This cortisol dysregulation idea has become a sort of mega-phenomenon, absorbing the power and anxieties of anything it touches. If you look up cortisol on TikTok, you’ll find weight loss tips, sleep hygiene tips, massage techniques, and more. You’ll be served videos not only on cortisol, but also on gut issues, mood issues, healing from trauma, smoothie recipes, menstrual cycle syncing, when you should and shouldn’t use caffeine, and just about any other health issue a woman might search for. (Sorry, men—most of this content isn't for you. Yet.)
Stepping away from TikTok-land for a moment to talk about actual physiology, cortisol is a hormone that we produce from our adrenal glands, which sit on top of our kidneys.
Besides epinephrine/adrenaline, the adrenal gland also produces hormones that regulate water and electrolyte balance, and small amounts of sex hormones. And—relevant to our topic today—they also produce cortisol. Where epinephrine is involved in momentary “fight or flight” reactions, cortisol is the hormone that helps us deal with stress in the longer term, like days to weeks or longer.
In other words, cortisol helps our bodies respond appropriately to stress, especially serious, life-threatening physical stress. If you’ve ever taken a glucocorticoid medication (with a name like cortisone, prednisone, or dexamethasone), or used hydrocortisone cream on a rash, those are all variations of cortisol.
What people say about cortisol on social media
We’ve covered some of the claims about cortisol above, but to give you a few more examples, here are some of the things healthfluencers say are signs that your cortisol is too high:
Being tired in the morning and “wired” or overthinking at night
Having belly fat or love handles (“cortisol belly”)
Cognitive difficulties like “brain fog” or trouble making decisions
Acne
Gut issues (any kind)
In reality, these symptoms aren’t specific enough to point to elevated cortisol, or to anything else, really. Some of these are common and minor enough that probably everybody experiences them sometimes; who doesn’t crave candy?
Others could signal serious medical issues if they are severe enough. For example, you might think you have a “moon face” if your normal face shape is round; that’s not actually a problem. But if your face has always been thin and then becomes round over the span of a few months or years, that’s a textbook symptom of Cushing syndrome; you should go see an endocrinologist.
This is “adrenal fatigue” all over again
The idea behind adrenal fatigue was that your body is so stressed it has burned out and stopped producing stress hormones; the symptoms include fatigue, weight gain, and cravings for salt and sugar. Sound familiar? Adrenal fatigue has been thoroughly debunked by scientists; the symptoms don’t even match the supposed cause.
Another phrase that’s now used, both by medical professionals and (perhaps more often) by TikTokers who are making shit up, is “HPA axis dysfunction.” Those letters refer to three parts of your body that are involved in regulating cortisol levels:
The pituitary (P) gland sits just below the hypothalamus, and when it receives CRH, it produces adrenocorticotropic hormone, or ACTH, to signal the cortisol-producing portion of the adrenal gland.
High cortisol causes the hypothalamus and pituitary to stop making, or to make less of, their respective cortisol-triggering hormones. If something in this system were to get screwed up—one of the components not properly responding to its signals, perhaps—that would be a problem. “HPA axis dysfunction” is an umbrella term (not a specific diagnosis) for ways that this can go wrong. On TikTok, though, it’s sometimes used as a drop-in replacement for “adrenal fatigue.”
Still, there are a few scapegoats. Since cortisol is often described (legitimately) as a stress hormone, the TikTok hormone gurus seem to assume that it affects everybody who feels stressed or leads a busy life—which is basically all of us. Caffeine is also mentioned in some of these social media posts, but there isn’t any strong evidence to suggest that your morning coffee is messing with your hormones.
"Cortisol levels in the blood are elevated after high intensity exercise, but these levels return to normal within an hour. We also adapt pretty quickly to high intensity exercise, as exercise physiologist John Hough points out here: Work from his research group showed that after 11 days of high-intensity cycling, those transient cortisol spikes got a lot lower. (Other research backs this up.) In other words, we get better at handling physiological stress the more practice we get—which any athlete or trainer could have told you. The cortisol release that’s triggered by exercise is just not considered to be a significant factor in weight gain, when you talk to actual endocrinologists (hormone specialists) or scientists who study exercise or metabolism."
What actually causes high cortisol
Here’s where we’ll make a brief stop in reality-land: There are medical conditions that cause high cortisol levels in the body, and these can be serious and even life-threatening.
So, slightly elevated cortisol as a result of normal life stresses is not usually a medical issue. But abnormally elevated cortisol is.
Ultimately, she turned out to have cancer—a tumor in her lung was sending out ACTH, a hormone that normally is a signal from the pituitary gland (located in your head, under your brain) that adjusts levels of cortisol in the body. Rogue cancer cells can sometimes butt into that hormonal conversation, and that’s what happened to Houser. After she got surgery to remove the tumor, her cortisol levels subsided and her symptoms went away.
alcohol use disorder
major depression, anxiety, and some other mental health diagnoses
Unscrupulous influencers, having convinced you that you have a health problem, have no shortage of answers for you. Most of these answers end up putting money in their pocket: There are dozens if not hundreds of “adrenal support” supplements out there, which TikTokers with affiliate codes will happily sell you. You can also part with your money by purchasing courses on specific types of massage or meditation, like EFT tapping (you tap on “meridian points” on your body while focusing on negative emotions) or “trauma-releasing” floor exercises.
Along the same lines, social media posts will call out sleep disturbances as a symptom of high cortisol, and then recommend basic sleep hygiene steps as a supposed treatment for high cortisol. Cortisol is an unnecessary middleman here, whether it’s actually involved or not; if your sleep sucks, you should try to sleep better. I’ll just add that if your sleep still sucks after setting up a no-phone bedtime routine and taking morning walks in the sunshine, maybe you should ask your doctor about getting evaluated for sleep apnea.
Why you should not listen to TikTok about how to lower your cortisol
That combination gets dangerous when real medical issues are involved—imagine if Bridget Houser, the woman with cancer, had taken to TikTok to diagnose and treat herself. Or to take another example, there’s a corner of TikTok where women tell each other that your husband’s “short fuse” is really a sign of high cortisol. I’m sorry, but if your husband has anger management issues, the type of help you need is not a video instructing you on what supplements to tell him to take.
On the other hand, if you’re having symptoms that are seriously affecting your life and your health, see a real doctor. An endocrinologist can diagnose hormonal problems, but you might have better luck starting with your symptoms instead of guessing at the cause. For example, if you often wake up in the night and feel groggy in the morning, you might want to consider talking to a sleep specialist.
One last note: If you’re scrolling TikTok and think you might have a problem with your hormones, there are plenty of “hormone balance coaches” who will offer to take you under their wing and order a bunch of expensive tests to figure out what’s going on. This is not the same as going to a doctor who actually knows what they are doing. These hormone coaches may order the wrong kinds of tests, and usually do not have access to the types of tests used in medical diagnosis of hormone issues. Please go see a real doctor.
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