Signs of High Cortisol: What It Feels Like and When to Get Tested

"High cortisol" can mean two very different things. Most often it describes the everyday pattern of ongoing stress, where cortisol stays higher at the wrong times of day and people feel wired, tired and unable to wind down. Much less often it means a medical condition in which cortisol stays very high for months, which causes visible changes such as a rounder face, weight gain around the middle and wide purple stretch marks. The signs overlap, and only tests can tell them apart. This guide explains both, what doctors look for, how cortisol is tested, and when to get checked.

It is educational, not medical advice, and it cannot diagnose you. If you are worried about your cortisol, talk with a doctor.

Key Takeaways

• Stress-related signs are common but not specific: trouble winding down, poor sleep and feeling wired but tired can have many causes.
• A flatter daily cortisol curve was linked to poorer physical and mental health across 80 studies (Adam et al., 2017).
• Physical signs doctors look for include a round face, a fatty hump between the shoulders, wide purple stretch marks, easy bruising and weak muscles (NIDDK).
• Only tests can show your cortisol level, using blood, urine or saliva, and doctors usually need more than one test.
• If it is stress, sleep, exercise, caffeine timing and other habits are the first step.

For the basics, including normal levels by time of day, see what is cortisol.

What Is High Cortisol?

Cortisol is a hormone made by your adrenal glands. In a healthy pattern it peaks within an hour of waking, falls through the day and is lowest around bedtime. It also rises during stress to make energy available, then settles.

With ongoing stress, that pattern can change: cortisol may stay higher in the evening, so the daily curve looks flatter. A review of 80 studies found that flatter daily cortisol curves were linked to poorer health across most of the outcomes examined, with the strongest link for immune and inflammation measures (Adam et al., 2017). This is a pattern seen across groups of people, not something you can confirm by how you feel.

The medical condition is different. When cortisol stays very high for a long time, doctors call it hypercortisolism or Cushing's syndrome. The most common cause is long-term, high-dose use of steroid medicines (glucocorticoids). When the body itself makes too much cortisol, the condition is rare, affecting about 40 to 70 people per million (NIDDK).

Common Signs Linked to Ongoing Stress

These are the experiences people most often describe with a stressed cortisol rhythm. They are common, have many possible causes, and do not prove your cortisol is high:

• Feeling wired but tired, especially in the evening.
• Trouble falling asleep or waking during the night; short sleep itself raised the next evening's cortisol by 37 to 45% in one study (Leproult et al., 1997).
• Relying on caffeine to get through the day, which itself raises cortisol (Lovallo et al., 2005).
• Cravings for sweet or salty food during stressful stretches.
• Feeling on edge or finding it hard to switch off after work.

If this sounds like you and you have none of the physical signs below, our guide on how to lower cortisol naturally is the place to start. For the long-term picture, see how chronic stress affects aging.

Many everyday body signs, such as headaches, tight muscles and an upset stomach, come from stress itself rather than high cortisol; our guide to the physical symptoms of stress covers them.

Physical Signs Doctors Look For

These signs are listed by the US National Institute of Diabetes and Digestive and Kidney Diseases for very high cortisol over a long time (NIDDK). Any of them is a reason to see a doctor rather than handle it on your own:

Sign	What it looks like
Round face	A fuller, rounder face than before
Weight gain in the middle	Weight gain with thin arms and legs
Fatty hump	Extra fat between the shoulders
Purple stretch marks	Wide marks, mainly on the abdomen, breasts, hips and under the arms
Easy bruising	Bruises from minor bumps
Weak muscles	Muscles that feel weaker than before

Doctors also check for problems long-term high cortisol can lead to, including high blood pressure, high blood sugar and mood changes (NIDDK).

Everyday weight around the waist during stressful times is much more common; our guide to cortisol belly covers what the research shows and what helps.

High Cortisol Face: What It Means

"High cortisol face" and before-and-after photos are popular online. A rounder, fuller face is a recognized sign of very high cortisol over a long time, often from steroid medicines (NIDDK). A puffy face after a short night, a salty meal or a few drinks is far more common and usually passes. Photos cannot tell the difference. If your face has become noticeably rounder over months, especially alongside the other signs above, see a doctor rather than trying to fix it with diet or supplements.

Signs of High Cortisol in Women

The signs above apply to everyone. In women, very high cortisol can also cause irregular or missed periods and excess hair on the face, neck, chest, abdomen and thighs (NIDDK). Cycle changes have many other causes, so a doctor can test rather than guess. For supplement options that included women in their trials, see our guide to supplements to lower cortisol.

