5 causes of cold intolerance

The reduced blood flow caused by PAD can increase cold sensitivity in the same way as vasoconstriction. This coldness is most commonly felt in the feet (particularly in the morning or right after exercise) but can also affect other body parts.

13 Reasons Why You’re Cold All the Time

Heidi Moawad is a neurologist and expert in the field of brain health and neurological disorders. Dr. Moawad regularly writes and edits health and career content for medical books and publications.

Michael Menna, DO, is a board-certified, active attending emergency medicine physician at White Plains Hospital in White Plains, New York.

Table of Contents
Table of Contents

Some people feel cold all the time and often need a blanket or coat to keep warm, while others around them seem just fine. As frustrating or worrisome as this may be, it is not an uncommon situation. There are medical and health conditions that can cause a condition known as cold intolerance.

Cold intolerance is not an illness but simply an abnormal sensitivity to cold environments or cold temperatures. It may be a symptom of a problem with your metabolism (the conversion of calories to energy) or caused by nervous system disorders that alter your perception of cold. Even being thin can make you extra sensitive to cold.

Part of the reason for these long wait times and short appointments is due to a nationwide shortage of physicians that is only getting worse. A report by the Association of American Medical Colleges predicts that, due to population growth and specifically growth of the elderly population, the physician shortfall in the U.S. could reach 121,300 by the year 2030.

This article looks at 13 different causes of cold intolerance, including why they occur and what you can do.

What Is Cold Intolerance?

Cold intolerance, also known as cold sensitivity or hypersensitivity, is an elusive condition in which you have an exaggerated reaction to cold, causing discomfort and/or the avoidance of cold.

That said, there is no universally accepted definition since the underlying causes are so varied, and not everyone with these conditions is intolerant to cold.

Scientists believe that multiple factors contribute to cold intolerance, which can be broadly categorized as:

• Humoral: These are hormonal problems that alter metabolism and thermal regulation.
• Circulatory: These are blood circulation problems that alter body temperatures.
• Neural: These are nervous system disorders that alter the perception of cold

Cold intolerance is a subjective response to cold irrespective of the ambient temperature. The response is largely physiological (related to the body), although it may also have psychological components (related to the mind).

Symptoms of Cold Intolerance

There is much variation in the sensitivity to cold that different people experience. Some may only shiver and put their hands in their pockets in response to the cold. Others may require layers of clothes to keep warm.

In addition to an abnormal response to cold, symptoms of cold intolerance may also cause:

• Numbness
• Stiffness
• Pain or burning sensations
• Weakness
• Swelling of the skin
• Skin color changes
• Sensitivity to touching cold objects

Cold Intolerance vs. Hypothermia

Cold intolerance is not the same thing as hypothermia (a reduction in body temperature when it loses more heat than it can generate). Cold intolerance occurs at temperatures that are otherwise tolerable to others in that environment.

Causes of Cold Intolerance

Cold intolerance is thought to be multifactorial, meaning that more than one cause is involved. With that said, there are certain medical or health conditions for which cold intolerance is common.

Thyroid Disease

Hypothyroidism , or low thyroid function, is one of the most recognized causes of cold intolerance.

The thyroid glands are responsible for producing hormones that play a central role in regulating metabolism, including how and when energy reserves in the body are used. In a cold environment, thyroid hormones can increase metabolism to help normalize your body temperature.

If you have hypothyroidism, the low output of thyroid hormones undermines this effect, making you more susceptible to the cold.

In people with hypothyroidism, hormone therapy can help normal thyroid levels and, in turn, alleviate symptoms of cold intolerance.

Anemia

Anemia is a condition in which you don’t have enough red blood cells to transport oxygen through the body. It can also occur if don’t have enough of an iron-containing protein, called hemoglobin , that is responsible for carrying oxygen molecules.

Iron deficiency anemia is a type of anemia caused by the lack of iron in the body. Iron is not only needed to make hemoglobin but is also essential in producing ample quantities of red blood cells.

