Cortisol is a hormone that helps keep your body in balance. But when levels are off, it can cause health problems.

Your body naturally releases cortisol in response to stress, helping regulate blood pressure, blood sugar and energy use. But if stress lasts too long, cortisol levels can stay high, which may lead to mental health issues, weight gain and trouble sleeping.

“Cortisol is a steroid hormone made by your adrenal glands, located on top of your kidneys,” says Chloe Condrey, PA-C. “It plays a key role in how your body stores and uses energy—especially during stressful times.”

What are signs of a cortisol problem?

Most people have normal cortisol levels, but when they get too high or too low, the symptoms can seriously affect your quality of life.

Signs of high cortisol: 

• Weight gain, especially in the belly or face.
• High blood pressure or type 2 diabetes.
• Mood changes or depression.
• Acne.
• Increased facial hair.
• Irregular menstrual cycles.
• Weak or thinning bones (osteoporosis).

Signs of low cortisol: 

• Ongoing tiredness or fatigue.
• Unexplained weight loss.
• Salt cravings.
• Nausea, vomiting or poor appetite.
• Darkened patches of skin (hyperpigmentation).
• Muscle aches or joint pain.

Should you get tested?

“Cortisol tests aren’t typically part of regular checkups, but your doctor may order one if you have multiple convincing symptoms,” says Condrey.

Common cortisol tests include:

• Dexamethasone suppression test: A blood test to evaluate if your body is producing too much cortisol. You’ll take a steroid (dexamethasone) before your blood is drawn to see if cortisol levels drop as expected. It's often used to screen for Cushing's syndrome, a hormonal disorder caused by excessive cortisol.
• 24-hour urinary cortisol test: Measures the amount of cortisol excreted in your urine over a full day. It's another screening tool for Cushing's syndrome, especially if symptoms suggest high cortisol.
• Corticotropin stimulation test: A blood test that checks how well your adrenal glands respond to adrenocorticotropic hormone. It's commonly used to evaluate adrenal insufficiency or Addison’s disease, conditions where cortisol production is too low.

If results are abnormal, your doctor may refer you to an endocrinologist, a medical specialist who diagnoses and treats disorders related to the endocrine system, for further testing. Insurance coverage for testing depends on your plan and medical need. 

Can you lower cortisol naturally?

Maintaining the following healthy habits can help regulate cortisol levels: 

• Eating a well-balanced diet and avoiding blood sugar spikes.
• Managing stress.
• Staying active.
• Getting enough quality sleep.  

Some studies also suggest that supplements such as ashwagandha, ginseng, magnesium and vitamin C may support healthy cortisol levels. However, research is limited. It’s best to talk with your doctor before starting anything new.

The bottom line

“Although cortisol-related conditions are rare, the hormone still plays an essential role in your overall health,” explains Condrey. “If you’ve been feeling off and can’t explain why, it’s a good idea to talk to your doctor about your symptoms.”