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High Cortisol Levels: Causes, Testing, and Care Options

An image of a vial of blood with cortisol level-test on itCortisol is your body’s main stress hormone. It's released by your adrenal glands when you experience stress from any source, whether it's psychological, physiological, or environmental. For example, your body might release cortisol to help you cope with a demanding work situation, an injury or illness, or exposure to toxins. Under normal conditions, your cortisol levels should drop once the stressful episode passes. But sometimes, when these stressful conditions continue for extended periods, high cortisol levels remain. This is when problems start.

The Role of Cortisol

A steroidal hormone made in your adrenals, cortisol’s actions are governed by your Hypothalamic-Pituitary-Adrenal (HPA) axis that controls your NeuroEndoMetabolic (NEM) stress response. As such, cortisol plays a significant role in many body functions:

  • In the short-term, it helps fight inflammation.
  • Plays a role in circadian rhythm function.
  • Helps with blood pressure regulation.
  • Boosts energy levels during times of stress.
  • Raises your blood sugar levels.

These functions are important when your body experiences stress and are typical during periods of high cortisol levels.

Stress and High Cortisol Levels

In your brain, your hypothalamus and pituitary gland act to adjust your body’s cortisol levels. When too high, they signal this to your adrenals, and their cortisol output decreases. If too low, it does the same, resulting in increased cortisol production. This communication takes place through chemical messengers called neurotransmitters.

Most cells in your body have cortisol receptors. These different cells receive and use cortisol differently, depending on what needs doing. This is how different parts of the body respond differently to cortisol. So when your fight or flight response kicks in, certain body functions increase while others decrease. Those needed for immediate survival may go into overdrive, increasing your blood sugar and heart rate, for example. On the other hand, during times of stress, those processes not needed for immediate survival may decrease or shut down entirely. This could reduce the action of your immune system, reproductive system, or digestive system.

Normally, once a stressful situation passes, your HPA axis will return to normal, with cortisol levels returning to their usual levels. But if the situation persists, your adrenals may continue, or even increase their higher cortisol output. This could have serious long-term consequences.

High Cortisol Levels and Hormone Imbalances

Cortisol levels are determined by your HPA axis, which is part of your NEM. Your NEM is composed of six different circuits of related organs and systems which, together, fight stress. One of these is the Hormone Circuit which consists of the adrenals, thyroid gland, and sex glands. Together, we refer to them as the ovarian-adrenal-thyroid (OAT) axis.

When one of these related organs dysregulates, it has an impact on the other two components and on the NEM as a whole. In the case of the OAT, hormone imbalances can occur that result in numerous, seemingly-unrelated health issues. And the root cause of these imbalances could be high cortisol levels. This often results from constant stress and adrenals striving to keep up with demand.

Ultimately, however, your adrenal glands may suffer under their burden. Constantly high cortisol can deplete essential vitamins, minerals, and precursor hormones needed to produce cortisol. Eventually, the adrenals become unable to keep up with demand. Burnout occurs, with adrenal fatigue resulting. The adrenals, in effect, reach a level where their cortisol production declines drastically. Extremely low cortisol levels may have their own set of health repercussions.

Other Causes of High Cortisol Levels

Higher stress levels may not be the only cause of high cortisol levels. It may also result from issues with your pituitary gland or the adrenals themselves.

Pituitary Gland Problems

An image of a doctor looking at brain scansThe pituitary gland may erroneously call for higher cortisol production due to issues with the gland itself. These issues include the presence of benign tumors, the presence of cancerous tumors, or because of hyperpituitarism. The latter is a condition whereby your pituitary gland has overactive tendencies.

Adrenal Tumors

The adrenal glands may erroneously increase their cortisol production due to either benign or malignant tumors on the glands.


Another possible cause is the use of medication. These include both oral corticosteroid medication and injectables. Many people with high cortisol levels have them because of taking corticosteroids for inflammatory health issues like asthma or rheumatoid arthritis. Others may need these medications after an organ transplant to prevent their body from rejecting the organ. Many people suffering from joint or back pain also develop high levels due to the use of injectable corticosteroids.

Symptoms of High Cortisol Levels

Many people with high cortisol levels do not know about it. They may feel fine for a long time before any symptoms start showing. Cushing Syndrome is a health issue associated with high cortisol. Common symptoms of the condition include the following:

  • High blood pressure
  • Constant fatigue
  • Weight gain for no apparent reason, especially around the middle and upper back
  • Rounding of your face
  • Brain fog
  • Feelings of irritability
  • Headaches
  • Feelings of weakness
  • Acne in adults
  • A flushed face
  • Skin that becomes thinner
  • Bruising easily
  • Injured areas that heal very slowly
  • Purple stretch marks

Many people with high cortisol may be told they have Cushing syndrome. But those on cortisone or corticosteroid medications may also present many of these symptoms.

Besides the above symptoms, women with Cushing syndrome may also experience an increase in facial or body hair and changes in their menstrual periods. Men may experience decreased libido, erectile dysfunction, or fertility issues.

