Do You Really Need to ‘Balance’ Your Cortisol Levels for Better Health?

  • Cortisol, most commonly known as the stress hormone, is a popular conversation point in the wellness space.
  • Experts agree that while too much or too little cortisol provides specific problems, the term “cortisol imbalance” is not a legitimate medical term.
  • To test cortisol levels, individuals should seek advice from a healthcare professional with hormonal expertise.

A new wellness topic is trending on social media: cortisol levels and how individuals can balance those levels for the sake of bettering their health.

Cortisol, most commonly known as the stress hormone, is a delicate conversation. It makes sense why people would debate “the perfect balance” of this hormone, but medical professionals are hesitant to lean into the social media world’s terminology.

Cortisol is a complex hormone that is difficult for doctors to assess and manage, “it seems highly unlikely that influencers would have the experience and knowledge to provide sound advice,” Lawrence Kirschner, MD, PhD, an endocrinologist at The Ohio State University Wexner Medical Center, told Health.

Dr. Kirschner explained that many times if a person doesn’t feel well, they want validation that their symptoms have a clear medical explanation. 

“Something like ‘cortisol imbalance’ is a term that sounds like something from a medical textbook. However, it isn’t a term that has a real meaning in a medical sense,” he noted. “Thus, any discussion of ‘cortisol imbalance’ as a medical condition is based on a piece of medical misinformation.” 

Since cortisol imbalance is not a valid medical diagnosis, he noted that reports describing a “treatment” are also a form of misinformation.

Still, cortisol levels can be too high or too low—but determining this is more complex than influencers may lead many to believe. Here’s everything you need to know about this hormone—and how to separate the facts from the fiction you see online.

What Is Cortisol?

Cortisol is a stress hormone that can appropriately raise sugar in the bloodstream, help convert glucose to energy, and assist in fight-or-flight situations. Cortisol is produced and regulated in adrenal glands located near the top of the kidneys. These glands affect both the central nervous system and the endocrine system.

“It is important to understand that cortisol acts in just about all tissues in the body, although these actions can be very different in different tissues in the body,” Dr. Kirschner explained. 

Cortisol can affect the following organ systems:

  • Nervous
  • Immune
  • Cardiovascular
  • Respiratory
  • Reproductive
  • Musculoskeletal
  • Integumentary

According to Dr. Kirschner, many factors regulate cortisol secretion, including time of day, stress (including physical, social, and emotional stress), medical conditions, medication use, and alcohol and other drug use.

Medical Conditions and High Cortisol

When cortisol isn’t regulated properly, it can lead to too much cortisol in the body, and in some cases excess disorders, such as Cushing’s syndrome.

“If you have too much cortisol, like in Cushing’s syndrome, it raises blood pressure, causes weight gain in your trunk and face, causes muscle weakness, easy bruising, thinning skin, irregular periods in women, acne, hair loss,” Caroline Messer, MD, an endocrinologist at Northwell Health, told Health

The most common cause of Cushing’s syndrome is the long-term term use of medications used to treat conditions like asthma, rheumatoid arthritis, and lupus. However, in some cases, an individual’s body may make too much cortisol due to tumors.

“We’re finding out more and more that for a lot of these patients, it tends to be a small adrenal mass that is over-secreting cortisol and it can really easily be overlooked for somebody’s whole life,” explained Dr. Messer.

If a tumor is determined to be the cause of excess cortisol, it is removed surgically.

“Because tumors that produce cortisol excess cause the normal system to ‘shut down,’ people are often given replacement steroids after tumor removal until their own system wakes up, a process which can take a few months up to two years, or sometimes longer,” noted Dr. Kirschner.

For those who can’t undergo surgery or if surgery doesn’t cure the excess cortisol, Dr. Kirschner explained that other options include medications that block the production or action of cortisol, and radiation (or rarely chemotherapy) to try to kill any remaining tumor. In rare cases, the adrenal glands are removed.

What Does It Mean to Have Low Cortisol?

When the body doesn’t make enough cortisol, this could be due to conditions like Addison’s disease. Fatigue, muscle weakness, loss of appetite, weight loss, and abdominal pain are symptoms of low cortisol.

“When there’s too little cortisol, which is a condition called adrenal insufficiency, you can’t maintain normal blood pressure, so you start having really low blood pressure, vomiting, lose appetite, sodium starts to drop,” explained Dr. Messer. 

Treatment for low cortisol is medication like hydrocortisone, which replaces the cortisol.

Lifestyle Habits That Affect Cortisol Levels

People who are under high stress, have inflammation, are overweight, or have diabetes or alcoholism may have mildly elevated cortisol levels that are not caused by medical conditions like Cushing’s disease, Dr. Messer noted.

When higher levels of cortisol are present but not pathological, doctors refer to this as pseudo-Cushing’s.

“In these cases, we try to treat the underlying cause—help you lose weight, lower blood sugar, decrease inflammation, decrease stress, help you drink less, etc.,” Dr. Messer continued.

While there isn’t medication to bring down cortisol levels, if there were, she noted that it wouldn’t change the underlying causes that raised it in the first place.

Pseudo-Cushing’s might be what is driving most of the social media attention around “balancing” cortisol, suggested Dr. Kirschner.

“Since cortisol is rarely out of ‘balance,’ restoring ‘balance’ isn’t something that most medical professionals will consider,” he said. “Much of the ‘cortisol imbalance’ talk really relates to people who don’t feel well, whether that is energy, stress, weight gain, anxiety, and so on.”

For these people, once serious medical conditions are ruled out, the best way to improve their health is often through general wellness activities like regular exercise, a healthy diet, time with family and friends, and quality sleep, added Dr. Kirschner. 

Testing Cortisol Levels

Telling the difference between “normal” and “abnormal” cortisol levels can be challenging, often requiring complex testing best handled by a healthcare professional experienced in hormone health.

According to Dr. Kirschner, cortisol levels are typically tested in the blood, saliva, or urine, although levels can also be measured in tissues like hair. Because hormone levels vary throughout the day and are highest in the morning, the timing of the testing is important for proper diagnosis.

For instance, when checking for high levels of cortisol, doctors recommend testing when cortisol levels are the lowest, which is between 11 p.m. and midnight. However, labs are not open during these hours to draw blood, so Dr. Messer recommends giving patients saliva tests that they can do at home during those hours.

Using more than one method to test is also crucial, she reiterated, because many medications (like birth control) can lead to elevation of the protein that is analyzed to evaluate cortisol levels, leading to false positives.

Giving a steroid late at night and checking cortisol levels the next morning is another way of testing, Dr. Messer added.

“The idea behind that is if we’re giving you a steroid then your body doesn’t need to produce cortisol, so cortisol should be suppressed the next morning, but if it doesn’t get suppressed the next morning then there’s an issue and we have to evaluate further,” she explained.

If cortisol levels are determined to be pathologically high, then imaging of the pituitary or adrenal glands might be conducted.

“The most important thing is not to be terrified if your cortisol comes back slightly elevated,” encouraged Dr. Messer. “It’s very likely that it’s not Crushing’s disease and with proper testing, we can tell [what caused it] and help you lower it naturally.”


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