Lab technicians running a test of cortisol vs. cortisone levels

Understanding Cortisol vs. Cortisone

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.

Table of contents

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.[1]

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.

What Is Cortisol?

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.[2]

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.[2] The HPA axis registers:

  • Acute stress, which is usually associated with the hormone epinephrine
  • Sustained or chronic stress, which triggers the release of cortisol (produced by the adrenal gland)

By steadily disbursing cortisol, your body can remain in a state in which it can respond to a perceived threat at any time.[2]

Cortisol levels also play some other vital functions in the body, including regulation of [2]:

  • Immune function – Cortisol is involved in several immune activities, like regulating or suppressing inflammation responses.[2]
  • Metabolic function – When cortisol is present, different parts of your body can access and use energy sources more efficiently.[2] For instance, heightened cortisol levels make glucose more available to areas like the brain and liver. Alternatively, elevated glucose encourages your muscles to use protein (rather than glucose) as an energy source.[2]

Though the HPA axis evolved to protect you from harm, it can become dysregulated under periods of prolonged stress—whether real or imagined.[3] 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.

What Is Cortisone?

Cortisone is a synthetic corticosteroid that your body can metabolize into cortisol.[1] Healthcare providers may refer to corticosteroids as “steroids” for short (others include prednisone and methylprednisolone).[1]

Because cortisol regulates the inflammatory response, corticosteroids are primarily used in medicine as an anti-inflammatory or pain-alleviating agent. [1] Healthcare providers may use a cortisone shot to treat conditions like [4]:

  • Arthritis
  • Tendinitis
  • Bursitis
  • Carpal tunnel
  • Autoimmune conditions

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. [4] If you’re still experiencing discomfort 10 days following your cortisone injection, reach out to your healthcare provider for assessment and other treatment options.[4]

What About Hydrocortisone?

Hydrocortisone is also a corticosteroid, but it relies on a different vehicle to carry cortisone to the body topically for use.[5] You can find over-the-counter hydrocortisone in the form of [5, 6]:

  • Ointments
  • Gels
  • Lotions
  • Creams
  • Liquid solutions
  • Foams
  • Sprays

Dermatologists commonly recommend hydrocortisone to remedy a host of inflammatory skin conditions, like dermatitis.[6] You can also take it orally by prescription to treat conditions ranging from asthma to ulcerative colitis.[7]

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.[7]

Is Cortisol Bad For You?

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.

Health Impacts Of High Cortisol

Having a high cortisol level can negatively impact your well-being over time. In the long term, elevated cortisol may result in [8]:

  • Weight gain (resulting in hormonal belly)
  • Muscle weakness or thinness, especially of the arms and thighs
  • Weakened bones and an increased risk of bone breaks and fractures
  • High blood sugar and an increased risk of type 2 diabetes
  • High blood pressure

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). [9] However, all people who regularly take steroid medication are more likely to get it. [9] Some people develop it as a side effect of a brain tumor.[9]

Health Impacts of Low Cortisol

Just as elevated cortisol can lead to chronic stress and other problems, low cortisol can also adversely impact the body.[10] Persistently low cortisol levels may be accompanied by symptoms like [10]:

  • Tiredness and fatigue
  • Weight loss
  • Reduced appetite
  • Low blood pressure

Both elevated and depressed cortisol levels may reflect or contribute to a dysregulated HPA axis, which can result from chronic stress.[11] 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.[11] Understanding the connection between hormones and weight loss can help you identify these symptoms.

Diagnosing Cortisol Imbalance

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 [8]:

  • 10 to 20 mcg/dLin the morning (between 6 and 8 am)
  • 3 to 10 mcg/dL in the late afternoon (around 4 pm)

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.[8]

Recommendations for Supporting Healthy Cortisol Levels

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. [12] This is the complement to your sympathetic nervous system’s stress response. It helps you relax and recuperate after dealing with stress.[12]

Identifying practices that work for you can be an experimental process, but the following recommendations are an excellent place to start.

Use Stress Management Tactics for Work

Work can be a major stress trigger for people with active lifestyles and busy schedules. Mitigating the pressure might mean:

  • Taking breaks – Strolling around the block, practicing deep breathing, or doing something you enjoy between tasks can help your brain and nervous system process stress absorbed by work.
  • Implementing time management techniques – Tactics like SMART goals can help manage daily and long-term stress. SMART goals are specific, measurable, achievable, realistic, and time-bound. Making big tasks smaller with SMART goals can help remind your brain that your responsibilities aren’t a physical threat.
  • Delegating smaller tasks – Delegating, or simply asking for help, can be a wonderful way to reduce your daily burdens and connect with others.