Symptoms of Low Cortisol Levels

It is also worth mentioning the symptoms of low cortisol levels, a condition referred to as Addison’s disease. Common symptoms of the condition include:

  • Loss of appetite
  • Weight loss
  • Constant fatigue
  • Low blood pressure levels
  • Feelings of constant weakness
  • Diarrhea
  • Nausea
  • Vomiting

It is worth talking to a healthcare provider if any of these symptoms persist to have them addressed. Low cortisol levels are associated with the latter stages of adrenal fatigue.

Health Issues Associated With High Cortisol Levels

Besides presenting as various symptoms, high cortisol can contribute to the development of several more severe health issues, especially if not addressed. Possible health issues that could stem from high cortisol levels include:

  • Type-2 diabetes
  • Osteoporosis
  • Hypertension (high blood pressure)
  • Frequent infections
  • Loss of muscle mass
  • Psychological disorders

Testing for High Cortisol Levels

To determine whether you have high cortisol levels, your healthcare practitioner would first do a physical exam to look for any of the signs and symptoms discussed. They would also rule out the use of corticosteroids. From there, they might look at doing various diagnostic tests.

An image of a cortisol lab orderThe tests can help your healthcare practitioner find the cause of your high cortisol levels and rule out other health issues like polycystic ovary syndrome that mimic the condition. Consuming substantial amounts of alcohol and depression could also mimic the symptoms associated with high cortisol.

Saliva Test

Normally, cortisol levels fluctuate throughout the day. It is typically higher in the mornings and lower in the evenings. People with high cortisol, however, usually do not experience a marked drop in their levels during the evening. A saliva test done later in the evening could thus determine whether high cortisol is causing your symptoms.

Urine and Blood Test

These tests are designed to check your cortisol hormone levels. Besides taking some blood to test, you might also be asked to collect urine samples over 24 hours.

In those taking hormone supplements, you may be asked to undergo other tests that measure your cortisol levels before and after you take your supplements.

Petrosal Sinus Sampling

This type of test helps your healthcare provider determine whether your high cortisol levels result from issues with your pituitary gland (petrosal sinuses). Here, a blood sample would be taken from veins draining your pituitary gland.

Imaging Tests: CT and MRI

A computerized tomography (CT) or a magnetic resonance imaging (MRI) scan allows a healthcare practitioner to determine whether your adrenals or pituitary gland show the presence of any abnormalities that could result in high cortisol levels.

Addressing High Cortisol Levels: Medical Care

The measures commonly taken to address high cortisol depend on the cause.

Reducing Corticosteroid Medications

If the cause of your symptoms is long-term use of corticosteroid medications, your healthcare practitioner may look at reducing your dosage while managing the condition that determined its necessity. Only change your dosages with the guidance of your healthcare practitioner. Stopping these medications immediately could result in further health issues.

Surgery for Tumors

If tumors in your pituitary or adrenal glands are the cause, your healthcare practitioner may suggest their removal. You may, however, need to take cortisol replacements for a while until your body’s cortisol production returns to normal. This may involve frequent blood tests to determine your dosage until such time as the medication can be stopped. Those diagnosed with Cushing syndrome may need a cortisol replacement for the rest of their lives after such a procedure.

Radiation Therapy for Tumors

If your healthcare provider is unable, for whatever reason, to remove a tumor on your pituitary gland, they may suggest radiation therapy. This therapy takes place over six weeks. They could also suggest stereotactic radiosurgery. Here, you receive one dose of radiation using a three-dimensional coordinates system to minimize radiation exposure to surrounding tissue.

Medications to Control Cortisol Production

Your healthcare provider may also suggest the use of medication to modify the excessive production of cortisol. Those undergoing surgery may also be prescribed medications beforehand to improve their symptoms beforehand and also minimize any possible risks during the procedure. These medications may have side effects, however. These include headaches, nausea, vomiting, fatigue, high blood pressure, and swelling. Some medications may have more serious side effects that include liver toxicity and neurological issues.

Natural Ways to Lower Cortisol

Stress is one of the main causes of high cortisol levels. That is why one of the best ways to lower cortisol involves reducing stress while providing adrenal support. The goal here is to heal the whole body while dealing with the root causes.

Sufficient Rest

An image of a resting womanLiterature suggests that not enough quality sleep could result in elevated cortisol levels. Shift workers, for example, tend to have higher cortisol levels when they sleep during the day instead of at night. Furthermore, those with rotating shifts may have a higher risk of developing mental health issues, heart disease, obesity, and type-2 diabetes. Those with insomnia also tend to have increased levels of cortisol.

This is why improving your sleeping habits can be a great way to lower cortisol levels. You can try these steps:

  • Cut down on your caffeine intake and avoid caffeine for six hours before going to sleep.
  • Limit your exposure to bright light for about an hour before going to bed.
  • Go to bed and wake up at the same time each day.
  • Develop a bedtime routine to train your mind and body to start shutting down at night. For example, take a shower and read a few pages of a book before turning off the light.
  • Make sure your bedroom is quiet, dark, and peaceful.


