, 2025-04-16 13:23:00
“Cortisol detoxing” is currently trending on social media. Influencers recommend exercises, special diets, supplements, and cortisol testing to reduce what they call the “stress hormone.”
Some primary care clinicians and other specialists say they are fielding requests from patients to order cortisol testing, probably in part because of social media misinformation. But cortisol testing can help diagnose a limited number of conditions, such as Cushing syndrome or adrenal insufficiency, both rare conditions.
Disha Narang, MD, an endocrinologist and director of Obesity Medicine at Endeavor Health in Chicago, said she often gets asked to test cortisol levels by patients who receive misinformation about the hormone on social media.
“My cortisol levels were so high, I was puffy all over my body, I couldn’t sleep at night, but I was fatigued all day long,” said one woman on TikTok promoting a supplement as a treatment for high cortisol. Meanwhile, a dietitian on TikTok explained how exhaustion after exercising could be a sign that cortisol levels are low and adrenal glands need to recover.
“There’s no science behind any of this,” Narang said.
Primary care clinicians should be aware of the sizable room for error when administering the test and analyzing test results, experts said.
“Overuse and sometimes inappropriate use of cortisol profiling by providers unaware of interpreting this data has led to patients erroneously being prescribed exogenous cortisol supplements, leading to iatrogenic/medication-induced Cushing’s and permanent adrenal insufficiency,” said Preethika S. Ekanayake, MD, an endocrinologist at UC San Diego Health.
Should You Test Cortisol Levels?
The Endocrine Society only has cortisol test guidelines for endocrine conditions, such as Cushing syndrome and adrenal insufficiency, and does not for more general symptoms, such as stress or chronic fatigue, said Maria Fleseriu, MD, the former chair of the Clinical Guidelines Committee at the organization.
And testing cortisol levels in patients who do not have symptoms of either hormonal disorder is not recommended, Fleseriu, director of the Pituitary Center at Oregon Health & Science University in Portland, Oregon, said.
Cushing syndrome, or pathologically elevated cortisol, is considered rare, affecting up to 70 out of 1 million people per year. The Endocrine Society does not recommend any treatment to lower cortisol in the absence of this disease.
Adrenal insufficiency affects 300 per million people, and symptoms include fatigue, poor appetite, salt cravings, and vertigo.
Without clinical suspicion of these conditions, cortisol testing can lead to false-positive results, said Katie Guttenberg, MD, associate professor of medicine in the Division of Endocrinology, Diabetes and Metabolism at UTHealth Houston.
Cortisol also naturally fluctuates throughout the day, she said, making a single blood test an unreliable measure of the hormone level.
Sleep patterns, mental health conditions, and acute stress can all affect the hormone, Fleseriu said.
“A spike in cortisol levels at a given moment doesn’t necessarily indicate a larger health problem,” Fleseriu said.
A Laundry List of Issues Can Create False Positives
Patients with chronic stress, metabolic syndrome, uncontrolled diabetes, or eating disorders are prone to producing false-positive results for elevated cortisol, said Fleseriu.
Many common nonendocrine conditions such as depression and alcoholism can lead to physiologic hypercortisolism, known as pseudo–Cushing syndrome, Guttenberg said.
Clinicians who are unaware of the pseudocondition may mistake elevated cortisol results for signs of true Cushing syndrome and order unnecessary testing, radiographic evaluation, invasive procedures, and medication, Guttenberg said.
Physiologic hypercortisolism is “particularly common in patients presenting with major depressive disorders,” said Guttenberg. “That is why I do not generally recommend measuring cortisol in this population.”
The treatment for physiologic hypercortisolism should be focused on the underlying condition, such as treatment for depression, said Guttenberg.
People who are pregnant or people taking medications and supplements such as contraceptives, glucocorticoids, and biotin can also produce a falsely elevated cortisol level, Guttenberg said.
Narang said she has cared for patients who were referred by primary care clinicians who conducted a cortisol test in the afternoon, when levels tend to be low, triggering a false-positive result and leading to suspicion of adrenal insufficiency.
False positives for adrenal insufficiency “may lead to unnecessary follow-up testing including lab work or imaging, and increased health anxiety,” said Priya Jaisinghani, MD, a clinical assistant professor in the Department of Medicine at NYU Grossman School of Medicine, New York City.
Educating Patients About Cortisol Testing
Education of patients on the role of cortisol in the body can help alleviate patient fears, Ekanayake said.
“The adrenal glands are very smart glands,” said Ekanayake. “I often educate my patients that there does not need to be extra assistance that we as individuals need to provide for the adrenal glands to remain healthy.”
Except in the case of Cushing syndrome and adrenal insufficiency, “these glands do not have failures or underfunction with age or stress,” Ekanayake said.
“Patients are hearing about cortisol from social media,” Narang said. “Various influencers might say that you need to ask your doctor about adrenal fatigue if you’ve been feeling tired and drained. But that’s not a real diagnosis.”
Clinicians should also educate patients who are focused on their cortisol levels on their broader health behaviors, Jaisinghani said. This might include counseling on sleep habits, stress management, and diet.
“These are the foundations of overall well-being and often have a greater impact on long-term health,” Jaisinghani said.
Brittany Vargas is a journalist covering medicine, mental health, and wellness.