Cortisol is a fascinating hormone that often gets misunderstood, especially on social media! Scroll through Instagram and you’ll see plenty of posts fearmongering about “high cortisol” being dangerous. While it’s true that chronically elevated cortisol can create problems, it’s not the enemy. In fact, cortisol is essential for health and survival. Like most things in the body, balance is key.
Cortisol’s Source: Where It Comes From and How It’s Regulated
Cortisol is produced by the adrenal glands, small triangular glands that sit atop each kidney. The secretion of cortisol is tightly regulated by a hormonal cascade known as the hypothalamic-pituitary-adrenal (HPA) axis.
Here’s how it works:
- The hypothalamus in the brain detects stress or changes in the internal environment and releases corticotropin-releasing hormone (CRH).
- CRH then signals the pituitary gland (also in the brain) to release adrenocorticotropic hormone (ACTH).
- ACTH travels through the bloodstream to the adrenal glands, prompting them to secrete cortisol into circulation.
Once cortisol levels are high enough, they feed back to the hypothalamus and pituitary gland to reduce CRH and ACTH, completing a negative feedback loop that maintains hormonal balance. This regulatory system allows cortisol levels to rise rapidly in response to acute stress and then fall once the stressor is gone.
Cortisol’s Natural Rhythm
Cortisol follows a circadian rhythm. Levels peak in the morning, helping you wake up and feel alert. Throughout the day, cortisol gradually tapers off, reaching its lowest point just before bedtime. This decline helps the body wind down, preparing for restful sleep. It is in opposition to melatonin in this manner.
What Happens When Cortisol Is Out of Balance?
Too much cortisol for too long, whether from chronic stress, a tumor, illness, or external steroids, can lead to problems like high blood pressure, weight changes, immune suppression, and eventually “burnout.” Although the physiology is complex and not straightforward, you can simply think about it like this. Essentially in this phase, the adrenal glands reduce their output, leaving cortisol levels too low. Symptoms may include fatigue, poor stress tolerance, low blood pressure, and worsening inflammation.
On the flip side, too little cortisol can also be harmful, as the body depends on this hormone for basic functions like regulating blood sugar, blood pressure, and immune activity.
Cortisol Injections for Pain and Inflammation
Corticosteroid injections (often just called “cortisone shots”) are commonly used to treat pain and inflammation in joints, tendons, or around nerves. These injections can provide meaningful, temporary relief—particularly for conditions like arthritis, bursitis, or tendonitis.
But Here’s What Many People Don’t Realize:
- They often don’t fix the root cause. Injections calm inflammation but don’t address underlying biomechanical, pathological, structural, or metabolic issues.
- At high enough doses they suppress your natural cortisol. After an injection, your body may reduce its own cortisol production. Serum cortisol levels can stay low for up to four weeks before slowly normalizing back to baseline.
- They can affect the immune system. While short-term suppression can reduce inflammation, repeated or high-dose use may weaken immune defenses and tissue healing.
Cortisol’s Vital Roles
Far from being just a “stress hormone,” cortisol has wide-ranging effects on nearly every system in the body:
- Stress Response: Provides quick energy and sharpens focus during the “fight-or-flight” response.
- Metabolism & Blood Sugar: Releases stored glucose to fuel muscles and the brain.
- Inflammation & Immunity: Reduces excess inflammation and prevents immune overreactions.
- Blood Pressure Regulation: Helps keep blood pressure stable.
- Sleep-Wake Cycle: Promotes wakefulness in the morning and tapers off for nighttime rest.
- Memory Formation: Supports learning and recall, especially in stressful moments.
- Salt & Water Balance: Helps regulate hydration and blood volume.
Takeaway
Cortisol is neither “good” nor “bad.” It’s a vital hormone that keeps your body functioning. Problems arise when levels are chronically too high or too low—whether from stress, illness, or overuse of corticosteroids.
If you’re considering or already receiving corticosteroid injections, it’s important to understand both the benefits and limitations. While they may provide relief, they should be paired with strategies that address the root cause of pain and inflammation—whether through physical therapy, nutrition, movement, or other integrative approaches. If you are interested to see where your own cortisol is and how it plays into your health, consider booking an appointment with Dr. Mary K Geyer.
FAQs:
1. What’s the difference between cortisol and corticosteroids?
Cortisol is a hormone your body naturally produces, while corticosteroids are synthetic drugs designed to mimic cortisol’s anti-inflammatory effects. Corticosteroid injections (like cortisone shots) are used to treat pain and inflammation but can suppress your body’s own cortisol production if overused.
2. Are corticosteroid injections safe?
Yes, they are generally safe when used appropriately and occasionally. However, repeated or high-dose injections can lead to side effects such as joint damage, immune suppression, elevated blood sugar, and suppression of your body’s natural cortisol production.
3. How long do the effects of a cortisone injection last?
Relief can begin within a few days and may last from a few weeks to several months, depending on the condition being treated and individual response. They are most effective for inflammation-related pain.
4. Can I get more than one cortisone shot?
Yes, but frequency should be limited. Most doctors recommend no more than 3-4 injections per year in a single joint or area to avoid tissue damage or systemic side effects.
5. Will a cortisone shot “cure” my pain?
Not usually. Cortisone shots reduce inflammation and can relieve pain, but they don’t fix the underlying problem (like joint degeneration, tendon tears, or biomechanical issues). That’s why they’re best used alongside other treatments like physical therapy or lifestyle changes.
6. What are the side effects of cortisone injections?
Common side effects include:
- Temporary pain flare at the injection site (“cortisone flare”)
- Skin thinning or lightening
- Elevated blood sugar (especially in diabetics)
- Suppression of natural cortisol production
- In rare cases, infection or joint damage
7. Can stress really increase cortisol levels?
Yes. Physical, emotional, or psychological stress can activate the HPA axis, leading to increased cortisol production. While short-term increases are normal and helpful, chronic stress can keep cortisol elevated, potentially contributing to health issues over time.
8. How do I know if my cortisol levels are too high or too low?
Symptoms of high cortisol may include:
- Weight gain (especially around the abdomen)
- High blood pressure
- Sleep disturbances
- Irritability or anxiety
Symptoms of low cortisol may include:
- Fatigue
- Low blood pressure
- Poor stress tolerance
- Dizziness or salt cravings
If you’re concerned, talk to a healthcare provider. Blood or saliva tests can measure cortisol levels at specific times of day.
9. Can I support my natural cortisol rhythm naturally?
Yes! Healthy lifestyle habits can support normal cortisol patterns:
- Get consistent sleep (especially going to bed and waking up at regular times)
- Manage stress through mindfulness, exercise, or therapy
- Eat balanced meals to support blood sugar stability
- Avoid excessive caffeine or sugar, which can stress the system
10. Should I be worried if I’ve had a corticosteroid shot?
Not necessarily. A single injection or occasional use is unlikely to cause major issues. But it’s smart to be informed. Talk to your doctor if you’ve had multiple injections, or if you’re experiencing fatigue, mood changes, or other unusual symptoms afterward.