Prioritize Sleep

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:

  • Going to sleep and waking up at the same time each day
  • Reducing screen time before bed
  • Creating a cool, calming bedroom environment
  • Avoiding caffeinated beverages in the hours before bedtime

Exercise Regularly

Some research suggests vigorous exercise significantly stabilizes cortisol and HPA axis activation in response to stressors.[13] Staying physically active also supports consistent sleep cycles and enhances the ability to get the recommended 7 hours of sleep per night.[14]

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.[15] Ideally, adults will engage in moderate exercise most days of the week, with room for recovery to help the body rest and repair.[15]

Limit or Avoid Alcohol

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.[16]

Alcohol works by temporarily flooding your brain and body with serotonin, a “feel-good” neurochemical.[16] 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.

Take Charge of Your Health With Everlywell

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.

Hormonal Belly: What it is And How To Treat It

The Connection Between Hormones and Weight Loss

What Are Signs That You May Need Hormone Replacement Therapy?

References

  1. Professional CCM. Corticosteroids. Cleveland Clinic. Last reviewed January 20, 2020. URL. Accessed January 1, 2024.
  2. Thau L. Physiology, cortisol. StatPearls - NCBI Bookshelf. Published August 28, 2023. URL. Accessed January 1, 2024.
  3. Sheng JA, Bales NJ, Myers SA, et al. The Hypothalamic-Pituitary-Adrenal axis: development, programming actions of hormones, and Maternal-Fetal interactions. Frontiers in Behavioral Neuroscience. 2021;14. doi:10.3389/fnbeh.2020.601939. URL. Accessed January 1, 2024.
  4. Professional CCM. Cortisone shots. Cleveland Clinic. Last reviewed February 4, 2023. URL. Accessed January 1, 2024.
  5. Hydrocortisone topical: MedlinePlus drug information. Last reviewed January 15, 2018. URL. Accessed January 1, 2024.
  6. Hydrocortisone (Topical Application Route). Published August 8, 2023. URL. Accessed January 1, 2024.
  7. Hydrocortisone (Oral route). Published November 7, 2023. URL. Accessed January 1, 2024.
  8. Professional CCM. Cortisol. Cleveland Clinic. Last reviewed December 10, 2021. URL. Accessed January 1, 2024.
  9. Professional CCM. Cushing Syndrome. Cleveland Clinic. Last reviewed December 27, 2022. URL. Accessed January 1, 2024.
  10. Addison’s disease - Symptoms and causes - Mayo Clinic. Mayo Clinic. Published December 8, 2022. URL. Accessed January 1, 2024.
  11. Introduction to the Hypothalamic-Pituitary-Adrenal Axis: healthy and dysregulated stress responses, developmental stress and neurodegeneration. PubMed. Published June 15, 2018. URL. Accessed January 1, 2024.
  12. Professional CCM. Parasympathetic Nervous System (PSNS). Cleveland Clinic. Last reviewed June 6, 2022. URL. Accessed January 1, 2024.
  13. Caplin A, Chen FS, Beauchamp MR, Puterman E. The effects of exercise intensity on the cortisol response to a subsequent acute psychosocial stressor. Psychoneuroendocrinology. 2021;131:105336. doi:10.1016/j.psyneuen.2021.105336. URL. Accessed January 1, 2024.
  14. How many hours of sleep are enough? Mayo Clinic. Published February 21, 2023. URL. Accessed January 1, 2024.
  15. Are you getting too much exercise?: MedlinePlus Medical Encyclopedia. Last reviewed August 15, 2022. URL. Accessed January 1, 2024.
  16. Clinic C. Anxiety and alcohol: Does drinking worsen symptoms? Cleveland Clinic. Published December 11, 2023. URL. Accessed January 1, 2024.
Jordan Stachel, M.S., RDN, CPT is most fulfilled when guiding others towards making stepwise, sustainable changes that add up to big results over time. Jordan works with a wide variety of individuals, ranging in age from children to the elderly, with an assortment of concerns and clinical conditions, and has written for publications such as Innerbody. She helps individuals optimize overall health and/or manage disease states using personalized medical nutrition therapy techniques.
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