Cold intolerance is strongly linked to iron deficiency anemia for two reasons:

• Lack of oxygen: Oxygen is not only involved in the burning of calories for energy and heat but also in the narrowing of blood vessels to help conserve heat. With all types of anemia, including pernicious anemia (caused by a lack of vitamin B-12) and aplastic anemia (caused by bone marrow problems). the lack of oxygen reduces both of these effects.
• Lack of iron: Iron is also needed to produce thyroid hormones. In people with iron deficiency anemia, low iron levels reduce the production of these hormones, further increasing cold sensitivity.

Iron deficiency anemia can be treated with iron supplements and prescription drug therapies.

Raynaud’s Syndrome

Raynaud’s syndrome is a condition in which a person’s fingers or toes turn blue or white upon exposure to cold and then bright red upon rewarming. It is caused by the abnormal narrowing of blood vessels (vasoconstriction) in response to cold or stress.

Although the cause of Reynaud’s syndrome is unknown, it is often experienced in people with connective tissue disorders like scleroderma or lupus.

The abnormal constriction of blood vessels deprives the tissues of oxygen. This, in turn, reduces the skin temperature and increases its sensitivity to cold. Other symptoms include numbness, tingling, or throbbing pain.

Reynaud’s syndrome is treated by managing the underlying cause, if any. It also includes avoiding cold, stress, and smoking (which increases vasoconstriction).

Anorexia

Anorexia nervosa , or simply anorexia, is an eating disorder characterized by a limited food intake. People with anorexia often eat so little that they cannot sustain basic bodily functions.

Cold intolerance is common in people with anorexia for several reasons:

• Malnutrition: The inadequate intake of food deprives the body of iron, B vitamins, folate, manganese, and sulfur needed to maintain metabolism. It also affects the production of hormones that regulate the core body temperature.
• Cachexia: Body fat helps insulate the body from cold. When enough body fat is lost, a person is less able to withstand cold. Cachexia is muscle wasting accompanied by the loss of body weight and body fat. It occurs in people with anorexia when the body has to turn to muscle and fat for fuel.

Medications, support groups, and talk therapy commonly treat people with anorexia.

Low Body Weight

Even in people who do not have anorexia, having a low body weight increases their susceptibility to cold. However, this isn’t the case for everyone, as some underweight people have a high metabolism and higher core body temperatures.

With that said, low body weight is inherently linked to less subcutaneous body fat . This is the layer of fat tissue just below the skin. The loss of this insulating layer increases the risk of cold intolerance.

In addition to reducing subcutaneous fat, low body weight is linked to an increased risk of anemia.

Diabetes

Diabetes is a group of diseases that causes excess glucose (sugar) in the blood. Persistently high glucose levels can cause progressive damage to many organs in the body, including the kidneys, circulatory system, and nerves.

Complications of diabetes can lead to cold intolerance in different ways:

• Kidney damage: Diabetic nephropathy is kidney damage caused by diabetes. When this happens, a waste product called urea can accumulate in the blood, triggering a decrease in the core body temperature. Low body temperature is characteristic of advanced kidney disease.
• Circulation problems: Persistently high blood glucose levels can damage the lining of blood vessels and reduce blood flow. This not only reduces the temperature of the legs and feet especially but can lead to the development of slow-healing sores.
• Nerve damage: Diabetic neuropathy is nerve damage caused by diabetes. Symptoms include numbness, burning, pins-and-needles sensations, and an increased intolerance to cold. In some people, even a cold breeze can cause extreme discomfort.

Managing diabetes with diet, exercise, and medications can help you avoid complications that lead to cold intolerance.

Medications

Certain medications can cause cold sensitivity. They do so by either impeding blood circulation or damaging nerves that regulate skin sensations.

The classes of drugs commonly associated with cold sensitivity include:

• Beta-blockers: Used to treat heart disease
• Chemotherapy drugs: Used to treat cancer
• Hormonal contraceptives: Use to prevent pregnancy or treat endometriosis
• Hormone replacement therapy: Used to treat menopause symptoms and low testosterone
• Immunosuppressants: Used to prevent organ transplant rejection and treat certain autoimmune diseases
• Interferons: Used to treat cancer and certain chronic viral infections
• Statin drugs: Used to lower cholesterol

Peripheral Artery Disease

Peripheral artery disease (PAD) is when one or more blood vessels servicing the arms, legs, head, or trunk become partially or fully blocked. It is usually caused by the build-up of fatty deposits on the walls of arteries, referred to as atherosclerosis .

