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Whether you are trying to focus in a frigid office or cozying up for bedtime, being cold is less than ideal. Of course, some people are prone to feeling cold naturally, especially in their hands and feet. If you constantly find yourself reaching for an extra layer and a pair of fuzzy slippers to stay warm, it’s not necessarily a sign of an underlying issue. Still, you may be wondering, Why am I always cold?

First, you should know that the human body has a complex thermoregulating system that allows it to hold steady at or very close to 98.6 degrees, according to Margarita R. Rohr, MD, an internal medicine specialist at NYU Langone’s Joan H. Tisch Center for Women's Health. “It is regulated by a ‘thermostat’ in your brain called the hypothalamus.” And several factors can affect your inner temp.

Cold intolerance can strike from time to time and is usually not something to worry about. But if you also have a concerning symptom, you may want to talk to your doctor. “For example, if in addition to feeling cold, a person had constipation and weight gain, it could be a sign of an underactive thyroid. Or, if feeling cold was accompanied by fatigue and craving ice chips, it could be a sign of iron deficiency anemia,” explains Dr. Rohr. A physical exam and blood work can help sort out what exactly is making you freeze all the time.

Ultimately, you should follow your gut instinct and use common sense, says Vivek Cherian, MD, a Chicago-based internal medicine physician. If always feeling cold is a new symptom or you feel like you're less and less able to withstand the cold, it is worth getting it checked out.

If you want some peace of mind from knowing what you could be dealing with, here are all the possible reasons for why you are shivering all the time.

With anemia, your body has a deficiency of red blood cells, which are responsible for carrying oxygen and removing carbon dioxide. In this case, you feel cold because your body is not getting enough oxygenated blood, according to Dr. Rohr. Other symptoms can include fatigue, feeling winded (especially with exercise), fast heart rate, dizziness, weakness, and pale skin, per the Cleveland Clinic.

There are many kinds of anemia. Some are a result of not having enough of certain nutrients in your body, such as iron-deficiency, folate-deficiency, and vitamin B12-deficiency anemia. Others are related to chronic conditions that cause low levels of hormones needed to create red blood cells, like lupus, hypothyroidism, and hyperthyroidism.

Treatment depends on what type you have. It could include taking an iron or vitamin B12 supplement or a transfusion of red blood cells.

Diabetes occurs when the body has trouble regulating blood sugar levels. It may also manifest as excessive thirst, peeing too much, or unexplained weight loss. People with this disease may also have cold hands and feet.

A complication of diabetes that can make you feel cold is peripheral neuropathy, where the nerves are damaged, most commonly in the hands and feet. It could also cause a burning sensation, numbness, pain, and tingling.

Diabetics can also develop peripheral vascular disease, which affects circulation in the arms and legs. “Poor blood flow through extremities could cause those with diabetes to feel cold,” explains Dr. Rohr.

Managing your diabetes and maintaining normal blood sugar levels can help fend off these conditions. There are also prescription meds that can ease the discomfort associated with peripheral neuropathy.

Certain drugs may cause cold sensitivity, such as beta-blockers, chemotherapy, hormonal birth control, and immunosuppressants, to name a few, says Dr. Cherian.

One way to make sure your meds are not causing problems is to review them with your doctor and see if a substitute may be available to you.

Fibromyalgia is characterized by pain all over the body, sleep problems, fatigue, and memory issues, per the CDC. The exact cause of fibromyalgia is still not completely known, but it is thought to involve a number of factors, including chemical imbalances, genetics, and even mood disorders that can ultimately lead to an increased sensitivity to pain, says Dr. Cherian. People who are affected can often develop both cold and heat intolerance.

It tends to affect people as they get older and those who suffer from lupus and rheumatoid arthritis. Research has shown that multiple physical or emotional stressors and trauma can trigger and aggravate this condition.

Even though scientists are still trying to pinpoint the causes of fibromyalgia, it can be effectively managed with a combination of therapy and stress reduction, pain relievers, and physical therapy.

