@sdcgcarroll My feeling is that you are better off with a doc who is conservative about when to start HU as long as he's factored in all clot risks (age, mutation type, prior clot history, etc). Hoping you can find ways to fight your fatigue. It is life-altering, but because it can't be seen, palpated, heard with a stethoscope, or measured in a lab, doctors tend to ignore it.