The reduced blood flow caused by PAD can increase cold sensitivity in the same way as vasoconstriction. This coldness is most commonly felt in the feet (particularly in the morning or right after exercise) but can also affect other body parts.

If left untreated, PAD can damage peripheral nerves (those located outside of the brain or spinal cord). This can lead to nerve pain that further exaggerates a person’s response to cold.

PAD is treated with medications and lifestyle changes, including a low-fat diet, weight loss, and routine exercise. Severe cases may require vascular surgery.

Lack of Sleep

As odd as it may seem, the chronic lack of sleep can increase your sensitivity to cold while awake.

In well-rested people, blood flow in the skin will fluctuate during sleep so that temperature changes in one part of the body change consistently with other parts of the body.

Sleep deprivation disrupts this process. As the sleep deficit builds and you lose more and more sleep, blood flow will progressively shift to the center of the body and decrease in the limbs. This promotes heat loss from the feet and hands, making them feel colder.

How Sleep Deprivation Affects Body Temperature

Sleep deprivation disrupts the circadian cycle , which regulates the pattern of sleep and wakefulness. This, in turn, interferes with the release of certain hormones that regulate sensory nerves in the skin. If this happens, the brain is less able to sense temperature changes in the arms and legs and will not redirect blood to them during sleep.

Sleep deprivation can be treated with improved sleep practices (referred to as sleep hygiene) and medications.

Suppose sleep apnea is causing the chronic loss of sleep. In that case, a healthcare provider may recommend a device called continuous positive airway pressure (CPAP) to prevent gaps in breathing that lead to nighttime awakenings.

Nerve Issues

Cold intolerance can occur when the peripheral nerves are damaged. This typically occurs when the insulated coating on nerves, called the myelin sheath, is damaged or stripped away. This can cause nerve cells to misfire, triggering shock-like pain, numbness, tingling, or burning.

The condition, known as peripheral neuropathy , can be so extreme that the weight of a bedsheet or a light breeze can cause pain. Peripheral neuropathy can increase a person’s sensitivity to cold, making it difficult to hold a cold soda or walk across a cold floor.

Causes of peripheral neuropathy include:

• Alcoholism
• Autoimmune diseases (like lupus or rheumatoid arthritis)
• Chronic kidney disease (CKD)
• Diabetes
• HIV
• Lyme disease
• Medications, including certain antibiotics, chemotherapy drugs, immunosuppressants, and HIV medications

Peripheral neuropathy can be difficult to treat but may benefit from nonsteroidal anti-inflammatory drugs (NSAIDs), anticonvulsant drugs, and antidepressants.

Estrogen

Estrogen is a hormone that regulates female reproduction. Estrogen levels change throughout life. including during the menstrual cycle, pregnancy, and menopause.

Fluctuating estrogen levels can increase cold sensitivity, particularly as females reach the end of their reproductive cycle.

During pre-menopause, fluctuations in estrogen can lead to the sudden onset of hot flashes followed by a steep drop in body temperature. The drop is thought to be caused by estrogen’s effect on nerve receptors that regulate the widening and narrowing of blood vessels.

The same fluctuations may explain why some people experience cold intolerance right before the start of their period. The luteal phase, which occurs right after ovulation, is when estrogen levels are at their peak. These extreme hormonal changes can lead to symptoms like increased coldness and shivering.

Pneumonia

When you have an infection like the flu or gastroenteritis, your whole body may feel cold even as you are burning up with a fever. You may even experience chills and shivers, known as rigors , that are so intense that you cannot stop.

Feeling cold during an infection is largely due to the consumption of extra energy to help fight the infection.

Rigors, on the other hand, are triggered by the presence of chemicals called pyrogens in the blood. The immune system produces pyrogens to raise the body’s temperature to help fight infection. But, they can trigger a contradictory reflex resulting in severe shivering and chills.