Fluctuations in estrogen levels could also be to blame. ICYMI, estrogen levels in women change over time throughout their menstrual cycle, menopause, and pregnancy.

These hormonal ups and downs can make you more susceptible to feeling cold, particularly for women who are approaching menopause and those who are about to start their periods, says Dr. Cherian.

There are a few things you can do to warm up: avoid alcohol and caffeine before bed, exercise regularly, limit nicotine use, spicy foods, and sugar, and wear socks to bed, according to the Cleveland Clinic. Your doctor may also recommend hormonal or non-hormonal therapies to soothe the discomfort of menopause symptoms, such as low-dose hormonal birth control and an antidepressant.

Another reason you are always cold could be hypothyroidism. This happens when your butterfly-shaped gland doesn’t produce enough thyroid hormones, says Dr. Rohr, which is involved in keeping your metabolism going. It slows down with hypothyroidism, and this could make you feel cold.

Thyroid hormones also play a part in regulating your temperature and heart rate, and too much or too little can have an impact on your whole body. That's why hypothyroidism is also associated with constipation, fatigue, hair loss, and weight gain.

The fix is usually a daily does of synthetic hormone levothyroxine to get your levels back to a normal range.

Another possibility is kidney disease, which is most commonly due to high blood pressure or diabetes. Left undiagnosed, these conditions can cause kidney damage over time, says Dr. Cherian. Your kidneys then may not be able to filter blood and remove wastes and toxins efficiently. Since these organs also stimulate the production of red blood cells, a potential effect of them not functioning well is anemia, which, as you know, can make you feel cold.

Some people may not feel ill or experience any symptoms, according to the CDC. The only way to know for sure if you have kidney disease is through specific blood and urine tests.

One of the most important treatment goals is to ensure the condition does not progress. Keeping your diabetes and hypertension under control can help. You can also manage it by eating a low-sodium, heart-healthy diet and reducing your protein intake, per the National Institute of Diabetes and Digestive and Kidney Diseases.

You may also want to take a closer look at your sleep habits. Turns out this is a pretty common contributing factor to cold intolerance, according to Dr. Cherian.

Our circadian rhythms can be disrupted by not clocking enough hours in bed, but which can interfere with hormones that regulate the sensory nerves in your skin, he explains, adding, “Because of this, our brain basically cannot detect temperature changes (particularly in our limbs), and blood flow is not redirected as efficiently.”

Thankfully, the fix is simple: practice proper sleep hygiene. Sometimes medications can also be helpful, and if you have sleep apnea, you may need a CPAP machine to improve the quality of your sleep.

Body fat can help maintain body temperature, as it acts as an insulator, says Dr. Rohr. Without this layer, you’re more prone to feeling cold. This could be due to certain conditions, such as those commonly found in the elderly, chronic medical conditions that cause loss of body fat, or fat loss associated with eating disorders.

“A visit with your doctor would be advised, so body mass index and weight can be measured to help determine a healthy weight for your height,” suggests Dr. Rohr. “Maintaining a healthy weight with an appropriate diet and exercise regimen would also help.” A nutritionist could help ensure you’re consuming enough calories.

Peripheral arterial disease (PAD) occurs when there is a buildup of plaque in the arteries of your arms and legs. “This leads to blockages and reduced blood flow to the extremities, making them feel cold,” says Dr. Rohr.

Other symptoms you may have with PAD include loss of hair in affected limbs, pain with working out that usually improves with rest, and occasionally ulcers of the skin.

The good news is there are many treatment options available, including dietary changes, physical activity, and smoking cessation. But more advanced cases may require surgery.

In Raynaud's phenomenon, the smaller blood vessels to the fingers and toes narrow, restricting blood flow. “This causes the affected extremities to feel cold due to lack of blood flow,” says Dr. Rohr. They may change color and look very red, white, or bluish.

Keeping your hands and feet warm is the best solution. “If usual self-care measures do not work, there are some prescription medications that can help,” says Dr. Rohr.