What the Different Levels of Cortisol Mean on Your Test

Feeling constantly wiped out or inexplicably jittery? These energy imbalances could be a sign of cortisol dysfunction.

Maintaining optimal cortisol can support various bodily functions such as metabolism and immune responses, suppress inflammation, and regulate blood sugar. That's why we'll explore the causes and implications of high and low levels to keep them in a healthy range.

Causes of high cortisol levels

Cortisol, often called the "stress hormone," naturally follows a rhythm throughout the day. In general, the normal range for cortisol levels in the blood is between 10-20 micrograms per deciliter (mcg/dL).

The highest levels are typically seen in the morning, peaking between 6 and 8 a.m. This is known as the cortisol awakening response (CAR) and is a part of the body's natural rhythm. [2] They then decrease, reaching their lowest point in the evening, usually between 11 p.m. and midnight.

But, various factors can disrupt this rhythm, such as:

Age

As we age, our body's stress response system, the hypothalamic-pituitary-adrenal (HPA) axis, becomes less fine-tuned. This can lead to two critical changes in cortisol, the body's primary stress hormone:

• Slightly blunted cortisol awakening response: The morning surge of cortisol helps us wake up and feel energized, maybe a little lower in older adults. [3]
• Higher average cortisol levels throughout the day: Even though the peak is lower, the body might not switch off cortisol production as effectively throughout the day, leading to slightly elevated levels.

Medication

Certain medications can significantly impact cortisol levels by directly affecting the adrenal glands which produce it. For example, prednisone mimics the hormone's effects, which can suppress natural production. [4]

Some antidepressants—particularly those that affect serotonin levels—can also interact with the body's stress response system and alter cortisol production. [5]

Acute and chronic stress

Understanding the nuanced impact of stress on cortisol levels involves distinguishing between acute—short-term—and chronic or long-term stress responses.

Acute stress, like a public speaking event or a tight deadline, leads to a temporary—within minutes to an hour—increase in the hormone's levels. This natural and adaptive response, known as a cortisol surge, helps the body react quickly and effectively.

On the other hand, when stressors become chronic or unrelenting, cortisol levels can stay elevated instead of dipping back down like they usually do. This sustained surge can disrupt the body's systems, impacting your overall health. [6]

Lifestyle factors

Inconsistent sleep schedules, insufficient sleep duration—less than 7-8 hours—and poor sleep quality can all contribute to elevated cortisol. [7] Regularly spiking your blood sugar with sweets or refined carbohydrates can also contribute, as the body releases this hormone to fight the rising insulin.



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Adrenal disorders

Several adrenal gland disorders can also lead to high cortisol levels. These include Cushing syndrome, which can be caused by tumors or long-term use of corticosteroid medications [8]

Other examples are primary aldosteronism, affecting blood pressure and potassium levels, and congenital adrenal hyperplasia, a genetic condition. One common cause of high cortisol from adrenal gland tumors is an adrenal adenoma. [9, 10]

Implications of high cortisol levels

Over time, high levels can lead to various health issues, such as:

• An increased risk of metabolic syndrome characterized by abdominal fat accumulation.
• High blood pressure and impaired blood glucose regulation lead to conditions like diabetes.
• Suppression of the immune system reduces the production of white blood cells and their ability to fight infections, increasing susceptibility to illness.
• Mood disorders such as anxiety, depression, and other mental health conditions.

Factors influencing low cortisol levels

Low cortisol levels can occur due to adrenal insufficiency, which can be categorized as primary, secondary, or tertiary.

• Primary: This type results from dysfunction of the adrenal glands themselves, where they fail to produce enough cortisol. Addison's disease is a typical example. Autoimmune diseases, infections, or direct gland damage can cause this type.

• Secondary: This occurs when the pituitary gland, located at the base of the brain, is impaired. This disrupts the normal signaling to the adrenal glands, leading to insufficient cortisol production.

• Tertiary: The rarest form that involves damage to the hypothalamus, a region above the pituitary gland. This damage disrupts its ability to signal the pituitary gland, which in turn, cannot stimulate cortisol production by the adrenal glands.

Implications of low cortisol levels

Chronically low cortisol levels can lead to health complications. If your body doesn't produce enough, you may experience symptoms like fatigue, muscle weakness, and weight fluctuations. Additionally, you may have issues with blood sugar regulation and high blood pressure.

» Explore the benefits of blood testing for optimal health

Testing cortisol abnormalities

Healthcare providers assess cortisol levels, considering individual differences and natural daily fluctuations. Blood, urine, and saliva tests help them diagnose underlying medical issues.

