Cortisol is a vital hormone produced by the adrenal glands, playing a role in stress responses, metabolism, and autoimmune diseases. While cortisol levels typically change with age, maintaining the ideal hormone balance at every life stage is necessary for proper body functioning.
Addison’s disease, a condition that causes an inadequate production of cortisol, affects about 1 in 100,000 people in the United States.
Exploring more about cortisol levels by age, and how they impact patient health across the lifespan, is important to ensure proper treatment of hormone imbalance.
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The Basics of Cortisol
Cortisol, also referred to as the “stress hormone,” is a hormone produced by the adrenal glands located on top of the kidneys in the human body. Hormones are the chemicals that carry messages throughout the body, instructing physiologic processes. Cortisol affects numerous body functions, including the regulation of the body’s response to stress.
Cortisol is responsible for:
- Suppressing inflammation in body tissues
- Controlling metabolism in the bones, liver, muscles, and fat
- Affecting sleep-wake cycles
- Regulating the body’s stress response
- Controlling the use of proteins, fats, and carbohydrates
- Regulating blood pressure and blood sugar
The body constantly monitors its cortisol to maintain steady levels. This is called homeostasis. When cortisol is too high or too low, health problems (some of which are life-threatening) can occur.
The normal levels of cortisol in the human body are influenced by various factors, including the time of day they’re measured. For example, typical cortisol levels are often higher early in the morning and are as follows:
- 6:00 am to 8:00 am: 10 to 20 mcg/dL
- 4:00 pm: 3 to 10 mcg/dL
Patient cortisol test results vary based on numerous factors, including age.
Cortisol Levels Throughout Life
What’s considered a normal cortisol test result depends on a patient’s age, health history, and many other other factors. Knowing more about ideal cortisol levels and what influences them is important to maximize a patient's overall health and well-being.
Childhood and Adolescence
Cortisol levels are established in infancy and may fluctuate during childhood and adolescence. Studies show that childhood trauma is linked to adverse health effects in adulthood via the body’s psychological response to acute stress.
Researchers found that childhood adversity might contribute to blunted cortisol reactivity and the risk of addiction, obesity, and other behavior-related diseases.
Research shows that typical cortisol levels increase across puberty as follows:
- 10.7 mcg/dL at age 13 in boys
- 14.4 mcg/dL at age 16 in boys
- 11.1 mcg/dL at age 13 in girls
- 15.9 mcg/dL at age 16 in girls
Additional studies found that higher cortisol levels in response to stress can contribute to symptoms of depression.
Researchers also found that early life stress in children is linked with elevated cortisol levels, cognitive deficits, and reduced cognitive performance when cortisol remains high long-term.
Adulthood
Cortisol levels and stress responsiveness may change throughout adulthood due to patient lifestyles, work-related stress, and parenthood. In the short term, high cortisol levels activate the body’s “flight or fight” response, allowing individuals to react quickly to life-threatening problems.
However, chronic stress and long-term high levels of cortisol can take a toll on the human body and lead to artery-clogging deposits, high blood pressure, brain changes, obesity, reduced sleep, depression, anxiety, and addiction during adulthood.
Cortisol levels are also affected by menstrual cycles and pregnancy in women.
Studies show that the menstrual cycle involves hormone level changes that influence a cortisol response to mental stress. Awakening cortisol levels appear to increase during the ovulation reproductive phase in women.
Cortisol levels also increase by two to four times in women during pregnancy. Research shows that high cortisol levels of during pregnancy are linked to low birth weight, reduced weight for length in newborns, and a higher risk of developing postpartum depression symptoms in mothers.
Older Age
Aging also impacts cortisol levels, as studies show that cortisol tends to increase with older age and is higher in older females than in males. Unlike many hormones that tend to decrease with age, cortisol concentrations typically increase in older adulthood and show irregular patterns (dysregulation).
Studies show that the health implications of altered cortisol patterns associated with aging include a higher risk of chronic diseases, such as heart disease, depression, anxiety, insulin resistance, and dementia.
Factors Influencing Cortisol Levels by Age
Factors that appear to influence cortisol levels by age are:
Genetic and Environmental Factors
Genetics and environmental factors, including exposure to early life stress, can influence cortisol levels and stress reactivity across the lifespan.
Examples include:
- Family history of hormone imbalance
- Genetic disorders
- Health conditions
- Poor quality sleep
- Obstructive sleep apnea
- Lack of exercise
Minimizing stress and adopting healthy habits may reduce the risk of a cortisol imbalance. Early detection and treatment of cortisol irregularities can minimize the chance of developing hormone-related medical complications.
Health Conditions and Medications
Common health conditions and medications that may affect cortisol levels, especially in older adults, include:
- Taking large amounts of corticosteroid medicines
- Tumors that make adrenocorticotropic hormone (ACTH)
- Adrenal gland tumors or excess tissue growth
- Primary or secondary adrenal insufficiency
- Cushing’s syndrome
- Addison’s disease
If your patient has or you suspect they have endocrine dysfunction, it’s crucial to routinely monitor them and manage these conditions.
Managing Cortisol Levels
Properly managing cortisol levels decreases the risk of developing health complications linked to chronic too-low or too-high cortisol levels.
Strategies for Maintaining Healthy Cortisol Levels
Tips for maintaining healthy cortisol levels include:
- Exercise regularly
- Eat a well-balanced diet
- Get adequate sleep
- Minimize stress using relaxation techniques (deep breathing or other methods)
- Take any medications exactly as instructed
- Report new or usual symptoms to a doctor at the first sign of a problem
- Maintain strong interpersonal relationships
While it’s not always possible to avoid stress entirely, encourage patients to take steps to minimize it as much as possible.
Treatment Options for Dysregulated Cortisol Levels
Diagnosing a cortisol imbalance involves a physical exam, a discussion of a patient’s medical history, and lab tests (blood, urine, or saliva tests).
Signs and symptoms of Cushing’s syndrome, adrenal insufficiency, and Addison’s disease include:
Cushing’s Syndrome (Excess Cortisol)
- Easy bruising
- Rounder face
- Weight gain
- Muscle weakness
- Purple streaks on the breasts, hips, stomach, or arms
- Thin legs and arms
- Increased fat between the shoulders or near the bottom of the neck
Adrenal Insufficiency or Addison’s Disease (Not Enough Cortisol)
- Chronic fatigue
- Loss of appetite
- Weight loss
- Abdominal pain
- Muscle weakness
Treatment options for individuals with dysregulated cortisol levels include healthy lifestyle interventions, medications, and therapy for underlying conditions or complications, such as depression.
Depending on the cause of cortisol dysregulation, patients may need to increase sodium in their diets, change their medications or dosages, or undergo radiation therapy or surgery to remove a tumor.
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Key Takeaways
Changes in cortisol by age, particularly increases during pregnancy or high-stress periods and decreases in older adulthood, are common and can dramatically impact patient health when not addressed. Understanding the risk factors for cortisol fluctuations, seeking early treatment for potential concerns, and minimizing stress is vital to optimizing patient health and well-being.
Patients should take a proactive approach to stress management and seek medical advice as soon as they develop concerns about cortisol levels and related health issues.
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