Cortisol and Chronic Stress: What Your Adrenals Are Telling You

Chronic stress doesn't just feel exhausting - it physically changes your hormones. Understanding cortisol can help explain why you feel wired but tired.

The Stress Response

Cortisol is your primary stress hormone. In acute stress, it spikes to help you respond. But chronic stress keeps cortisol elevated, eventually depleting your reserves.

The Cortisol Curve

Healthy cortisol follows a daily rhythm:

• Morning: Highest (helps you wake up)
• Midday: Gradual decline
• Evening: Lowest (allows sleep)

Chronic stress disrupts this pattern.

Symptoms of Cortisol Dysfunction

High Cortisol

• Anxiety and racing thoughts
• Weight gain (especially belly)
• Difficulty sleeping
• High blood pressure
• Sugar cravings

Low Cortisol (Adrenal Fatigue)

• Difficulty waking up
• Afternoon energy crashes
• Need caffeine to function
• Salt cravings
• Low blood pressure

Testing Cortisol

Morning Blood Cortisol

Should be tested before 9am. Normal is 10-20 mcg/dL.

4-Point Salivary Cortisol

Tests cortisol at multiple times to assess the daily rhythm.

DHEA-S

Often tested alongside cortisol as another adrenal marker.

Beyond Testing

While tests provide data, your symptoms matter too. Many people with "normal" cortisol still experience stress-related health issues.

References

• Chrousos, G. P. (2009). Stress and disorders of the stress system. Nature Reviews Endocrinology, 5(7), 374-381.
• McEwen, B. S. (1998). Protective and damaging effects of stress mediators. New England Journal of Medicine, 338(3), 171-179.
• Nicolaides, N. C., et al. (2015). Stress, the stress system and the role of glucocorticoids. Neuroimmunomodulation, 22(1-2), 6-19.