Regular exercise may help reduce stress and improve the quality of your sleep. It also contributes to your overall physical and mental health. Do not overdo it, however, because intense exercise increases your cortisol levels quite drastically. Three hours or so of low to moderate-intensity exercise a week will work well as it gives you enough time between workouts to rest. Good examples of low to moderate-intensity exercise include yoga, Pilates, or a brisk walk.

Deep Breathing

There are many deep breathing techniques that you can employ, such as alternate nostril breathing and the three-part breath. By controlling your breathing, you help stimulate your parasympathetic nervous system to rest and relax. This helps calm your sympathetic nervous system and lower your cortisol levels.


Meditation makes you aware of your thoughts and breath. It helps clear the mind and allows a state of relaxation. Mindfulness lets you become aware of any thoughts that cause you stress. It helps you accept them, release them, and move on. This helps lower stress levels and cortisol production.

Engage In Social Activities and Have Some Fun

Any healthy relationship or hobby leads to feelings of happiness and thus a reduction in stress levels. This, in turn, affects your cortisol levels as well.

Being with people allows you to talk, share jokes, and laugh. Laughing helps promote the release of endorphins. It also helps to suppress cortisol production.

Hobbies also count as social activities and stress-relievers. The simple act of gardening, for example, gives you the chance to not just interact with your neighbors but decreases your stress levels as well. Taking an art class, doing martial arts, or starting a collection are also ways to get out and connect with others as well.

Adopting a dog or cat could also help reduce cortisol levels. Petting them and looking after them is an enjoyable experience and gives you something to care for.

Talk to a Therapist About High Cortisol Levels

An image of a man talking with a TherapistYou do not have to have "something wrong with you" to experience the benefits of talking to a therapist. Often, talking to someone outside a situation helps you focus your thoughts and eases stress. Sometimes we sit with negative feelings about a situation for a long time, and these feelings contribute to our stress levels. Talking to a therapist may help you resolve these feelings.


Your diet may also influence your cortisol levels. Certain foods contribute to your body’s stress load. These include sugary, processed, or fast foods. And high cortisol levels may even make you crave these foods, although they often lack the nutrients your body needs.

Instead, here are a few tips for a healthy, nutritious diet that supports cortisol management:

  • Fresh fruits and vegetables contain antioxidants and polyphenolic compounds. They help fight free radicals that create oxidative stress.
  • Focus on healthy, whole foods like legumes, whole grains, fruits, vegetables, chicken, fish, and lean beef.
  • Incorporate healthy fats in your diet. Omega-3 fatty acids promote brain health and thus help reduce stress – nuts, seeds, and fatty fish like salmon are reliable sources.
  • Drink enough water as its linked to dehydration.
  • Include probiotic foods in your diet because they promote gut and brain health.
  • Consider green tea instead of coffee. Compounds in green tea may help reduce stress while promoting mental alertness.

Supplements for High Cortisol Levels

Many natural supplements help with cortisol management.

  • Ashwagandha is an adaptogen and may help reduce cortisol levels, according to literature.
  • Rhodiola is another adaptogen. It may help with stress and cortisol management while boosting your metabolism and energy levels.
  • Chamomile may help reduce anxiety and thus help with cortisol management. Chamomile tea is another option.
  • Lemon balm may help reduce feelings of anxiety and thus help improve cortisol levels.
  • Phosphatidyl Serine helps to modulate cortisol levels and bring them down if very elevated. Beware of feeling tired when taking this as your body might be used to the high cortisol levels and bringing it down acutely can cause symptoms.

If considering the use of supplements, please first talk to your healthcare provider. They are best able to determine whether it is appropriate for your body's needs. Note, if you have adrenal fatigue or other health conditions, your body can be especially prone to paradoxical reactions to supplements.

High Cortisol Levels Takeaway

High cortisol levels may have a debilitating effect on your health. But by taking steps to reduce your cortisol levels, you may promote adrenal health and reduce many of these issues or even reverse them.

If you suffer from high cortisol, here are a few things you can do to help alleviate the situation.

  • Ask your healthcare provider about doing tests to determine the root cause.
  • Consider making dietary changes, reducing stress, and doing some low-level or moderate exercise.
  • Explore the use of natural supplements with your healthcare provider.

If you would like to know more about or need assistance with high cortisol levels, the team at Dr. Lam Coaching can help. We offer a free* no-obligation phone consultation at +1 (626) 571-1234 where we will privately discuss your symptoms and options. You can also send us a question through our Ask The Doctor system by clicking here.

© Copyright 2022 Michael Lam, M.D. All Rights Reserved.

Dr. Lam’s Key Question

High cortisol levels are a major symptom of early-stage adrenal fatigue. By addressing this issue, you may provide your adrenals with some much needed support. In later-stage adrenal fatigue, cortisol levels drop, however. It's also important to identify why your cortisol levels are too high to make sure there's not a tumor you're leaving untreated.

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