia. NIA lists them: cold feet and hands, a puffy face, pale skin, shivering, slurred speech, and sleepiness or confusion. Hypothermia means a core temperature below 95°F. Our guide to warning signs that need a doctor covers the general rules.

The bottom line

Always being cold is a symptom, not a personality trait. An underactive thyroid affects nearly 5 in 100 Americans and is the first cause to rule out. Iron-deficiency anemia is the most common anemia and shows up as cold hands and feet. Raynaud's, peripheral artery disease, diabetic nerve damage, low body weight, beta blockers, and aging fill in most of the rest. One blood draw covering TSH, CBC, ferritin, and B12 finds the majority of causes, and most of them are treatable.

Last updated: September 2026. This article is for informational purposes only and does not constitute medical advice. Persistent cold intolerance, especially with weight loss, color changes in the fingers or toes, or numbness, should be evaluated by a clinician.