Cortisol, often labelled the body’s “stress hormone”, has become a popular fixation across social media and wellness platforms. Influencers regularly link it to poor sleep, facial swelling and stubborn belly fat, often offering supplements or lifestyle plans that claim to bring levels back under control. Doctors, however, say most people have little reason to worry.
Far from being harmful, cortisol is essential for survival. Produced by the adrenal glands above the kidneys, the hormone plays a vital role in regulating blood pressure, metabolism, inflammation, immune response and how the body reacts to stress. It also follows a natural daily rhythm, rising in the morning to help you wake up and gradually declining at night to support sleep.
“Our cortisol level is regulated by the minute,” said Dr Roberto Salvatori, an endocrinologist at Johns Hopkins University. “It is very sensitive.” Levels also rise temporarily when the body is under physical or emotional strain, such as during illness or acute stress — a normal and necessary response.
True disorders related to cortisol are relatively rare. Chronically low cortisol levels may indicate adrenal insufficiency, including Addison’s disease, an autoimmune condition in which the adrenal glands are damaged. Excessively high cortisol levels are seen in Cushing’s syndrome, often caused by benign tumours in the adrenal or pituitary glands. Treatment typically involves medication, surgery or both, and diagnosis requires careful monitoring.
Symptoms associated with cortisol disorders are broad and often overlap with other health conditions. Fatigue, weight changes, blood pressure fluctuations, sleep issues and changes in body fat distribution can all stem from multiple causes. As a result, diagnosing cortisol-related conditions usually involves repeated testing through blood, saliva or urine, alongside a detailed understanding of a patient’s medical history.
“There’s a lot of nuance to interpreting cortisol,” said Dr Katie Guttenberg, an endocrinologist at UTHealth Houston. She cautioned against people ordering cortisol tests on their own, noting that a single blood test is rarely useful and may lead to unnecessary anxiety. Certain medications, including hormonal birth control, can also skew results.
Doctors are equally wary of supplements marketed as cortisol-lowering remedies. Despite widespread claims about ingredients such as ashwagandha or magnesium, endocrinologists say there is no solid evidence that over-the-counter products can safely regulate cortisol levels. Unregulated supplements may even pose risks.
“They’re not innocuous,” warned Dr James Findling of the Medical College of Wisconsin, adding that even prescribed treatments for high cortisol must be carefully managed to avoid dangerous side effects.
There are situations where cortisol may be elevated without an underlying tumour, sometimes referred to as “pseudo Cushing’s syndrome”. This can be linked to conditions such as chronic alcohol use and is typically treated by addressing the root cause rather than the hormone itself.
For most healthy people, doctors say the focus should shift away from hormone-hacking trends and back to basic wellbeing. Eating balanced meals, sleeping well, staying active and seeking mental health support when needed remain the most reliable ways to manage stress.
“Nothing new about any of that,” Findling said.
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