What Is Cortisol and When Should You Be Concerned?

Cortisol is a naturally occurring hormone produced by the body’s adrenal glands. Though it is popularly known as the “stress hormone,” cortisol is necessary for key body functions. A person’s cortisol level fluctuates throughout the day, and high cortisol only becomes a cause for concern in very rare conditions.

The best approach to cortisol management is to address the causes of stress that trigger an increase in the hormone’s production.

“It’s very common for our cortisol levels to rise and fall,” said Cedars-Sinai endocrinologist Natasha Malkani, MD. “For the vast majority of us, the most direct and impactful way to even it out is to get our stress under control.”

What Does Cortisol Do in the Body?

Cortisol is a steroid hormone manufactured in the adrenal glands.

“Our bodies need these hormones,” said Nabeeha Siddiqui, MD, a family medicine doctor at Cedars-Sinai. “Cortisol is responsible for maintaining constant blood pressure and blood sugar levels, regulating the immune system, curbing inflammation and dictating our fight-or-flight response.”

Cortisol levels naturally fluctuate throughout the day. Stress causes a rise in cortisol production, but the increase is typically temporary and doesn’t necessarily indicate a larger health problem, Malkani said.

“Just because a person’s cortisol level spikes at a given moment in time, which is a normal response to life stress, it does not mean they will have high cortisol forever,” she said. “In fact, having too much—or too little—cortisol is actually quite rare.”

Signs and Symptoms of High Cortisol or Low Cortisol

A doctor can check cortisol levels with a blood test, but this is usually only necessary when a person has very specific symptoms.

Cushing’s syndrome is a rare condition that occurs when a person has high cortisol levels for a long time. It can cause symptoms such as bruising on the stomach, high blood pressure that is difficult to control, increased fat distribution on the collarbone and the back of the neck, and weak arm muscles.

Adrenal insufficiency—another rare disorder—can cause low cortisol and is generally accompanied by symptoms such as sudden and unexplained weight loss, fatigue, nausea, vomiting, low blood sugar and lightheadedness.

“These symptoms tend to be pretty dramatic, and if patients are experiencing them, they should have their doctor test their cortisol levels to assist with diagnosis,” Malkani said. “Otherwise, I would urge them not to be overly concerned about cortisol. Feeling stressed about the stress hormone will only lead to more stress.”

Can You Lower Cortisol?

Most often, high cortisol is simply correlated to the stressors people encounter during the course of an ordinary day. You can help keep cortisol levels in check by developing constructive stress-management techniques.

“When I see a patient who is concerned about cortisol and stress, I want to know what their lifestyle is like. We discuss getting regular exercise, eating a balanced diet and practicing good sleep hygiene, along with seeking help, if needed, to manage their mental health—which is also very important in stress control,” Siddiqui said. “Getting yourself into a good rhythm with those things can dramatically lower stress and is an essential component of effective preventive care.”

Many websites and holistic practitioners tout the benefits of natural remedies for cortisol reduction (such as coconut water, apple cider vinegar and rhodiola), but Siddiqui pointed out these remedies are not backed by evidence.

“People should stick with the science,” she said. “What the data suggests is that when stress goes up, cortisol does, too. So, the most direct and impactful way to get those levels down is to make sure we’re taking care of ourselves.”

A Proactive Approach

The bottom line when thinking about cortisol: Prioritize healthy lifestyle choices, and don’t skip routine checkups with your primary care doctor.

“Having good coping skills is critical to keeping stress low,” Malkani said. “Rather than worrying about cortisol, people should focus on building stress-reduction strategies. Also, they should check in with their doctors regularly to ensure they are staying on top of emerging health concerns. Working together, we can manage stress and cortisol to help patients stay healthy over the long term.”