Cortisol Imbalance: High vs Low

"Cortisol imbalance" can also mean too little. When the adrenal glands do not make enough cortisol, the most common symptoms are fatigue, muscle weakness, loss of appetite, weight loss and abdominal pain (NIDDK). Because fatigue shows up with both high and low cortisol, and with many other things, symptoms alone cannot tell you which way your levels lean.

How to Know If You Have High Cortisol

A cortisol test measures cortisol in blood, urine or saliva. Blood is often drawn in the morning, when levels are highest, and again around 4 p.m., when they are normally much lower. Saliva can be collected at home at several times of day. A single result cannot explain the cause, so abnormal results usually lead to more tests (MedlinePlus).

When doctors suspect the medical condition, they use tests such as late-night saliva cortisol, 24-hour urine cortisol and a low-dose dexamethasone suppression test, and they usually need two of them because no one test is perfect (NIDDK). A one-off home saliva kit cannot replace that work-up.

Our guide to how to test cortisol levels explains blood, urine and saliva tests, including at-home saliva kits.

When to See a Doctor

Safety note: see a doctor if you notice a rounder face, weight gain around the middle with thinner arms and legs, wide purple stretch marks, easy bruising, muscle weakness, very high blood pressure, or irregular periods with new hair growth, or if exhaustion lasts for weeks. Tell your doctor about any steroid medicines you use, including inhalers, creams and injections, and never stop a prescribed steroid on your own.

If It Is Stress: What Helps

• Habits first: sleep, mostly easy exercise, morning-only caffeine, regular meals, less alcohol, slow breathing and time outdoors all have human studies behind them; see how to lower cortisol naturally.
• Food: see cortisol triggering foods, and our check of the viral cortisol cocktail.
• Supplements: see supplements to lower cortisol for the human trials.

Two of our sprays contain L-theanine, the calming amino acid found in tea: Theanine Nasal Spray (36 mg of L-theanine per two-spray serving, used as needed) and Kanna Nasal Spray (kanna extract with L-theanine, in three strengths). More guides are in our stress and mood guide.

Sources

• Adam EK et al. Diurnal cortisol slopes and mental and physical health outcomes: A systematic review and meta-analysis. Psychoneuroendocrinology, 2017. PubMed
• National Institute of Diabetes and Digestive and Kidney Diseases. Cushing's Syndrome. NIDDK
• Leproult R et al. Sleep loss results in an elevation of cortisol levels the next evening. Sleep, 1997. PubMed
• Lovallo WR et al. Caffeine stimulation of cortisol secretion across the waking hours in relation to caffeine intake levels. Psychosom Med, 2005. PubMed
• National Institute of Diabetes and Digestive and Kidney Diseases. Adrenal Insufficiency and Addison's Disease. NIDDK
• MedlinePlus, National Library of Medicine. Cortisol Test. MedlinePlus

Frequently Asked Questions

What are the signs of high cortisol?

With everyday stress, people often describe feeling wired but tired and sleeping poorly, but these are not specific. Very high cortisol over months causes physical signs such as a round face, weight gain in the middle, purple stretch marks, easy bruising and weak muscles.

How do you know if you have high cortisol?

Only a test can show it. A doctor can order blood, urine or saliva tests, often at specific times of day, and usually more than one.

What does high cortisol face look like?

A rounder, fuller face that develops over months, usually with other signs. Short-term puffiness after poor sleep or salty food is common and is not the same thing.

What are the signs of high cortisol in women?

The same physical signs as in men, plus irregular or missed periods and excess hair on the face, chest or abdomen. A doctor can test, since these have other causes too.

Can stress cause high cortisol?

Stress raises cortisol for a while, and ongoing stress is linked to a flatter daily cortisol curve. That is different from the medical condition, which usually comes from steroid medicines or, rarely, a gland problem.

What is a cortisol imbalance?

It can mean cortisol that is too high or too low. Both can cause fatigue, so symptoms alone cannot tell which, and testing is needed.

Can a home saliva test tell me my cortisol is high?

A single home sample cannot diagnose anything, because cortisol changes through the day. Doctors use timed samples and usually two different tests.

How can I lower high cortisol from stress?

Start with steady sleep, mostly easy exercise, morning-only caffeine, regular meals, less alcohol, slow breathing and time outdoors. See a doctor first if you have any of the physical signs above.

These statements have not been evaluated by the Food and Drug Administration. This content is for education and is not medical advice. Our products are not intended to diagnose, treat, cure or prevent any disease. Talk with a healthcare provider before starting a new supplement if you are pregnant, breastfeeding or taking medication.