Cortisol is a hot topic these days, especially as many struggle to manage their stress. You may also have heard of the term “cortisol face” or “moon face,” which can be attributed to high cortisol levels.
“Cortisol is a hormone produced by the adrenal glands that helps regulate your metabolism, blood sugar, inflammation, blood pressure and sleep-wake cycle,” explains Dr. Mark Hyman, co-founder and CMO of Function Health, which offers a cortisol lab test. “It’s most known for managing the body’s response to stress.”
But what exactly does a cortisol imbalance look like, and how does it affect the body? To find out, we consulted doctors for symptoms, causes, when to see a doctor for cortisol testing and how to regulate cortisol.
What is cortisol?
“Cortisol is a hormone produced by your adrenal glands in response to stress,” says Dr. Fady Hannah Shmouni, medical director at Eli Health, which sells an instant cortisol test. “When a stressful situation arises, cortisol can help your body prepare to respond by increasing energy, focus or alertness.”
Shmouni states that in the short term, your body’s cortisol response is necessary and helpful. However, chronic stress can cause cortisol to remain elevated, which can negatively affect your organs, including your brain. For instance, elevated cortisol can disrupt sleep, increase inflammation or impair memory.
Dr. Andy Franklyn-Miller, a dual board-certified sports and exercise medicine physician, adds that cortisol is like your body’s built-in alarm system and is often called the “stress hormone.”
“Cortisol is part of the glucocorticoid family, and it’s released as part of the hypothalamic-pituitary-adrenal (HPA) axis, your body’s stress response headquarters,” Franklyn-Miller says. In the morning, your cortisol spikes to help you get moving. At night, it dips to help you rest.
Where the adrenal glands are located.
Symptoms of cortisol imbalance
“Cortisol imbalances often go unnoticed until symptoms become disruptive,” explains Hyman. “If you feel wired at night, crash mid-afternoon or struggle to get restful sleep, your cortisol could be out of sync.”
Franklyn-Miller adds that it can be difficult to spot a cortisol imbalance, since it can mimic other conditions. However, telltale signs include persistent fatigue, trouble sleeping or unexplained weight changes. “Home wearables tracking heart-rate variability, such as Whoop, Oura or Apple Watch, can also give indirect clues, as low HRV often correlates with cortisol dysregulation due to stress and a reduction in HRV,” he says.
Symptoms of high cortisol
“Under normal conditions, your cortisol levels peak in the morning to help you wake up and then gradually decrease throughout the day,” Shmouni explains. “But if you experience chronic stress, your body may make excess cortisol, and one of the most common ways this shows up is in disruptions to energy patterns.”
Some common symptoms of high cortisol, according to Shmouni, include nighttime sleep disturbances, energy dips caused by blood sugar spikes and crashes, and feeling constantly tired. Hyman adds that chronically high cortisol can also lead to:
- Anxiety and irritability
- Weight gain
- Sleep disruptions, fatigue
- High blood pressure
- Frequent illnesses due to a weakened immune system
Over time, Hyman states that elevated cortisol can cause more serious problems, like cardiovascular disease, insulin resistance and cognitive decline.
High cortisol is often connected to conditions like Cushing’s syndrome or chronic stress, according to Franklyn-Miller, who adds that weight gain can be especially noticeable in the midsection and face (also known as “moon face”). You can experience osteoporosis and muscle loss, since cortisol can break down tissue over time, or skin changes, like thinning skin, bruising easily or stretch marks.
Symptoms of low cortisol
Hyman states that low cortisol symptoms often include:
- Fatigue that doesn’t improve with rest
- Low blood pressure
- Cravings for salt or sugar
- Dizziness upon standing
- Mood swings or depression
“Low blood pressure, fogginess, weight loss and muscle weakness can occur; any serious symptoms are a sign that you should consult your doctor, as they could mean a more serious adrenal issue (like adrenal insufficiency) is at play,” advises Shmouni.
According to Franklyn-Miller, low cortisol is often seen in Addison’s disease. People with Addison’s disease may notice a darkening of the skin.
What causes a cortisol imbalance?
“There’s no single cause of cortisol imbalance — it’s a result of multiple stressors piling up,” says Hyman. “This can include: chronic psychological stress (work, relationships, trauma), poor sleep habits, blood sugar imbalances, overtraining without recovery, inflammation, infections and nutrient deficiencies, especially B vitamins and magnesium.”
Franklyn-Miller explains that the HPA axis is designed for short-term stress, so constant, long-term activation or suppression can lead to an imbalance.
Stress
If you deal with long periods of stress — caused by factors like a high-pressure job, financial struggles or family responsibilities — Shmouni says that cortisol can stay elevated in the body instead of fluctuating normally throughout the day.
“This can create a cycle whereby elevated cortisol is not appropriately managed, resulting in prolonged cortisol release,” he states. “If we don’t see that someone’s cortisol levels decline throughout the day, with a normal awakening response in the morning, it can be a sign that cortisol is dysregulated.”