With some infections, like atypical pneumonia (also known as “walking pneumonia”), a person may only experience a sore throat, fatigue, and a constant feeling of coldness. Although walking pneumonia is milder than regular pneumonia, recovery can take up to six weeks, during which you may always feel cold.

Bacterial infections may resolve on their own or require antibiotics. Common viral infections are often left to run their course but, in some cases, may benefit from the early use of antiviral drugs.

Fibromyalgia

Fibromyalgia is a chronic condition that causes pain all over the body as well as memory problems, fatigue, and sleep difficulty. The cause of fibromyalgia is unknown, but it is thought to be the result of multiple factors, including genetics, mood disorders, past diseases, and chemical imbalances that increase pain hypersensitivity.

Research has shown that people with fibromyalgia often have trouble adapting to temperature changes and have high levels of intolerance to both heat and cold. This is thought to be caused by a process known as pain inhibition in which the nervous system slows down pain signals whenever it is faced with chronic pain.

This, in turn, can lead to cold intolerance by slowing down the body’s response to cold. Because the body does not respond as quickly, the person may feel cold far more intensely than others.

Physical therapy, stress reduction, and medications like antidepressants and muscle relaxants may help people with fibromyalgia better manage their symptoms.

Summary

Cold intolerance is an abnormal or exaggerated reaction to cold exposure. It can occur when a person’s body temperature is persistently lower due to any number of medical reasons. Or, it can occur when a person’s body temperature is normal but they perceive cold differently.

The causes of cold intolerance are clustered around problems involving the circulatory system, nervous system, and endocrine (hormonal) system. Often, multiple causes are involved. Even certain medications or the lack of sleep can trigger intolerance to cold.

If your sensitivity to cold is reducing your quality of life, ask your healthcare provider for a referral to an endocrinologist specializing in hormonal disorders or a neurologist specializing in nervous system diseases.

Frequently Asked Questions

What causes chills?

Chills are your body’s response to cold temperatures but can also occur before or during an infection like the flu or malaria. Chills are caused by the rapid contraction and relaxation of muscles that aim to bring the body temperature up.

Why are my hands and feet always cold?

Cold hands and feet can be caused by peripheral artery disease (PAD). PAD is most often the result of fatty deposits that build up in arteries, reducing blood flow and oxygen levels in tissues. The reduced circulation, in turn, leads to increased coldness in the hands and feet. PAD is common in people over 50 with a history of diabetes or smoking.

Why are some parts of my extremities cold but not others?

One possible explanation is Reynaud’s syndrome. This is an elusive condition that causes hands or feet to turn blue or white when exposed to cold. The cause of Reynaud’s syndrome is unclear, but, in certain people, it can affect one hand or foot (or even part of the foot or hand) but not the other.

Why are people assigned female at birth always cold?

People assigned female at birth are more susceptible to cold for many reasons, not least of which is their typically smaller body size. Studies have also shown that they tend to have slower metabolisms than people assigned male at birth, so their bodies generate less heat than assigned males of the comparable body size.

27 Sources

Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.

