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During the 2020 Annual Meeting of the Society of Hematologic Oncology (SOHO), the MPN Hub was pleased to speak to Gabriela Hobbs, Massachusetts General Hospital, Boston, US. We asked: How would you manage a young man with polycythemia vera (PV) and fatigue? Although risk-stratification scores for cytoreduction therapy for PV only take into account thrombosis, knowledge of additional systemic symptoms are key for the management of patients with PV. Fatigue is the most common symptom of PV, and Gabriela Hobbs emphasizes the importance of good sleep hygiene, managing comorbidities, and adopting a healthy lifestyle to optimize energy. For a young patient with PV, cytoreduction is usually the last port of call, however, there are some instances, as outlined in this interview, when individuals may be eligible.