Certain medications or medical conditions
If you deal with chronically elevated cortisol levels, Shmouni says that this may be a side effect of medications like steroid inhalers, as one example. On the other hand, Franklyn-Miller reports that long-term use of corticosteroid drugs (e.g., prednisone) can shut down natural cortisol production, causing low cortisol.
As Franklyn-Miller mentioned earlier, certain medical conditions, like Cushing’s syndrome, can also cause high cortisol. “Cushing’s syndrome, caused by tumors or excessive steroid use, floods the body with cortisol,” he reports.
When it comes to low cortisol, it may be caused by adrenal insufficiency. “Conditions like Addison’s disease damage the adrenal glands, slashing cortisol production,” Franklyn-Miller explains. Autoimmune disorders can also cause low cortisol, as the body attacks its own adrenal glands and reduces cortisol output.
Your lifestyle: Sleep, exercise and nutrition
“Poor sleep, overexercising or a high-sugar diet can spike cortisol by stressing the body,” says Franklyn-Miller.
When planning your workout, consider your stress and sleep. If you had trouble sleeping last night and are dealing with high stress at work, it may not be the best time for an intense workout. If you find that a workout leaves you feeling fatigued or sick, you may be going too hard.
In addition to a high-sugar diet, alcohol and caffeine can also affect cortisol levels. For most adults, the FDA recommends 400 milligrams of caffeine or two to three 12-fluid-ounce cups of coffee. However, certain medications or conditions can make someone more sensitive to caffeine, so make sure to consult your doctor if you’re unsure.
According to the American Heart Association, it’s advised to limit alcohol to two drinks per day for men and one drink per day for women. The National Institute on Alcohol Abuse and Alcoholism explains that in the US, a standard drink contains 14 grams or about 0.6 fluid ounces of “pure” ethanol.
For sugar, the AHA states that men shouldn’t consume more than nine teaspoons of added sugar daily. For women, consumption should be no more than six teaspoons of sugar per day.
Ensure you’re eating a balanced diet filled with colorful fruits and vegetables, leafy greens, whole grains and protein. And of course, make sure you’re drinking enough water.
How to regulate cortisol
“Regulating cortisol is like tuning an instrument — it takes mindful adjustments to your lifestyle,” says Franklyn-Miller, who recommends the follow strategies:
- Prioritize sunlight exposure after waking up: “Only 20 minutes can stimulate your circadian release of cortisol, helping with body balance.”
- Focus on sleep: “Stick to a consistent sleep schedule.” In general, 7 to 9 hours of sleep is recommended, but it depends on your age.
- Manage stress: “Practices like mindfulness meditation, yoga or diaphragmatic breathing can calm the HPA axis.”
- Exercise smart: “Moderate exercise, like walking or yoga, balances cortisol, but overtraining can spike it. Aim for 30 minutes most days.”
- Eat balanced meals: “Avoid high-sugar diets, which can elevate cortisol. Focus on whole foods, like vegetables, lean proteins and healthy fats. Omega-3s, found in fish, may lower cortisol.” Hyman also recommends prioritizing fiber.
- Limit caffeine: “Too much coffee can mimic stress, raising cortisol. Try cutting back after noon.”
When should you see a doctor about cortisol levels?
“If you experience significant symptoms that interrupt your ability to participate in daily activities, or if you experience extreme changes in appetite, energy, mood or sleep, bring this up with your medical provider so that they can work with you to manage symptoms and make lifestyle adaptations,” advises Shmouni.
Franklyn-Miller adds, “Also, if lifestyle changes (better sleep, stress management) don’t improve symptoms after a few months, or if you’re on long-term steroids, get checked.” He explains that the gold standard for checking cortisol is through lab tests for blood, saliva or urine samples. For these, consult your doctor.
Shmouni states that common signs of dysregulated cortisol include: Physical aches and pains, feeling mentally “checked out,” appetite changes, chronic fatigue or low energy, difficulty concentrating or brain fog, increased use of alcohol or caffeine, stretch marks, weight changes, mood swings or irritabilities, trouble sleeping or feeling exhausted even after a full night of rest.
“That said, while these signs can indicate your cortisol is working overtime, short-term changes don’t necessarily equate to dysregulated hormones,” Shmouni explains. “To determine if you’re experiencing chronic dysregulation, a further hormone evaluation (whether through an at-home test or a lab at your doctor’s office) might be needed.”
Symptoms of too much cortisol include nighttime sleep disturbances, energy dips, constant fatigue, anxiety and irritability, weight gain, high blood pressure and frequent illnesses due to a weakened immune system.
Adjusting your lifestyle can fix cortisol levels. Focus on sleep, stress management, a balanced diet, the right amount of exercise and limiting caffeine.
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