Medically reviewed on January 3, 2024 by Jordan Stachel, M.S., RDN, CPT. To give you technically accurate, evidence-based information, content published on the Everlywell blog is reviewed by credentialed professionals with expertise in medical and bioscience fields.
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Separated by only a few letters, cortisol and cortisone sound similar but perform different actions in the biological and medical world.
What’s the difference between cortisol vs cortisone?
The former (cortisol) is a major, naturally occurring hormone involved in your body’s stress response system. The latter (cortisone) is a man-made, antiinflammatory substance in the class of corticosteroids. Healthcare providers use these to treat a variety of clinical inflammatory conditions.
Cortisol and cortisone are closely related through chemistry, as your body (specifically, the kidneys) must convert cortisone into cortisol to use it. Understanding the connection between both substances and your health can help you feel more empowered about the care you receive.
Cortisol is often cast as the hormone responsible for making you feel stressed, worried, activated, or anxious. However, it’s actually one of several players involved in the stress response of your body’s sympathetic nervous system.
The human stress response is largely regulated by a feedback system known as the hypothalamus-pituitary-adrenal (HPA) axis, which involves several different parts of your brain and body. The HPA axis registers:
By steadily disbursing cortisol, your body can remain in a state in which it can respond to a perceived threat at any time.
Cortisol levels also play some other vital functions in the body, including regulation of :
Though the HPA axis evolved to protect you from harm, it can become dysregulated under periods of prolonged stress—whether real or imagined. Over time, high cortisol levels or a dysregulated HPA axis can compromise your metabolic and immune systems, as well as other areas of the body.
Cortisone is a synthetic corticosteroid that your body can metabolize into cortisol. Healthcare providers may refer to corticosteroids as “steroids” for short (others include prednisone and methylprednisolone).
Because cortisol regulates the inflammatory response, corticosteroids are primarily used in medicine as an anti-inflammatory or pain-alleviating agent.  Healthcare providers may use a cortisone shot to treat conditions like :
A cortisone shot can be highly effective and useful, but may take some time to take effect. For instance, you may not notice a recession in pain or swelling for a week after receiving one.  If you’re still experiencing discomfort 10 days following your cortisone injection, reach out to your healthcare provider for assessment and other treatment options.
Hydrocortisone is also a corticosteroid, but it relies on a different vehicle to carry cortisone to the body topically for use. You can find over-the-counter hydrocortisone in the form of [5, 6]:
Dermatologists commonly recommend hydrocortisone to remedy a host of inflammatory skin conditions, like dermatitis. You can also take it orally by prescription to treat conditions ranging from asthma to ulcerative colitis.
Though hydrocortisone is fairly common in medicine, it’s important to use it under the guidance of your healthcare provider. Any kind of steroid medication can present problems with overuse that can adversely impact your hormonal and metabolic health.
In itself, no—cortisol isn’t bad for you. Cortisol and your overall stress response are crucial mechanisms your body has evolved to protect itself.
That said, it is possible to experience negative health outcomes if your HPA axis can’t moderate its stress response efficiently. In some people, this dysregulation presents as too much or too little cortisol in your system.
Having a high cortisol level can negatively impact your well-being over time. In the long term, elevated cortisol may result in :
Cushing’s syndrome is a rare condition that can arise in individuals with heightened levels of cortisol. Only an estimated 40 to 70 in 1 million people develop Cushing’s syndrome annually, and it primarily affects women and people assigned female at birth (AFAB).  However, all people who regularly take steroid medication are more likely to get it.  Some people develop it as a side effect of a brain tumor.
Just as elevated cortisol can lead to chronic stress and other problems, low cortisol can also adversely impact the body. Persistently low cortisol levels may be accompanied by symptoms like :
Both elevated and depressed cortisol levels may reflect or contribute to a dysregulated HPA axis, which can result from chronic stress. Common physiological consequences of HPA axis dysregulation include chronic digestive problems and depressed immune function; supporting a healthy stress response through lifestyle changes can often help soothe these symptoms. Understanding the connection between hormones and weight loss can help you identify these symptoms.
Even if you don’t feel stressed or anxious, it’s possible to have a cortisol imbalance or HPA axis dysregulation. Signs and symptoms can be highly variable between people, and if you’re used to your current state of affairs, it’s possible to experience chronic stress without realizing it.
Fortunately, cortisol testing can identify an imbalance. Though levels tend to fluctuate at different times during the day, for most people, a healthy cortisol level range is :
You can measure your cortisol levels by screening your urine and saliva cortisol content, either with the help of a healthcare provider or with at-home testing.
Integrating work and life practices that encourage emotional equilibrium may reduce the effects of outside stressors by helping your body activate the parasympathetic nervous system.  This is the complement to your sympathetic nervous system’s stress response. It helps you relax and recuperate after dealing with stress.
Identifying practices that work for you can be an experimental process, but the following recommendations are an excellent place to start.
Work can be a major stress trigger for people with active lifestyles and busy schedules. Mitigating the pressure might mean:
Normally, cortisol peaks in the early part of the day and tapers off in the late afternoon. Adhering to a regular sleep schedule can help reinforce this pattern, keeping your cortisol levels balanced throughout the day and into the next.
You can support better sleep and HPA axis functioning by:
Some research suggests vigorous exercise significantly stabilizes cortisol and HPA axis activation in response to stressors. Staying physically active also supports consistent sleep cycles and enhances the ability to get the recommended 7 hours of sleep per night.
Bear in mind that while sensible amounts of exercise help to reduce stress, overtraining can have the opposite effect, contributing to poor sleep and feelings of anxiety. Ideally, adults will engage in moderate exercise most days of the week, with room for recovery to help the body rest and repair.
Alcohol is conventionally used to help people relieve stress and enjoy themselves. However, relying on alcohol for anxiety relief can heighten stress levels in the long term.
Alcohol works by temporarily flooding your brain and body with serotonin, a “feel-good” neurochemical. After those effects recede, however, many people experience mood dysregulation, anxiety, and panic.
Consuming alcohol regularly or in large amounts can ultimately reduce rapid eye movement (REM) and deep sleep cycles, as well as damage your nervous system’s ability to self-regulate. If you’re struggling to manage stress without alcohol, reach out to a counselor or healthcare provider for guidance.
Keeping track of the many variables of modern healthcare shouldn’t be stressful. With a wide variety of affordable care options and at-home tests, Everlywell gives you more insight into your health and the power to make changes where necessary.
In particular, the online women’s health care options from Everlywell connect you with healthcare professionals prepared to work with you on a care plan built for your body. Find out more by visiting Everlywell and booking your first appointment today.