For instance, high levels detected in these tests may indicate Cushing's syndrome, while low levels could suggest adrenal insufficiency. Imaging techniques like X-rays and CT scans can further pinpoint causes like tumors or adrenal gland abnormalities that affect cortisol production. [11]

Possible treatment options

If a cortisol deficiency is identified, healthcare providers will likely recommend replacement therapy. This treatment involves medications like hydrocortisone or prednisone, which mimic the body's natural production.

Chronic stress is a significant contributor to high cortisol levels, but genetics and underlying health conditions can also play a role. To manage it, doctors may recommend lifestyle modifications like stress management techniques, regular exercise, and a balanced diet.

» Learn how to interpret your blood test results

Take charge: navigating cortisol levels for optimal health

The field of cortisol management is rapidly evolving, with ongoing research exploring genetics, lifestyle factors, and the brain-body connection to stress and hormones [10].

Exciting new treatment possibilities are being explored, including medications, gene therapy, and even AI. Its potential to predict and personalize treatment plans offers a glimpse into a future where cortisol management is more precise and effective.

For example, InsideTracker uses algorithms to interpret health data and identify personalized optimal cortisol levels and factors like age, sex, and ethnicity to offer tailored recommendations for improving overall health.

Reference list:

[1] L. Thau, J. Gandhi, and S. Sharma, “Physiology, cortisol,” StatPearls - NCBI Bookshelf, Aug. 28, 2023. Available: https://www.ncbi.nlm.nih.gov/books/NBK538239/

[2] N. Bowles et al., “The circadian system modulates the cortisol awakening response in humans,” Frontiers in Neuroscience, vol. 16, Nov. 2022, doi: 10.3389/fnins.2022.995452. Available: https://pubmed.ncbi.nlm.nih.gov/36408390/

[3] E. Van Cauter, R. Leproult, and D. J. Kupfer, “Effects of gender and age on the levels and circadian rhythmicity of plasma cortisol.,” The Journal of Clinical Endocrinology & Metabolism, vol. 81, no. 7, pp. 2468–2473, Jul. 1996, doi: 10.1210/jcem.81.7.8675562. Available: https://pubmed.ncbi.nlm.nih.gov/8675562/

[4] “Corticosteroids,” PubMed, Jan. 01, 2024. Available: https://pubmed.ncbi.nlm.nih.gov/32119499/

[5] A. Subramaniam, A. M. LoPilato, and E. F. Walker, “Psychotropic medication effects on cortisol: Implications for research and mechanisms of drug action,” Schizophrenia Research (Print), vol. 213, pp. 6–14, Nov. 2019, doi: 10.1016/j.schres.2019.06.023. Available: https://pubmed.ncbi.nlm.nih.gov/31307858/

[6] K. Hannibal and M. D. Bishop, “Chronic Stress, cortisol dysfunction, and pain: A Psychoneuroendocrine Rationale for Stress management in Pain Rehabilitation,” Physical Therapy, vol. 94, no. 12, pp. 1816–1825, Dec. 2014, doi: 10.2522/ptj.20130597. Available: https://pubmed.ncbi.nlm.nih.gov/25035267/

[7] A. H. Garde et al., “Effects of lifestyle factors on concentrations of salivary cortisol in healthy individuals,” Scandinavian Journal of Clinical & Laboratory Investigation, vol. 69, no. 2, pp. 242–250, Jan. 2009, doi: 10.1080/00365510802483708. Available: https://pubmed.ncbi.nlm.nih.gov/18985537/

[8] M. Reincke and M. Fleseriu, “Cushing Syndrome,” JAMA (Chicago, Ill.), vol. 330, no. 2, p. 170, Jul. 2023, doi: 10.1001/jama.2023.11305. Available: https://pubmed.ncbi.nlm.nih.gov/37432427/

[9] “Congenital adrenal hyperplasia,” PubMed, Jan. 01, 2024. Available: https://pubmed.ncbi.nlm.nih.gov/28846271/

[10] “Adrenal adenoma,” PubMed, Jan. 01, 2024. Available: https://pubmed.ncbi.nlm.nih.gov/30969728/

[11] F. Wang et al., “CT and MRI of adrenal gland pathologies,” Quantitative Imaging in Medicine and Surgery, vol. 8, no. 8, pp. 853–875, Sep. 2018, doi: 10.21037/qims.2018.09.13. Available: https://pubmed.ncbi.nlm.nih.gov/30306064/