Hormones

Why Do I Feel Anxious All the Time?

The Pin Health Staff Writer

September 20, 2026 9 min read

There's a particular kind of anxiety that doesn't quite make sense. Not anxiety about something specific – but a persistent, low-grade sense of unease that's there when you wake up, there when nothing particular is wrong, there in the background of ordinary days. For many people, this kind of anxiety has a biological driver that's entirely measurable.

Anxiety is one of the most common experiences reported in primary care – and one of the most frequently treated as a purely psychological phenomenon when the underlying driver is physiological. Hormonal imbalances, nutritional deficiencies, thyroid dysfunction, and blood sugar dysregulation can all produce anxiety that’s indistinguishable from what would be diagnosed as generalized anxiety disorder – and that doesn’t respond meaningfully to psychological interventions alone.

This doesn’t mean anxiety is never psychological. It often is. But it means that treating anxiety without checking its biological underpinnings is treating a symptom without identifying its cause. And for a significant proportion of people with persistent anxiety, the cause is sitting in their blood work, waiting to be found.

Cortisol: When Your Stress Response Won’t Turn Off

Cortisol is the body’s primary stress hormone – essential for getting you through genuine threats and demanding situations, problematic when it stays elevated long after the threat has passed. Chronic stress – whether from work, relationships, financial pressure, or the accumulated load of modern life – keeps cortisol elevated in ways that the body wasn’t designed to sustain.

Elevated cortisol feels like anxiety. It produces the same physiological state – heightened alertness, muscle tension, racing thoughts, difficulty relaxing – that acute stress responses produce. The difference is that with chronic cortisol elevation, there’s no obvious threat to explain the feeling. The anxiety seems disproportionate to circumstances. The nervous system is on high alert for reasons the conscious mind can’t identify.

Cortisol also disrupts sleep – particularly the restorative early morning sleep that should coincide with cortisol’s natural rise. People with dysregulated cortisol often wake in the early morning hours with racing thoughts, unable to return to sleep. This sleep disruption then elevates cortisol further, creating a reinforcing cycle that perpetuates both the anxiety and the sleep problems.

What’s particularly important about cortisol dysregulation is its interaction with other hormones. Chronically elevated cortisol suppresses thyroid function, reduces sex hormone production, promotes insulin resistance, and depletes the nutritional reserves – particularly magnesium and B vitamins – that support a calm nervous system. This is why chronic stress rarely produces just one symptom: it disrupts multiple systems simultaneously.

Thyroid Dysfunction: The Anxiety Nobody Expects

Thyroid dysfunction is among the most common causes of anxiety that’s misidentified as psychological – particularly hyperthyroidism, or overactive thyroid, which produces a state of physiological overdrive that feels almost identical to clinical anxiety.

Excess thyroid hormone accelerates every metabolic process in the body. The heart beats faster. The nervous system becomes hypersensitive. Sleep becomes difficult. The digestive system speeds up. Muscles feel tense and tremulous. People with hyperthyroidism frequently present to their doctors reporting anxiety, heart palpitations, and insomnia – and are sometimes treated for panic disorder before anyone checks their thyroid.

But even hypothyroidism – underactive thyroid – can produce anxiety, particularly in its early stages when the thyroid is failing and hormone levels are fluctuating. The relationship between thyroid function and anxiety runs in both directions, and thyroid markers – TSH, Free T3, Free T4, and thyroid antibodies – should be part of any thorough investigation of unexplained anxiety.

Magnesium: The Calming Mineral Most People Are Missing

Magnesium is involved in the regulation of the nervous system in ways that are directly relevant to anxiety. It acts as a natural calcium channel blocker – moderating the excitability of neurons and preventing the overactivation that underlies anxiety states. It supports GABA function – the primary inhibitory neurotransmitter that produces feelings of calm. And it regulates the HPA axis – the hormonal system that controls the cortisol stress response.

Magnesium deficiency is extraordinarily common – estimated to affect a significant proportion of the Western population – for reasons that include dietary inadequacy, soil depletion, and increased urinary excretion under chronic stress. Chronic stress depletes magnesium, and magnesium depletion worsens the stress response – another reinforcing cycle.

The connection between low magnesium and anxiety is supported by research showing that magnesium supplementation reduces anxiety in people with low baseline levels. It’s one of the most straightforward nutritional interventions for anxiety – but it requires knowing that magnesium is low, which requires testing. Standard serum magnesium tests are often inadequate because serum levels are tightly regulated – RBC magnesium, which measures levels inside red blood cells, is a more sensitive indicator of true magnesium status.

Blood Sugar Dysregulation: The Anxiety Roller Coaster

Blood sugar fluctuations produce physiological states that are functionally indistinguishable from anxiety. When blood glucose drops rapidly – whether after a high-carbohydrate meal, after skipping meals, or in the context of early insulin resistance – the body releases adrenaline and cortisol to raise it. This hormonal response produces shakiness, heart racing, sweating, and a sense of impending dread that feels exactly like an anxiety attack.

