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CHICAGO/PORTLAND/SAN DIEGO – A health trend swirling on social media platforms like TikTok, dubbed “cortisol detoxing,” is causing concern among medical professionals who warn it’s driven by misinformation and could lead to unnecessary, potentially harmful medical testing.
Influencers are promoting specific diets, exercises, supplements, and cortisol level testing to manage what they often refer to as the “stress hormone.” Claims range from high cortisol causing body puffiness and sleep problems, as one TikTok user promoting a supplement stated, to low cortisol causing exhaustion after exercise, as suggested by a dietitian on the platform.
However, endocrinologists and primary care physicians report an increase in patient requests for cortisol testing based on these social media claims, despite the lack of scientific backing. “There’s no science behind any of this,” stated Dr. Disha Narang, an endocrinologist and Director of Obesity Medicine at Endeavor Health in Chicago, who frequently encounters patients influenced by online misinformation about cortisol.
Medical experts emphasize that cortisol testing has specific, limited applications, primarily for diagnosing rare endocrine conditions like Cushing syndrome (abnormally high cortisol) or adrenal insufficiency (abnormally low cortisol). Cushing syndrome affects up to 70 people per million annually, while adrenal insufficiency affects around 300 per million. Symptoms of the latter include fatigue, poor appetite, salt cravings, and vertigo.
The Endocrine Society, a leading professional organization, only provides cortisol testing guidelines for these specific conditions and does not recommend testing for general symptoms like stress or chronic fatigue, according to Dr. Maria Fleseriu, former chair of the society’s Clinical Guidelines Committee and Director of the Pituitary Center at Oregon Health & Science University. Testing individuals without clinical suspicion of these disorders is actively discouraged.
Experts highlight several significant issues with unnecessary cortisol testing:
- High Potential for False Positives: Cortisol levels naturally fluctuate throughout the day, peaking in the morning and decreasing later on. A single blood test, especially if timed incorrectly (like an afternoon test potentially mimicking low cortisol), is unreliable, noted Dr. Katie Guttenberg, Associate Professor at UTHealth Houston. Factors like sleep patterns, mental health conditions (like depression), acute stress, pregnancy, and certain medications (contraceptives, glucocorticoids, biotin) can all influence levels and lead to false results.
- Misdiagnosis and Inappropriate Treatment: Chronic stress, metabolic syndrome, uncontrolled diabetes, eating disorders, depression, and alcoholism can cause “physiologic hypercortisolism” or “pseudo-Cushing syndrome,” which can be mistaken for true Cushing syndrome if testing is done inappropriately. Dr. Guttenberg advises against routine cortisol testing in patients with major depression for this reason, recommending treatment focus on the underlying depression instead.
- Risk of Harmful Interventions: Misinterpreting test results can lead to a cascade of unnecessary follow-up tests, imaging, invasive procedures, and even incorrect medication prescriptions. Dr. Preethika S. Ekanayake, an endocrinologist at UC San Diego Health, warned that inappropriate cortisol profiling has led to patients being wrongly prescribed cortisol supplements, resulting in medication-induced Cushing’s syndrome and potentially permanent adrenal insufficiency. False positives suggesting adrenal insufficiency can also cause significant health anxiety, added Dr. Priya Jaisinghani of NYU Grossman School of Medicine.
Instead of seeking tests based on social media trends, experts urge patient education. Dr. Ekanayake reassures patients that, outside of specific diagnosed conditions, “the adrenal glands are very smart glands” that function well without special interventions related to age or stress. Dr. Narang pointed out that terms like “adrenal fatigue,” often used by influencers, are “not a real diagnosis.”
Clinicians are encouraged to redirect conversations with concerned patients towards foundational health behaviours. Dr. Jaisinghani suggests counselling on sleep habits, stress management techniques, and balanced diets, noting, “These are the foundations of overall well-being and often have a greater impact on long-term health.”
Disclaimer: This news article is based on information provided regarding expert opinions on cortisol testing and social media trends. It is intended for informational purposes only and does not constitute medical advice. Always consult with a qualified healthcare professional for any health concerns or before making any decisions related to your health or treatment.
