In This Article
In This Article
If you are feeling tired in the morning, too awake in the evening, and tense throughout the day, it is possible that you have high cortisol levels.
Cortisol is commonly known as the “stress” hormone because of its role in the body’s response to stress.
When your body is in “fight or flight” mode, cortisol tells your body to burn stored sugars for extra energy while also keeping your mind alert for danger.
Cortisol, however, is not just used in such situations.
It is a type of steroid hormone called glucocorticoids. “Gluco” refers to their role as a primary regulator of glucose metabolism or the conversion of sugars to energy. “Corti” refers to the adrenal cortex, which is a part of the adrenal glands that produce cortisol and other glucocorticoids.1
All glucocorticoids play a role in managing the body’s metabolism, stress response, and blood pressure. Cortisol, in particular, has a large effect on the sleep cycle and how your body responds to stress.
“Cortisol is responsible for a wide range of metabolism and processes that involve the immune responses,” explains our in-house medical expert, Dr. Rizza Mira.
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Some of the most common symptoms include fluctuating/unpredictable energy levels, tension, and headaches, among others. They can vary in terms of frequency and severity, depending on your levels.
Cortisol levels in both men and women naturally fluctuate throughout the day. For example, cortisol is typically at its lowest at night so that the body can achieve a calm state for sleep, and increases during the day.
Cortisol also spikes in response to acute stress such as in response to immediate danger. These sharp increases in cortisol are part of the body’s natural response to threats and should return to normal levels after the threat has passed.
In general, people assigned female at birth tend to produce less cortisol in response to stress than biological men.2,5 A comparatively very high cortisol response for women is potentially unnatural or a sign of medical concern.
When cortisol is unnaturally high regularly, it can cause several negative effects on the body. These effects include:
Overly high cortisol production means that your body is perpetually maintaining some level of alertness and stress. And yet, because of a disrupted sleep cycle and metabolism, you may still feel tired.
“This is true when the levels of cortisol are at their lowest point but are still at a high level for a normal individual,” says Dr. Mira.
The constant sensation of being in a fight-or-flight response can also take a toll on your mental health. This can produce a sensation of anxiety which may or may not have a clear trigger.
“Too much stimulation of this response can also cause behavioral disorders, that, overtime can cause a vicious cycle of mood disorders,” explains Dr. MIra.
Cortisol also affects mental health. Too much cortisol may act as a sign of the onset or increased severity of a mental illness such as anxiety disorder or depression.3 A mental health professional will consider the role of elevated cortisol production in any such symptoms.
Too much cortisol also affects reproductive health. Libido can decrease significantly while the body is in a high-cortisol state. Other symptoms of increased cortisol levels may also affect libido, such as insufficient sleep.
Stress can have a negative impact on both the ability to conceive and maintain a healthy pregnancy.4
Whether there is a stimulus for stress or not, as cortisol levels rise, so does the body’s stress response. Levels constantly being out of the norm may contribute to infertility.
The increased or abnormal production of any hormone also disrupts the production of other hormones. Any disrupted production of estrogen and progesterone can disrupt the menstrual cycle or affect fertility.
“High cortisol is the number one inhibitor of the hormone responsible for ovulation, sperm production and release, and other sex hormones,” says Dr. Mira.
Several factors can cause high cortisol levels, but chief among them may be chronic stress.
Chronic stress is when you experience an amount of stress regularly, typically due to your day-to-day situation. Unlike acute stress, which is an effect of sudden and unexpected danger, chronic stress results in prolonged stimulation of the fight-or-flight response.
Some factors that commonly cause chronic stress are a stressful job, persistent financial or romantic issues, some medications and medical conditions, and other frustrating environments.
Chronic stress causes the body to produce a higher-than-normal amount of cortisol over a prolonged period. As this becomes the norm, several symptoms mentioned above may begin to appear or worsen.
This can also cause “adrenal fatigue,” a currently non-medical term6 to describe a feeling of fatigue due to adrenal glands not being able to keep up with the demand of a constant fight-or-flight response.
This is especially true for biological women whose baseline cortisol response is already lower than that of men.2,5
Adrenal tumors or an enlarged adrenal gland (hyperplasia) could be one cause of elevated levels of cortisol.
An overactive pituitary gland can also have the same effect, as this gland produces adrenocorticotropic hormone (ACTH), which tells the adrenal gland how much cortisol to create.
Hormones in the body operate in a check-and-balance mechanism. Adequate signals should be sent to the pituitary gland so that just enough hormones can be produced. In adrenal hyperplasia, for example, the adrenals provide excess amounts of cortisol that are not sensed by the pituitary gland.
Dr. Rizza Mira
High levels of cortisol for an extended amount of time may also cause Cushing syndrome.7 Cushing syndrome is a set of symptoms that include:
Cushing syndrome is rare but may occur as a result of glucocorticoid treatments.
Cortisol tests are uncommon, but they may be necessary if you or your doctor believe that you may have abnormal cortisol levels.
Cortisol tests may also be called free cortisol, salivary cortisol, or urinary cortisol tests. This is because these tests may require a sample of your blood, saliva, urine, or any combination of the three to be more accurate.8
The nature of your symptoms may influence what type of test your healthcare provider recommends. You may also be instructed to take certain samples during a specific time of day.
Cortisol tests do not require fasting but may be done multiple times in a day or over several days for a more accurate reading. This is because cortisol level can fluctuate widely based on the time of day and immediate circumstances, such as when you are at work or at home resting.
Cortisol levels in the morning normally range from 5 to 25 micrograms per deciliter (mcg/dL), but this can still vary based on other factors.8 This is why taking multiple tests is sometimes important so your doctor or healthcare team can determine your normal range.
“Cortisol levels follow a circadian rhythm: highest in the morning and lowest at night,” explains Dr. Mira.
The results of a cortisol test may require taking other tests if your doctor thinks you have too much cortisol or too little.8 These tests include an ACTH stimulation test to check your adrenal gland health, a dexamethasone suppression test, or an MRI or CT scan to locate potential tumors and enlarged glands.
Apart from medical interventions, such as when cortisol levels are high due to adrenal gland tumors or other diseases, there are also ways to lower cortisol naturally.
“The first step to managing high levels of cortisol is determining the exact source of excess cortisol,” instructs Dr. Mira.
As the production of cortisol is the body’s response to stress, managing stress effectively can reduce it.
Therapy or consulting with a mental health professional may give you additional stress management techniques.
While cortisol affects sleep, achieving better sleep also, in turn, helps regulate levels of cortisol.
If any of the above-listed symptoms of high cortisol are persistent (chronic) or high intensity (acute), then this may be a sign to consult a medical professional and get tested.
If you also have multiple symptoms of Cushing syndrome, this may be a clear sign of too much cortisol.
In particular, if fatigue, insomnia, or other symptoms begin to drastically impede your daily lifestyle, consider reaching out to your doctor.
Increased cortisol levels over a long period of time lead to other health complications such as high blood pressure, rapid weight gain, and worsening mental health. Diagnosing glandular problems and tumors early is important so they may still be effectively treated.
Treatment will depend on the source of increased cortisol levels.
Tumors in the adrenal gland are potential signs of adrenal cancer and require treatments such as radiation therapy and surgery. Chemotherapy may also be an option if the cancer has spread from the adrenal gland to other parts of the body.
There are also medications for the regulation of cortisol production. Your doctor will advise you to slowly stop taking these medications.
Other medications are metyrapone, levoketoconazole, osilodrostat, mitotane, or ketoconazole. These are antiglucocorticoid medications that suppress the production of cortisol and other glucocorticoids. Consult your doctor for the best treatment option for your case.
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