People with reactive hypoglycemia – where blood sugar spikes and then crashes more dramatically than normal after eating – often experience what they describe as anxiety attacks two to three hours after meals. They may not connect the timing to food because the lag makes the pattern non-obvious.

Fasting insulin and fasting glucose together reveal whether blood sugar regulation is a factor. HbA1c gives a longer-term picture of average blood sugar over the preceding months. These markers are rarely checked in people presenting with anxiety – but when blood sugar dysregulation is driving the symptoms, addressing the metabolic issue produces improvements in anxiety that psychological interventions alone cannot.

Hormonal Changes in Women: When Estrogen and Progesterone Shift

For women, the hormonal fluctuations of the menstrual cycle, perimenopause, and postpartum recovery are among the most common and underappreciated drivers of anxiety.

Progesterone has direct anxiolytic – anti-anxiety – effects through its conversion to allopregnanolone, a neurosteroid that activates GABA receptors in the brain. When progesterone drops – in the premenstrual phase, during perimenopause, or postpartum – GABA activity decreases and anxiety increases. Women who experience significant premenstrual anxiety or who notice their anxiety worsening through perimenopause are often experiencing progesterone-driven changes in GABA activity.

Estradiol fluctuations also drive anxiety – not because estrogen itself causes anxiety, but because the rapid drops in estradiol that occur during the perimenopausal transition trigger cortisol responses and affect serotonin and norepinephrine systems. Hot flashes, which are driven by estradiol fluctuation, are often accompanied by anxiety – reflecting the same autonomic nervous system dysregulation.

Iron and B12: When the Foundation Is Missing

Nutritional deficiencies that affect the nervous system can produce anxiety through less direct but significant pathways. Ferritin – iron storage – affects the production of dopamine and serotonin, both of which regulate mood and anxiety. Low ferritin is associated with anxiety and restlessness, particularly the kind that worsens at night and produces difficulty relaxing or falling asleep.

Vitamin B12 is essential for the synthesis of myelin – the protective sheath around nerves – and for the production of neurotransmitters including serotonin and dopamine. B12 deficiency produces neurological symptoms that can include anxiety, irritability, and a heightened nervous system reactivity that feels like anxiety even when circumstances don’t warrant it.

Vitamin D deficiency has also been consistently associated with anxiety and depression in the research literature, though the direction of causality is still being investigated. Vitamin D receptors exist throughout the brain, and deficiency appears to affect both mood regulation and the stress response.

What to Test If You Feel Anxious All the Time

A comprehensive blood panel for unexplained anxiety should include:

Hormonal markers: Cortisol (ideally with timing noted – morning cortisol is highest and most meaningful), TSH with Free T3, Free T4, and thyroid antibodies (TPO and TG), estradiol and progesterone in women (timed to cycle phase for accuracy), testosterone in both men and women.

Metabolic markers: Fasting glucose, fasting insulin, and HbA1c – to assess blood sugar regulation and insulin sensitivity.

Nutritional markers: RBC magnesium, vitamin D, vitamin B12, folate, and ferritin – the nutritional foundations of nervous system function.

Inflammatory markers: hs-CRP – chronic inflammation is increasingly recognized as a driver of anxiety and depression through its effects on neurotransmitter metabolism.

This panel won’t diagnose anxiety disorder – that’s a clinical assessment that involves far more than blood work. But it will identify whether specific, measurable, addressable biological factors are contributing to the experience. And for a significant proportion of people with persistent unexplained anxiety, the answer is yes.

The Bottom Line

Persistent anxiety that doesn’t match your circumstances – that’s there in the background of ordinary life, that doesn’t respond fully to stress management or psychological approaches – deserves biological investigation. The hormonal, nutritional, and metabolic factors that drive anxiety are measurable, specific, and in many cases, straightforwardly addressable.

This isn’t a claim that anxiety is never psychological. It often is. But it’s a recognition that for many people, anxiety has a biological component that’s running underneath the psychological experience – and that treating the biology alongside the psychology produces better outcomes than either alone.

The blood work doesn’t explain everything. But it explains more than most people expect – and finding a specific, measurable cause for feelings that have seemed inexplicable is, for many people, the beginning of genuine improvement.

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Key Takeaways

• Persistent anxiety often has measurable biological drivers – hormonal, nutritional, and metabolic factors that aren’t visible without testing
• Elevated cortisol produces anxiety that feels psychological but is physiological – chronic stress keeps the nervous system in a state of alert that feels disproportionate to circumstances
• Both hyperthyroidism and hypothyroidism can cause anxiety – thyroid markers including antibodies should be checked in anyone with unexplained anxiety
• Magnesium deficiency is common and directly affects nervous system regulation – RBC magnesium is more sensitive than serum magnesium for detecting true deficiency
• Blood sugar fluctuations produce anxiety-like states – fasting insulin and glucose reveal whether metabolic dysregulation is contributing
• Progesterone decline drives anxiety in women – particularly premenstrually, through perimenopause, and postpartum
• Ferritin, B12, and vitamin D deficiencies all affect nervous system function – nutritional foundations should be checked alongside hormonal markers