Susan Merenstein, Pharmacist/Owner

(412) 586-4678

Cortisol - The Stress Hormone

  • The only hormone in the body that increases with age
  • Produced by the adrenal glands
  • When one is stressed, cortisol elevates and then it should decrease. This does not always happen in today’s world of 365-24-7.

Functions of Cortisol

  • Balances blood sugar
  • Weight control
  • Immune system response
  • Bone turnover rate
  • Stress reaction
  • Sleep
  • Protein synthesis
  • Mood and thoughts
  • Influences testosterone/estrogen ratio
  • Influences DHEA/insulin ratio
  • Affects pituitary/thyroid/adrenal system
  • Participates with aldosterone in sodium reabsorption
  • Is an anti-inflammatory

Reference: Miller, W., “The hypothalamic-pituitary-adrenal axis: A brief history,” Horm Res Paediatr 2018; 89(4):212-23.

What Elevates Cortisol?

  • Stress
  • Depression
  • High progestin (fake synthetic progesterone) intake
  • Sodium depletion
  • High prolactin
  • Inflammation
  • Cushing’s disease
  • Obesity and high sugar and processed carbohydrate intake

What Lowers Cortisol?

  • Chronic stress
  • Addison’s disease
  • Opioid use
  • Chronic marijuana use
  • Accutane
  • Glucocorticoid use


  • One study suggested that as many as 75% to 90% of visits to primary care doctors are stress related.

Reference: Head, K., et al., “Nutrients and botanicals for treatment of stress: adrenal fatigue, neurotransmitter imbalance, anxiety, and restless sleep,” Altern Med Rev 2009; 14(2):114-40.

Chronic Stress

  • Chronic stress has been shown to contribute to accelerated aging and premature death in medical studies.

References: Nielsen, N., et al., “Perceived stress and causes specific mortality among men and women: results from a prospective cohort study,” Amer Jour Epidemiol 2008; 168(5):481-91.

Carroll, B., et al., “Ageing, stress and the brain,” Novartis Found Symp 2002; 242:26-36.

  • Another study revealed that chronic stress accelerated the aging process and was associated with shortened telomeres.

Reference: Wikgren, M., et al., “Short telomeres in depression and the general population are associated with a hypocortisolemic state,” Biol Psychiatry 2012; 71(4):294-300.

Consequences of Elevated Cortisol

Compromised immune system:

  • Decreases the release of antibodies
  • Causes an inhibition in the proliferation of T cells
  • Increases in inflammatory cytokines
  • Inhibits the release of some interleukins
  • Latent virus activation
  • Shift from Th1 to Th2 cytokine expression

Reference: Yaribeygi, H., et al., “The impact of stress on body function: A review,” EXCLI Jour 2017; 16:1057-72.

More Consequences of Elevated Cortisol

  • Confusion
  • Shakiness between meals
  • Memory is not as sharp
  • Low energy
  • Night sweats
  • Binge eating
  • Increased blood pressure
  • Increased cholesterol
  • Increased triglycerides
  • Increased blood sugar
  • Increased osteoporosis risk by increasing loss of minerals in the bones
  • Increased insulin/insulin resistance
  • Increased infections
  • Thin skin
  • Fatigue
  • Irritability
  • Sugar cravings
  • Easy bruising
  • Muscle weakness
  • Weight gain around the middle** and ***
  • Sleep disturbances
  • Impaired hepatic conversion of T4 to T3
  • Favors the development of leaky gut syndrome

**There is a strong inter-relationship between activation of the HPA axis and energy homeostasis. Patients with abdominal obesity have elevated cortisol levels. Furthermore, stress and glucocorticoids act to control both food intake and energy expenditure. Glucocorticoids are known to increase the consumption of foods high in fat and sugar in animals and humans.

***In women, high-cortisol individuals eat more in response to stress than low-cortisol leading to increased food intake and reduced energy expenditure and thus, predisposition to obesity. Therefore, cortisol responsiveness may be used as a marker to identify individuals who are at risk of weight gain and subsequent obesity.

Abnormal Cortisol Levels Are Associated With:

  • Menopause
  • CFS
  • Fibromyalgia
  • Depression
  • Impotence
  • Anorexia nervosa
  • Insulin resistance/diabetes
  • Generalized memory loss
  • IBS
  • Exacerbations of multiple sclerosis
  • Panic disorders
  • PMS
  • Infertility
  • Sleep disorders
  • Osteoporosis
  • Heart disease
  • Rheumatoid arthritis
  • Breast cancer
  • Alzheimer’s disease


Wichmann, S., et al., “Cortisol stress response in post-traumatic stress disorder, panic disorder, and major depressive disorder patients,” Psychoneuroendocrinology 2017; 83:135-41.

Thau, L., et al., “Physiology, cortisol,” StatPearls (Internet), February 8, 2021.

Symptoms of Hypoadrenalism: Low Cortisol

  • Fatigue
  • Low blood pressure
  • Sensitivity to light
  • Insomnia
  • Digestive problems
  • Emotional imbalances/lack of motivation
  • Hypoglycemia
  • Decreased sexual interest
  • Decreased immunity
  • Lack of stamina
  • Emotional paralysis
  • Poor wound healing
  • Alcoholism and drug addiction
  • Allergies
  • Unresponsive hypothyroidism (does not respond to treatment)
  • Feeling of being overwhelmed
  • Nutritional deficiencies
  • Long-term stress
  • Dysbiosis
  • Chronic inflammation
  • Chronic pain
  • Toxic exposure
  • Overly aggressive exercise
  • Hypoglycemia
  • Poor sleep hygiene
  • Depression
  • Severe allergies

Hormones are a Web

  • If cortisol is increased, it decreases the making of progesterone and its activity.
  • Cortisol competes with progesterone for common receptors.
  • When cortisol is elevated, thyroid hormone is more bound and less active.
  • Decreased estradiol in a woman is a stressor to her body (causes decline in function of NE, serotonin, dopamine, and acetylcholine).

Treatment of Hyperadrenalism

  • Replacement of DHEA if it is low with adrenal support
  • Adaptogenic herbs
    • Rhodiola
    • Ginseng
    • Ashwagandha
    • Calming herbs
    • Stress reduction techniques
    • If cortisol is high in the evening, then add phosphatidylserine 300 mg which may be taken any time of the day.

Treatment of Hypoadrenalism

  • Nutrients
    • Vitamin C
    • B vitamins-plus extra B5 Pantothenic Acid
    • Calcium
    • Magnesium
    • Zinc
    • Selenium
    • Copper
    • Sodium
    • Manganese
    • Adrenal extracts (if adaptogenic herbs do not work)
    • Calming herbs
    • Licorice (cannot use if the patient has hypertension)
    • Stress reduction techniques-Meditation, Yoga, Breathing techniques

Cortef ®

  • Do not use for more than 6-9 months
  • Continue adrenal extracts while on cortef
  • Wean the patient off of cortef. Do not stop suddenly.

Suggested Tests
Saliva/Blood Spot Combo Kit Test
Saliva 5 Test