Explore next steps to improve your mental health. 
Have you given any thought to your cortisol levels lately? The so-called “stress hormone” is a popular topic that’s often blamed for a wide range of symptoms, including exhaustion, bloating, anxiety, brain fog, muscle cramps, and lack of focus. However, as with any health “issue” that gains traction on social media, it can be hard to know who to trust or what information is truly worth your consideration.
Our bodies have been flooded with cortisol since the earliest humans ran from tigers and bears to stay alive. So why is the hormone getting so much attention more recently? Here’s what you need to know.
What Is Cortisol?
Cortisol is a hormone made and released by your adrenal glands, two triangle-shaped organs that sit on top of each of your kidneys. It’s known as the “stress hormone” because it’s a primary player in your fight-or-flight response, or your body’s reaction to stress.
Cortisol also helps your body with many other important functions, including controlling blood sugar levels, regulating blood pressure, and reducing inflammation.
Your brain knows when there’s too little cortisol in your bloodstream, so it communicates with your adrenal glands to adjust their production and distribution of the hormone, depending on what your body needs. For example, cortisol is enmeshed in your sleep-wake cycle: Your brain signals your adrenal glands to release it to help you wake up. Cortisol levels peak in the early morning and then gradually taper throughout the day.
Simply put, your body relies on cortisol to carry out many vital functions, and your brain is constantly fine-tuning your levels.
How Cortisol Drives Your Stress Response
When you’re met with a physical or psychological threat, cortisol and other hormones spring into action, priming your body to face the threat or flee from it. The physiological reaction—mental alertness, higher blood pressure, a faster heart rate, rapid breathing—is designed to give your muscles the energy you need to get through a stressful scenario. That’s why nonessential body functions like digestion also slow down.
The thing is, your brain is a “really old machine,” says Kate Hanselman, a board-certified psychiatric mental health nurse practitioner at Thriveworks. It’s built to respond to life-or-death situations, like surviving in the wilderness. But our stressors look a lot different now than they did for our ancient ancestors.
“When we think about stress today, we’re not talking about being hunted by a pack of wolves. We’re talking about running late or feeling overwhelmed,” Hanselman says.
Millions of years ago, the fight-or-flight response helped humans hear cracking twigs, spot the wolves, and run or hide for safety. “In modern life, we don’t have as many opportunities to expel the impacts of cortisol,” Hanselman says. Meaning, you don’t actually run when your boss sends an anxiety-inducing email (as much as you’d probably like to). The email might cause a temporary cortisol spike, and that’s normal. Levels of the hormone naturally fluctuate, so once the tense moment passes, your body goes back to baseline.
High Cortisol Levels: When Is It a Problem?
It’s impossible to know if your cortisol level is a concern without seeing a primary care doctor or endocrinologist. Only a blood test can indicate if your cortisol levels are abnormally high. If that happens, your doctor will likely screen you for a condition like Cushing’s syndrome (also called hypercortisolism), a rare disorder that occurs when your adrenals pump out too much cortisol for a long period. Cushing’s is usually triggered by long-term, high-dose use of oral steroid medications or benign tumors on the pituitary gland at the base of the brain.
Signs of High or Low Cortisol
Physical symptoms of Cushing’s syndrome are pretty distinct, Hanselman explains. Not everyone with the condition shows these signs, but they can include:
- Weight gain
- A fatty hump between the shoulders
- Increased fat around the neck
- Easy bruising
- Purplish stretch marks
- Hair loss, particularly in women
- High blood pressure
- Muscle weakness
- A rounder face
Experts sometimes see higher-than-normal cortisol levels in other hormone-related conditions as well, like polycystic ovary syndrome, which has been linked to an increased risk of depression, anxiety, and other mental health conditions.
On the flip side, it’s also possible to have low cortisol levels, leading to conditions like:
- Addison’s disease, when the adrenal glands don’t produce enough of the hormone
- Hypopituitarism, when the pituitary gland fails to tell the adrenals to produce the hormone
These conditions can lead to symptoms like fatigue, dizziness, low blood sugar, muscle cramps, weakness, and stomach upset. Again, a blood test is required to diagnose any conditions associated with high or low cortisol levels.
Common Misconceptions About Cortisol
When people post about cortisol on social media, they’re generally not pointing to a diagnosable condition. Rather, they’re talking about stress itself and usually conflate any negative health consequences with “high cortisol.”
If you’re chronically stressed—which happens when any type of stress goes on for weeks or months—you’ll feel physically and mentally unwell.
For example, when you’re working nonstop, dealing with a life transition, or recovering from a health scare, there’s often a cascade of mental and physical effects that can come with the stress, Hanselman says. You might have achy muscles, trouble sleeping, or brain fog, among other symptoms—and these don’t all come down to a single hormone.
Stress can cause you to freeze up as much as it can rev you up. You may be so drained that all you can do after work is lie on the couch and watch TV. So, understandably, you might notice some physical changes if you used to be more active after work. “Is it cortisol keeping weight on you, or is it your response to stress, regardless of what the hormone is doing, keeping weight on you?” Hanselman posits.
The bottom line: While it’s true that higher cortisol levels are linked to chronic stress, it’s also important to note that cortisol levels are not entirely within your control, nor are they a single issue to resolve—especially by taking the latest “hormone-balancing” supplements someone may promote on TikTok.
What to Do if You Think You Have High Cortisol
If you’re so stressed that you’re worried about your cortisol levels, speak with your doctor about your symptoms. “I recommend primary care first because that’s the place where they can rule out a lot,” Hanselman says. “They can run tests to tell you if it’s something diagnosable and treatable.”
Next, turn your efforts toward what you can control: reducing stress in general. If it’s bad enough that you’re seeking medical attention, connecting with a mental health professional might be more helpful to you than trying to figure it out alone. They can help you pinpoint the source of your stress, make lifestyle changes, and set attainable goals that support your mental health.
“I can’t tell you how many people come to me and say, ‘I’m stressed and I don’t know why,’ or ‘I’m stressed but I think I should be able to handle this,’ and we can actually recalibrate your expectations,” Hanselman says.
Clinician Cliffnotes (The TL;DR)
Having abnormally high or low cortisol levels is rare and tied to specific health conditions. On social media, the idea of high cortisol is often conflated with the physical and mental effects of chronic stress, which still warrant attention.
“If this topic is resonating with you, talk to your primary care provider and a mental health specialist,” Hanselman says. “We can help you figure out what it is, what it isn’t, and what to do about it.”