1. Stjernbrandt A, Carlsson D, Pettersson H, Liljelind I, Nilsson T, Wahlstrom J. Cold sensitivity and associated factors: a nested case–control study performed in Northern Sweden. Int Arch Occup Environ Health. 2018;91(7):785–797. doi:10.1007/s00420-018-1327-2
2. National Institute of Diabetes and Digestive and Kidney Diseases. Hypothyroidism (underactive thyroid).
3. Maushart CI, Loeliger R, Gashi G, Christ-Crain M, Betz MJ. Resolution of hypothyroidism restores cold-induced thermogenesis in humans. Thyroid. 2019;29(4):493–501. doi:10.1089/thy.2018.0436
4. National Heart, Lung and Blood Institute. In brief: your guide to anemia.
5. Johnson-Wimbley TD, Graham DY. Diagnosis and management of iron deficiency anemia in the 21st century. Therap Adv Gastroenterol. 2011;4(3):177-84. doi:10.1177/1756283X11398736
6. Beard JL. 14. Micronutrient deficiency states and thermoregulation in the cold. In: Nutritional Needs in Cold and High-Altitude Environments: Applications for Military Personnel in Field Operations. Washington, DC: National Academies Press; 1996.
7. Maverakis, E., Patel, F., Kronenberg, D. et al. International consensus criteria for the diagnosis of Raynaud’s phenomenon. J Autoimmun. 2014;48-49:60-5. doi:10.1016/j.jaut.2014.01.020
8. Smith LL. The central role of hypothermia and hyperactivity in anorexia: a hypothesis. Front Behav Neurosci. 2021;15:700645. doi:10.3389/fnbeh.2021.700645
9. Ling Y, Carayol J, Galusca B, et al. Persistent low body weight in humans is associated with higher mitochondrial activity in white adipose tissue. Am J Clin Nutr. 2019;110(3):605-616. doi:10.1093/ajcn/nqz144
10. Qin Y, Melse-Boonstra A, Pan X, et al. Anemia in relation to body mass index and waist circumference among Chinese women. Nutr J. 2013;12:10. doi:10.1186/1475-2891-12-10
11. American Diabetes Association. 2. Classification and diagnosis of diabetes: standards of medical care in diabetes—2022. Diabetes Care. 2022;45(Supplement 1):S17-S38. doi:10.2337/dc22-S002
12. Barreto FC, Stinghen AEM, de Oliveira RB, et al. The quest for a better understanding of chronic kidney disease complications: an update on uremic toxins. J Bras Nefrol. 2014;36(2):221-235. doi:10.5935/0101-2800.20140033
13. Kenny GP, Sigal RJ, McGinn R. Body temperature regulation in diabetes. Temperature (Austin). 2016;3(1):119-145. doi:10.1080/23328940.2015.1131506
14. National Institute of Diabetes and Digestive and Kidney Diseases. What is diabetic neuropathy?
15. Sharma AM, Norton PT, Zhu D. Conditions presenting with symptoms of peripheral arterial disease. Semin Intervent Radiol. 2014;31(4):281-291. doi:10.1055/s-0034-1393963
16. Romeijn N, Verweij IM, Koeleman A, et al. Cold hands, warm feet: sleep deprivation disrupts thermoregulation and its association with vigilance. Sleep. 2012;35(12):1673-1683. doi:10.5665/sleep.2242
17. Harding EC, Franks NP, Wisden W. Sleep and thermoregulation. Curr Opin Physiol. 2020;15:7-13. doi:10.1016/j.cophys.2019.11.008
18. Castelli G, Desai KM, Cantone RE. Peripheral neuropathy: evaluation and differential diagnosis. Am Fam Physician. 2020;102(12):732-9.
19. Zhang Z, DiVittorio JR, Joseph AM, Correa SM. The effects of estrogens on neural circuits that control temperature. Endocrinology. 2021;162(8). doi:10.1210/endocr/bqab087
20. Nagashima K. Thermoregulation and menstrual cycle. Temperature (Austin). 2015;2(3):320-321. doi:10.1080/23328940.2015.1066926
21. Walter EJ, Hanna-Jumma S, Carraretto M, Forni L. The pathophysiological basis and consequences of fever. Crit Care. 2016;20(1):200. doi:10.1186/s13054-016-1375-5
22. Centers for Disease Control and Prevention. Atypical pneumonia.
23. Schmidt-Wilcke T, Diers M. New Insights into the pathophysiology and treatment of fibromyalgia. Biomedicines. 2017;5(2). doi:10.3390/biomedicines5020022
24. Albrecht PJ, Hou Q, Argoff CE, Storey JR, Wymer JP, Rice FL. Excessive peptidergic sensory innervation of cutaneous arteriole-venule shunts (AVS) in the palmar glabrous skin of fibromyalgia patients: implications for widespread deep tissue pain and fatigue. Pain Med. 2013;14(6):895-915. doi:10.1111/pme.12139
25. MedlinePlus. Chills.
26. National Heart, Lung, and Blood Institute. Raynaud’s.
27. McMurray RG, Soares J, Caspersen CJ, McCurdy T. Examining variations of resting metabolic rate of adults: a public health perspective. Med Sci Sports Exerc. 2014 Jul;46(7):1352–8. doi:10.1249/MSS.0000000000000232

By Heidi Moawad, MD
Heidi Moawad is a neurologist and expert in the field of brain health and neurological disorders. Dr. Moawad regularly writes and edits health and career content for medical books and publications.

