TikTok is telling us cortisol is bad – but is it really?

Is your face puffy? Do you have a low sex drive? Does your skin keep flaring up? If you answered yes to any of these questions, you could be suffering from ‘high cortisol levels’ – at least according to the wellness influencers of TikTok, where cortisol has become a trending topic.

“Cortisol is a steroid hormone secreted by the adrenal gland,” explains Professor Richard Ross, Professor of Endocrinology at the University of Sheffield. It has many important functions such as regulating your body’s metabolism and sleep-wake cycle – and is often referred to as the “stress hormone”, owing to the fact that in moments of stress, high concentrations of cortisol are released into our bloodstream from our adrenal glands.

Chronic stress isn’t good for anyone – it’s long been known to increase your risk of heart disease and diabetes, while a recent Yale study found that a stressful lifestyle can even reduce your lifespan. But much of the advice knocking around TikTok at the moment conflates ‘high stress’ with ‘high cortisol’, and implies that we should strive to purge all cortisol from our bodies. While Professor Ross notes that “any stress can cause an acute rise in your cortisol levels”, these fluctuations are so minor that we don’t need to worry about them – if you are in good health, your body will naturally keep your hormones ‘balanced’ anyway. “Cortisol levels increase and decrease in oscillations all throughout the day,” adds Professor Stafford Lightman, professor of medicine at the University of Bristol.

In spite of this, wellness influencers on TikTok are erroneously blaming high cortisol for a whole smorgasbord of health issues: from sleep problems, to anxiety, to acne, to sugar cravings, to low sex drive, to weight gain – particularly in the face, hence the volume of videos about so-called ‘cortisol face’. Many offer viewers tips on how to bring down their cortisol levels, such as forgoing caffeine, walking 10,000 steps a day, and, naturally, buying a medley of supplements. 

Granted, high cortisol levels can be a real issue – but only for the small minority of people with hormone conditions like Cushing’s syndrome. Cushing’s syndrome is caused by having too much cortisol in your body, which mostly affects people who have been taking steroid medicine for a prolonged period of time. It can cause weight gain, low libido, and mood swings – many of the kinds of symptoms reeled off by wellness influencers extolling the value of ‘balancing’ your cortisol levels – but it is also characterised by other signs such as high blood pressure, a rounded ‘hump’ between the shoulders, purple stretch marks, and muscle weakness.

It’s ultimately an extremely uncommon condition, affecting around one in 40 to 70 million people, so it’s unlikely experiencing weight gain or low libido alone points to a diagnosis of high cortisol levels. “Measuring cortisol is complex,” explains Professor Ross, adding that investigating cortisol levels usually requires the input of a qualified endocrinologist.

30-year-old Jules began seeing videos about cortisol on her TikTok FYP after interacting with other wellness content on the app, and began to wonder if some of her health concerns were related to her cortisol levels. “It felt easy to point the finger at stress or cortisol, which is often a factor out of our control,” she says. The more content she saw, the more she worried, and so one day she booked an appointment with an endocrinologist to test her for Cushing’s syndrome. “The tests came back negative,” she says, explaining that she subsequently grew much more sceptical of the creators posting about cortisol. “It felt like an easy ploy for certain creators to garner attention.”

While there are grains of truth among the reams of TikTok advice – it’s true that drinking less caffeine probably will make you feel less stressed and anxious, for instance – experts reckon that the vast majority of it is pointless and ineffectual. For example: can drinking bone broth really reduce your cortisol levels? “No,” says Professor Lightman, adding that “there is no such thing as ‘raised cortisol’ outside of clinical conditions [like Cushing’s syndrome].” Besides, Cushing’s syndrome requires much more extensive treatment than ‘going on a daily walk’.

In spite of the rarity of Cushing’s syndrome, it’s unsurprising that videos about ‘lowering your cortisol’ remain hugely popular on TikTok given the way wellness influencers regularly peddle pseudoscience on the app. “This trend speaks to the shift we see in society enabled by the increasing digitalisation of health and the power of social media wellness fads,” says Dr Rachael Kent, senior lecturer at King’s College London, author, and host of the Digital Health Diagnosed podcast. “The core ethos of this trend is ultimately about reducing stress, but the medicalisation of the language used to promote this gains viral traction.”

The buzz around cortisol is also in keeping with other recent wellness trends which promote extreme self-surveillance as a means of achieving good health, such as the glucose-tracking technology or gut health testing offered by companies like ZOE. But while it’s understandable that you might be keen to micromanage your health in the face of the NHS crumbling, a neurotic fixation with your body will ultimately do more harm than good. “I am worried that we are creating a population of worried well,” says Professor Lightman. Dr Kent agrees. “My research has also shown how this sort of content which advocates for continual self-surveillance of the body through tech becomes a great source of mental stress over time,” she adds. “Life does not need to be ‘optimised’, but health apps and social media would have its users believing that it does.”

Some of the advice kicking around the cortisol side of TikTok isn’t all bad: reducing your caffeine intake and getting enough sleep probably will make you feel more like a human being and less like a tightly wound ball of nerves. But that’s because these things will help you manage stress – not your ‘cortisol levels’. While of course you should approach a doctor if you’re concerned about any unusual symptoms, there’s no reason why you should leap to the conclusion that your cortisol levels are chronically out of whack just because your skin is breaking out or you’re not in the mood for sex. Ultimately, as Jules learnt: “stressing about cortisol is just counterintuitive.”