It’s hard to be the person who is always freezing — perpetually chilly people are often coldly received.

Our discomfort is frequently written off and pleas to raise the thermostat denied because, the argument usually goes, it’s easier for us to put on extra layers than it is for uncomfortably warm people to remove them. Summers in an office building are a special level of hell, forcing us to commute between pleasant warmth and arctic frost. Sweaters, blankets and hot mugs of tea are only temporary solutions, which leads us to ask: What is the problem exactly? Why am I always cold?

So much blood

There are plenty of medical conditions that could make someone feel cold, perhaps the most well-known being anemia. The blood disorder is caused by a shortage of red blood cells, which carry oxygen throughout the body; one of the functions of these cells is the regulation of body temperature. Symptoms of anemia that the Mayo Clinic lists include: cold hands and feet, as well as fatigue, shortness of breath, dizziness and others. Anemia has a variety of underlying causes, including iron deficiency, infections, other diseases like cancer or kidney disease, and genetics.

Another blood-related cause of being cold is hypotension, or low blood pressure. That low pressure means less blood — and thus less oxygen — is flowing to the organs and extremities, which can make a person feel cold. The U.S. health department’s National Heart, Lung and Blood Institute notes other symptoms of the condition that are similar to those of anemia: dizziness, fainting, fatigue, nausea and blurred vision. Most dangerous is a severe form of hypotension called “shock,” which can be fatal and occurs when the lack of blood flow damages organs, according to the U.S. National Library of Medicine.

In the same vein there is also Raynaud’s Phenomenon, a restriction in blood vessels that could make someone feel cold, among other symptoms. Although many things can cause Raynaud’s, such as lupus, carpal tunnel syndrome or certain medications, the most ironic listed at the National Institute of Arthritis and Musculoskeletal and Skin Diseases is when it’s caused by living in a place that is often cold.

Gland to meet you

The pesky thyroid or pituitary glands could also be cold culprits. With both glands, that would mean they are not active enough. An autoimmune disease and radiation are two of the most common sources of hypothyroidism, according to the American Thyroid Association. People without enough thyroid hormone often feel colder, fatigued, forgetful and depressed, and could have dry skin and constipation.

The thyroid gland is located in the neck and is stimulated by the brain’s pituitary gland, so hypopituitarism, underperformance of that latter gland, can also cause much of the same issues as a low-functioning thyroid, among many other problems.

Not just in our heads

Cold extremities are just another side effect of the anxiety devil. notes that anxiety is linked to humans’ “fight or flight” instinct, and so during times of high stress will direct blood toward the core organs and away from the extremities in order to protect what is most important for survival.

Other mental agitators and illnesses can lead to feeling cold as well, such as with the eating disorder anorexia — starving the body can cause low blood pressure and slow the metabolism, both of which can lower body temperature.

Everyone else

Feeling cold could be a secondary symptom in some cases. For example, diabetic nephropathy, a kidney disease stemming from diabetes-caused organ damage, can lead to anemia. But for those of us who don’t have any of these conditions, it must be that our office thermostats cater to someone else’s body temperature, or that our running temperatures are different from the average person. And that’s nothing to be ashamed of. The next time a Warmie tries to make you feel guilty for always feeling cold, tell that person to direct all complaints to your cold, cold heart.