Carol it is hard to pinpoint exactly at what age I was when I started to feel low energy and fatigue. I know in my teens I would walk to and fro' high school and sometimes even walk home at lunchtime if I needed something. So I obviously had boundless energy then. I know that sports at school would knock me and take me quite a while to recover.
Don't get me wrong, I have the core constitution of my mother which is to go, go, go but I have limitations that my mother doesn't or didn't have until very recently and she's 83. She often makes my CAH sister and I feel so inadequate (our self imposed judgement not hers), as do our non-CAH siblings.
However when I was in my twenties and thirties and trying to get pregnant I recall my endo at that time who was also a reproductive endo offering me clomid and IVF. My paramount concern was (as it was relatively early days of reproductive technologies), there was significant risk of having a multiple birth and as I felt so fatigued much of the time I felt I couldn't cope with twins/ triplets etc. So we declined the repeated offers of my endo for over a decade. Consequently, as you know we never had any birth children although we did adopt a beautiful little baby boy. I coped well with one baby although my husband was very helpful at night when the baby woke on those occasions I couldn't summon any energy to get up.
So somewhere between my teens and probably late twenties this fatigue set in. It wasn't constant but almost so.
Regarding medications I take Prednisolone 6mgs. This I now believe is the absolute nadir for me which doesn't leave me any margin at all when other stressors arise. I have tried several times to decrease to 5.5mgs and it always fails. On this dose of 6mgs which I take at twelve hourly intervals at about 3-4am and 3-4 pm, I feel ok but I take other supportive meds which may have contributed to my new found energy.
I think in an above message I mentioned I take DHEA because of longterm undetectable levels but an endo last year found that I also had very low urinary T3 levels, one cause of which can be cortisol excess according to the explanation acompanying the results. So whether that means the low T3 is due to iatrogenic causes such as excessive replacement corticosteroid (because it certainly isn't due to excess endogenous cortisol) or because of problems converting T4 to T3 which the explanation also suggests can be caused by androgen and growth hormone deficiencies presents some interesting scenarios which are all possibilities.
I now also take thyroid replacement so perhaps all of these combined factors are helping to pull together some long aberrant levels. One doesn't expect to get more energy as one gets older unless there are specific and correctable reasons for the fatigue in the first place.
Sorry for the long ramble but there seems to be many potential unexplored avenues with this condition which are interesting to tease out.