5 causes of cold intolerance

Some people naturally tend to feel colder than others without any discernible cause. However, cold intolerance can also indicate an underlying medical condition, such as hypothyroidism, anemia, or peripheral artery disease.

Dysfunction of the thyroid gland, arterial blood flow, and low body fat can all cause a person to feel cold.

In this article, learn about a range of possible reasons for cold intolerance. We also describe when to see a doctor.

There are many reasons why a person might feel cold all the time, including:

1. Hypothyroidism

Cold intolerance is a common symptom of hypothyroidism.

Hypothyroidism occurs when the thyroid gland does not produce enough thyroid hormones. These hormones help regulate metabolism and temperature.

When the thyroid is not producing enough thyroid hormones, the body’s processes tend to slow down.

Other symptoms of hypothyroidism include:

• fatigue
• depression
• thinning hair
• constipation
• menstrual issues
• a low heart rate

A doctor can diagnose hypothyroidism with a simple blood test. Treatment often consists of thyroid hormone replacement.

2. Raynaud’s phenomenon

Raynaud’s phenomenon causes blood vessels to narrow when a person experiences cold or stress. This decreases blood flow and may cause affected areas to feel cold.

It commonly affects the arteries in the fingers and toes. Some people may also experience symptoms of Raynaud’s in their lips, ears, and nipples.

During episodes, the affected areas can turn pale. As blood flow returns, the fingers and toes can feel numb or painful.

Treatment involves avoiding triggers if possible and, for some people, medication or surgery.

3. Anemia

Anemia occurs when a person does not have enough red blood cells circulating and carrying oxygen throughout the body. Symptoms of anemia , including feeling cold, result from a relative lack of oxygen.

Other symptoms can include:

• weakness or fatigue
• dizziness or lightheadedness
• trouble breathing
• increased heart rate
• headache
• pale skin

There are several kinds of anemia. Types that may make a person feel cold include:

Iron-deficiency anemia

Iron deficiency anemia is the most common type of anemia. It typically occurs due to blood loss but can also result from poor iron absorption.

People who are pregnant or menstruating are at risk of iron deficiency anemia.

Vitamin-deficiency anemia

Anemia can also result from nutritional deficiency. Low levels of vitamin B-12 and folic acid can lead to anemia, usually from inadequate dietary intake.

4. Anorexia nervosa

Anorexia nervosa (AN) is an eating disorder characterized by weight loss or inadequate weight gain and a distorted body image.

People with AN may intensely restrict their food intake, exercise excessively, or purge with laxatives or by vomiting.

People with anorexia often have a low core temperature. They may also have low levels of body fat and a reduced basal metabolic rate. All of these factors can cause a person to feel excessive cold.

Other symptoms of anorexia can include:

• weight loss
• stomach problems, such as constipation or cramping
• trouble concentrating
• dizziness or fainting
• irregular periods
• dry, brittle hair or nails
• weakness
• poor wound healing
• intense fear of becoming overweight
• restricting certain foods or categories of food
• being secretive about food intake
• fear of eating in public
• social isolation

Treatment of anorexia nervosa often involves a multidisciplinary team of doctors, nurses, and nutritionists. A person may benefit from talk therapy in addition to medication and a nutrition plan.

5. Peripheral artery disease

Peripheral artery disease occurs when plaque builds up in the arteries that carry blood to the rest of the body. Another name for this buildup is atherosclerosis.

The accumulation of plaque in the arteries makes them narrower, which means that it is more difficult for blood to flow through them.

Peripheral artery disease often causes decreased blood flow to the extremities, creating a feeling of coldness, numbness, tingling, or pain in the hands, feet, or both. In severe cases, peripheral artery disease can lead to tissue death.

Treatment for peripheral artery disease often includes lifestyle changes, such as exercising and quitting smoking. Some people also need surgery.