Cortisol: The Body's Built-in Alarm System:

Most of us are aware that stress or anxiety affects us physically. We may notice an upset stomach, a faster heartbeat, or a “feeling” of being uneasy that sticks with us. You may not know that there are actual physiological causes for these symptoms.

Brace yourself—there will be a bit of science here, but I promise to break down the five-dollar words into bite-sized pieces. 

The Physiology of Stress: Unraveling the HPA Axis

Understanding the HPA axis, a crucial part of our stress response system, is key to comprehending how our bodies react to stress. When we encounter a physical or mental stressor, such as a bear about to attack us or the stress of being late for a meeting, the HPA axis is triggered. This axis, activated for both real threats and perceived threats, is responsible for the secretion of hormones. In other words, our glands are not discerning and cannot differentiate between a bear about to attack us and us being late for a meeting or thinking someone is upset with us and being worried about it. 

Many medical providers only recognize the problems elevated cortisol levels cause if they are above a certain threshold level, which is then called Cushing’s syndrome. However, other medical providers have begun to recognize that long-term elevated cortisol levels, even if they are not above this level to diagnose Cushing’s syndrome, can lead to different medical conditions. 

Even if you do not meet the diagnostic criteria for Cushing’s syndrome, it's crucial to understand that just having chronically elevated cortisol levels can lead to a range of health issues. These include weight gain in the upper back and abdomen, high blood pressure, increased bruising, muscle weakness, mood changes, high blood sugar, increased fatigue, headaches, and acne. These symptoms highlight the importance of managing stress and cortisol levels.

When Does Cortisol Become a Concern?

Before reaching the threshold for diagnosis of Cushing’s syndrome, you may notice symptoms of cortisol dysregulation. Cortisol helps with memory formulation, regulates metabolism, reduces inflammation, and regulates blood sugar. There are different reasons why your body may produce too much cortisol. As I previously mentioned, chronic stress is frequently associated with elevated cortisol levels. 

Some medications can affect cortisol levels. The primary class of medication known to affect cortisol levels is corticosteroids. These treat asthma, arthritis, cancer, lupus, and other autoimmune diseases. They may have names like prednisone, cortisone, methylprednisolone, or dexamethasone. This is not an issue if these medications are used for short-term (also called “burst” dosing) periods but when taken in high doses or for an extended time. Some studies show a link between oral contraceptives and cortisol levels. 

Testing for Cortisol: Understanding the Landscape:

I do not recommend at-home cortisol testing when considering cortisol levels. At a healthy baseline, cortisol levels vary throughout the day, and for a non-medical person, interpreting results can become confusing very quickly. When you begin adding in the symptoms that are usually the reason you feel the need for testing, your medical provider can direct you to the best testing option. 

For cortisol, the possibilities include blood, saliva, and urine tests. Some tests may consist of specific instructions regarding gathering urine first thing in the morning or collecting all your urine for 24 hours. Or you may need to receive a dose of medication the day before a blood draw the following day. 

Given the variation in cortisol levels throughout the day, the impact of various medications, stress, and sleep, and the baseline expected in various measuring methods, it is crucial to consult your healthcare provider about the best testing method for you. Additionally, the interpretation of test results should be done as part of your total clinical picture. This underscores the importance of professional guidance in cortisol testing and management. This is one more reason an at-home test is not something I recommend.

Partnering with Your Healthcare Provider for Optimal Cortisol Management:

Remember, you have the power to influence your cortisol levels. By discussing your concerns with your healthcare provider, you can take the first step towards optimal cortisol management. This is especially important if you are dealing with chronic stress, disordered sleep, the medications mentioned above, or something else affecting your cortisol level. Without a physical cause for your glands to give you more cortisol than you need, you will likely need to focus on lifestyle modifications. 

These lifestyle modifications may include stress management techniques like therapy and medication to help with stress and anxiety if needed. If your sleep is so disordered that it is affecting your health, then you may need some testing or medication to help with this as well. 

The important thing is that you and your healthcare provider will need to work together to achieve the best health outcomes possible for you. Suppose your traditional medicine provider is not listening to you regarding concerns about elevated cortisol levels. In that case, you may need to seek out a provider with a more holistic approach.

1. _{Herman, J. P., McKlveen, J. M., Ghosal, S., Kopp, B., Wulsin, A., Makinson, R., Scheimann, J., & Myers, B. (2016). Regulation of the Hypothalamic-Pituitary-Adrenocortical Stress Response. Comprehensive Physiology, 6(2), 603–621.} 
2. _{Karin, O., Raz, M., Tendler, A., Bar, A., Korem Kohanim, Y., Milo, T., & Alon, U. (2020). A new model for the HPA axis explains dysregulation of stress hormones on the timescale of weeks. Molecular systems biology, 16(7), e9510.}
3. _{U.S. Department of Health and Human Services. (n.d.). Cushing’s syndrome - NIDDK. National Institute of Diabetes and Digestive and Kidney Diseases.}