Breaking down the truth about cortisol
At a glance
- Cortisol helps your body respond to stress and regulate salt, water and blood pressure
- Commonly confused symptoms like fatigue/bloating are usually lifestyle-related, not cortisol imbalances
- Avoid social media myths; talk with your provider if symptoms are severe and persistent
You’re scrolling on social media and see a post that says, “If you have the following symptoms, you need to lower your cortisol levels.”
Those symptoms include bloating — especially in the face — fatigue, acne or weight gain. The confusing part is that these symptoms can be caused by many things, not just one hormone.
Your tiredness or skin conditions might be more about lifestyle and stress than a health problem, says Nabonita Barua, MD, with MultiCare Endocrinology Specialists in Tacoma.
“People are fatigued for a lot of reasons,” adds Carol Wysham, MD, with MultiCare Rockwood Clinic Endocrinology and Diabetes Education. “People want a reason for it that is easy to explain and fix … and there are plenty of people out there who will feed on that and give them an unnecessary test or treatment plan.”
Public conversations like this come and go, adds Dr. Wysham. In the 1980s, it was low blood sugar, and in the 1990s, yeast infections. Social media can make these conversations seem even louder and more confusing these days.
Resist the urge to jump to conclusions based on a few things you heard online. Dr. Wysham and Dr. Barua recommend tracking your symptoms and bringing concerns to your primary care provider.
To help you understand, we broke down what you need to know about cortisol.
What is cortisol?
Cortisol, also known as the fight-or-flight hormone, is produced in the adrenal gland. It helps your body respond to stress and fight infection, says Dr. Barua. It also helps regulate salt, water and blood pressure, adds Dr. Wysham.
Because it’s involved in so many important processes, cortisol can have a significant impact on life-sustaining functions and overall quality of life.
What causes cortisol abnormalities?
The best way to find out what’s causing your symptoms and check your cortisol levels is to talk to your provider and complete any tests they recommend.
A blood test will be the first step, although cortisol can be tricky to measure, Dr. Wysham warns. Cortisol is released in bursts and is highest in the morning. A single cortisol test may not be enough to determine your normal range. So, you may need to have multiple blood draws or do salivary tests throughout the day to track levels.
If tests show abnormal levels, your doctor or other health care provider will request imaging of the adrenal and pituitary glands.
If you truly have low or high (hyper) cortisol, there’s likely a physical cause, such as a mass on the adrenal or pituitary glands, Dr. Barua explains. This would require surgery to remove. A traumatic injury to your adrenal gland could also affect your cortisol levels, Dr. Wysham adds.
Additionally, some medications and treatments may affect adrenal and pituitary glands. For example, taking prednisone for more than a few weeks could suppress adrenal glands and result in lowered cortisol levels, Dr. Wysham explains.
What are the signs of high and low cortisol?
Some of the most common symptoms of elevated cortisol:
- Bloating in the face (aka moon face)
- Weight gain
- Muscle weakness
- Anxiety
- Uncontrolled high blood pressure (hypertension)
- Prediabetes or diabetes
- Poor wound healing
- Acne
- Pink or purple stretch marks on thighs, stomach and hips from rapid weight gain
Long-term high cortisol may also cause thinning of the skin, excessive bruising, hair loss or, for women, unwanted facial hair.
Because of cortisol’s anti-inflammatory properties, people with low levels may experience:
- Fatigue
- Dizziness
- Low blood sugar (hypoglycemia)
- Abdominal pain
- Nausea
Low cortisol may also cause unintentional weight loss, loss of appetite and/or improper or inadequate response to trauma.
If not cortisol, what else could be causing my symptoms?
If your provider finds no physical issues, they will check for other possible conditions or habits.
Many things can produce symptoms that mirror low or high cortisol, including:
- Lack of sleep
- Obesity
- Lack of (or excessive) physical activity
- Alcohol consumption
- Depression
- Long-term uncontrolled diabetes
- High or long-term stress
Healthy adrenal glands (meaning, there’s no underlying condition) will continue producing cortisol no matter how much stress you experience, Dr. Wysham says. Your symptoms may just look similar to those of a cortisol imbalance.
What are the biggest myths about cortisol?
“There are more falsehoods than truths in these conversations,” Dr. Wysham says. “Yes, we’re learning more, and there are more subtle manifestations of low or hyper cortisol, but we can figure those out with routine testing.”
Your body contains nearly 1,000 different hormones that change daily or even hourly, she adds. For people with menstrual cycles, those variations can be even more dramatic throughout their cycle.
The key things to remember:
- The only way to know if your cortisol is abnormal is through testing with your doctor or other health care provider
- More often than not, symptoms are a result of lifestyle habits or conditions, not cortisol.
- True signs of abnormal cortisol will be long-lasting (constant bloating or redness in the face, rather than just occasional).
- If you’ve made long-term lifestyle changes and symptoms haven’t resolved, it’s time to see your provider.
What's next
- Avoid these other common social media health trends and myths
- See how MultiCare’s endocrinology team can care for you
- Looking to lower your stress? Have you tried reading?
