Is It Really Your Cortisol?

What my patients are ACTUALLY asking when they ask me about cortisol

BOOK UPDATE 👉

• Join me in DC during publication week! I’ll be in conversation with my friend Franklin Foer on August 12 at 7 pm at Politics & Prose.

• Just in! My first official review from Publisher’s Weekly: "[A] smart debut guide to making informed health decisions... Patients will feel empowered."

• SURPRISE BONUS: Beyond the Prescription book club sign-ups will stay open for another week! Get the details here ⬇️

I was in LA last weekend, celebrating my wedding anniversary (26 years!). Cortisol, the infamous stress hormone, was on the brain.

First, my husband had been taking high-dose steroids for a persistent migraine headache. Momentarily forgetting this, I asked him at dinner, “Is it me, or are you talking super fast—and a little loud, too?” (26 years of marriage is really a union of honesty and bluntness.)

“Love, remember I’m taking 60 mg of Prednisone! I could run a 4-minute mile on this stuff!”

Oh right.

It’s funny how administering an oral equivalent of cortisol—the same stress hormone that can leave you wired, revved, and unable to sleep—can also quiet inflammatory processes like migraines and poison ivy and asthma flare-ups.

Then, watching the roller coaster dip and soar on the Santa Monica pier, I felt my palms sweat and my heart gallop. Even though I wasn’t ON the rickety ride myself, my own adrenaline (cortisol’s fast-acting cousin) kicked in—the same primitive reflex those teenagers in line were paying for: the thrill, the simulation of danger.

Before we talk about whether cortisol is good or bad, let’s get the biology straight. Cortisol is a hormone produced in the adrenal glands. It releases into the bloodstream on a circadian rhythm and spikes during periods of physical or emotional stress. It’s a built-in survival mechanism. (Unlike adrenaline, which spikes in seconds on a roller coaster or in a burning building, cortisol works on a slower clock.) There are rare conditions in which the adrenal glands make far too much cortisol (Cushing’s syndrome) or far too little (Addison’s disease); both are real, both are testable, and neither is what most of my patients are dealing with.

For people with normal adrenal function, cortisol isn’t a problem, it’s a signal. Its presence is our best friend when we’re in danger. But when it’s being made in excess, we can feel unwell and our bodily systems can go on the fritz. The body isn’t the problem; it’s doing exactly what it’s hard-wired to do. It’s also inviting us to take stock of what’s going on in our lives.

So why is the internet ablaze with headlines suggesting that cortisol is bad for you? Why do wellness influencers claim that excess cortisol—made by our own bodies—is responsible for everything from weight gain and diabetes to depression and fatigue? Why are there supplements promising to “balance” your adrenals, protocols to lower your cortisol, and mushroom blends to calm your nervous system?

It’s not that cortisol is newly discovered. I think it’s that modern life has made us wired and tired and unsure of what’s wrong with our bodies. Most people don’t know who to trust or what questions to ask.

Last week, a patient in her mid-40s came in to see me for her annual physical. After we reviewed her labs and decided she was squarely in perimenopause, she lowered her voice and asked me the question she came in to ask: “Do you think it’s my cortisol?”

She wasn’t wrong. But the cortisol question is the right instinct dressed up as the wrong question. I get it. She had been combing the internet for answers like we all do. The right question is one only she can ask herself (and the one your doctor likely doesn’t have time to): What physical, emotional, or situational stress am I under—and what, realistically, can I do about it?

That question deserves an answer. And it cannot be answered by a supplement or a protocol. It can be answered, instead, by an honest conversation (with yourself or with your doctor) about your sleep, your alcohol intake (not what you tell your friends it is), your relationships, your hormonal status, your everyday coping kit, what you eat when no one is watching, and what you would change about your life if you gave yourself permission and you weren’t afraid.

The things that actually lower cortisol are not exotic. They are sleep, movement, protein, sunlight, human connection, healthy boundaries, and, for some women, hormone therapy, or an SSRI, or an honest hour with a therapist. They are unglamorous, they are hard to implement, and most of them are free. (Which is why I’ll never make a quick buck off of selling you products!)

So when my patient asks me, “Do you think it’s my cortisol?”—I tell her yes. I tell her she’s right to be paying attention. And then I tell her that the most powerful thing she can do is to insist—of me, and anyone responsible for her care—that the conversation she came in for is the conversation we have.

Which brings me back to my husband and the Santa Monica pier. My husband’s migraine resolved on our trip. He stopped taking Prednisone and returned to his normal 10/10 energy (from a speed-talking 15/10). The roller coaster came to a halt, the screaming subsided. Kids tumbled onto the platform, laughing and releasing adrenaline into the salty air.

Not everyone has an instant off-switch. So whatever is keeping you wired and tired (and depositing weight around your middle) doesn’t taper, because your life doesn’t either.

The upshot: Cortisol isn’t itself the problem. It’s a call to action, to ask yourself the hard questions about what’s going on inside you.

Those questions are exactly what I wrote my book to help you find. Because health isn’t about having all the answers. It’s about asking better questions—of yourself and of the people responsible for your care.

Whats’s YOUR current cortisol level? (e.g., low? simmering? on fire?)

My book, Beyond the Prescription, comes out on August 11! I wrote it with you in mind.

---

Please hit the ❤️ or 🔄 button so more people can discover this post! Even better, please share it with friends and loved ones! 🙏