In a now viral TikTok, Mandana Zarghami starts by saying: “You’re not ugly, you just have a cortisol face.” Published under the hashtag #cortisolface, the video was part of a trend of other wellness and beauty influencers explaining the term. But what is cortisol? How does it affect our body? And why has it drawn so much attention on social media?

First, “cortisol is a hormone that we produce from birth and is essential for life,” explains Paola Portillo, who is a specialist in endocrinology at Hospital Zambrano Hellion in Monterrey of TecSalud.

In the past few months, hundreds of people have shared videos claiming that their “cortisol face” – referring to a round and inflamed face – is due to high levels of this hormone in their body, which they associate with increased stress in their daily lives.

However, for experts, the relationship between stress and cortisol is not as simple as social media would have us believe because this hormone -one of more than 50 produced by our body- has multiple functions in different areas of our body.

How Does Cortisol Affect Our Body?

Cortisol is produced in response to physical and mental stress, and it’s crucial for survival because it helps the body regulate its response to perceived threats by adjusting blood pressure, glucose, and metabolism. In a healthy person, cortisol production follows the circadian rhythm, and its levels tend to be higher in the morning to help us wake up and lower at night.

But as Portillo explains, there’s been several changes in people’s lifestyles that could impact their cortisol production. Higher stress, insomnia, and fluctuating emotional states normally affect a person’s circadian rhythm and effectively, their cortisol. 

This is what happened two years ago to influencer Mandana Zarghami, who had been struggling for months with weight gain, inflamed skin that wouldn’t stop breaking out, and uncomfortable stomach bloating. Since she wasn’t taking contraceptives, she didn’t know what to attribute these sudden changes to.

After seeing two different doctors who, according to her, downplayed her symptoms, she was more desperate than ever: “I felt so incredibly unhappy with my appearance that I was willing to take extreme measures to see results.”

Although her blood tests came back normal, Zarghami knew she had to do something to feel better and began researching holistic solutions and lifestyle changes that could help her.

While hormone levels can rise under stress, this doesn’t necessarily mean that the person is suffering from an illness or ailment. In fact, endocrinologist Paola Portillo says that cortisol can return to normal levels “with lifestyle changes.”

For Zarghami, that change in her habits made all the difference: “They tell you to go to these doctors for answers, but they only give you these pills that are supposedly going to magically cure you. I decided to take my health into my own hands.”

The process of finding what changes worked for her required a lot of trial and error -lemon water made her acid reflux worse, a popular supplement circulating on TikTok made her dizzy- but eventually she found what worked for her. She eliminated processed foods and switched to a Mediterranean diet with more lean proteins. She also gave up weightlifting, focusing on low-impact exercises like walking.

Her story resonated with thousands of people on social media, where many users report feeling ignored by traditional healthcare providers. “I think a lot of people are looking for holistic ways to heal because they go to doctors and aren’t listened to,” notes Zarghami.

Does Cortisol Only Rise Due to Stress?

Contrary to popular opinions on social media, medical experts warn against oversimplifying the relationship between stress and cortisol levels. For example, Roberto Salvatori, an endocrinologist at Johns Hopkins in Baltimore, Maryland, emphasizes that there is no scientific evidence that normal stress-induced cortisol causes the same facial changes seen in medical conditions that affect cortisol production (such as Cushing’s syndrome).

“The most common cause of elevated cortisol is actually our prescription pad,” explains Salvatori, referring to medications like steroids used to treat conditions such as asthma, arthritis, and colitis.

Cortisol level tests aren’t simple either – morning measurements can be misleading since everyone naturally has higher levels at that time. Also, women taking contraceptives or estrogen therapy may show artificially elevated results. “Every test has false positives,” warns Salvatori. “You don’t want to do tests without a good reason because it can generate unnecessary anxiety.”

The key is to distinguish between temporary elevations and medical conditions like Cushing’s syndrome, where cortisol is consistently high. Therefore, according to endocrinologist Portillo, it’s important to understand the context when it comes to levels of this hormone.

Should We Trust the Opinions We See on Social Media?

The increase in social media content about cortisol gained particular momentum during the pandemic when stress levels were collectively elevated. While this raised awareness about hormonal health, medical professionals are concerned about the risk of self-diagnosis and oversimplification of complex medical problems.

“When there’s a void, anyone fills it,” notes Salvatori, acknowledging the appeal of health advice on social media when patients feel ignored by medical professionals.

The solution, according to medical experts, lies in finding a balance between listening to patients’ concerns and maintaining scientific rigor. In this regard, Portillo advocates for a more integrated approach to medical care that considers lifestyle factors while still relying on medical expertise. This may include evaluating sleep quality, exercise habits, and stress management along with traditional medical treatments.

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