Cortisol Doesn’t Play Fair: How Stress Shows Up Differently in Women and Men
Cortisol often gets labeled the "stress hormone," but it's more than just a marker of a busy day. It plays a vital role in energy regulation, blood sugar balance, immune response, inflammation, and circadian rhythm. However, when cortisol stays elevated over time, due to chronic stress, poor sleep, inflammation, or metabolic dysfunction—its impact can ripple throughout the body, disrupting nearly every major system.
At Austin Medicine, we often see how elevated cortisol can present differently in women and men. Understanding these distinctions is key to identifying the root cause and building an effective, individualized treatment plan.
The Role of Cortisol in the Body
Cortisol is produced by the adrenal glands in response to physical or emotional stress. In the short term, it helps the body adapt: increasing alertness, mobilizing energy, and suppressing non-essential functions like digestion and reproduction. But chronic activation of this stress response can lead to downstream effects, including:
Blood sugar dysregulation and insulin resistance
Increased belly fat
Muscle breakdown
Poor sleep quality
Suppressed immune function
Thyroid hormone disruption
Estrogen, progesterone, and testosterone imbalances
Over time, the body may shift from a state of elevated cortisol (high output) to a flattened, blunted response (low output), also known as HPA axis dysfunction or "adrenal fatigue."
How Elevated Cortisol Affects Women
In women, cortisol dysregulation often interacts with sex hormones in a more pronounced way than in men. Common presentations include:
Menstrual Irregularities: Cortisol suppresses the release of gonadotropin-releasing hormone (GnRH), disrupting the menstrual cycle and contributing to irregular periods, missed cycles, or worsened PMS symptoms.
Progesterone Depletion: Chronic stress can lead the body to divert resources away from making progesterone (a process known as "pregnenolone steal"), which can result in anxiety, mood swings, and difficulty sleeping.
Fatigue and Brain Fog: Women are more likely to report low energy, poor memory, and mental fogginess when under prolonged stress.
Weight Gain Around the Midsection: Cortisol promotes the storage of visceral fat, especially around the abdomen, which is particularly common in women with high perceived stress.
Sleep Disruption: Elevated evening cortisol can suppress melatonin, making it harder to fall asleep or stay asleep.
Thyroid Dysfunction: Cortisol blunts TSH and inhibits the conversion of T4 to active T3, making hypothyroid symptoms worse or masking them entirely.
Increased Inflammation and Autoimmunity: Chronic stress contributes to the development and flaring of autoimmune conditions, which are more prevalent in women.
How Elevated Cortisol Affects Men
In men, high cortisol also disrupts multiple systems but often presents differently:
Low Testosterone: Elevated cortisol has an inverse relationship with testosterone. Chronic stress reduces testosterone production, contributing to low libido, fatigue, reduced muscle mass, and mood changes.
Belly Fat and Muscle Loss: Men may notice increased central weight gain along with decreased lean muscle tissue, especially if testosterone drops.
Irritability or Anger: While women tend to internalize stress as fatigue or anxiety, men may display it as impatience, anger, or frustration.
Poor Sleep and Recovery: High cortisol impairs recovery from exercise and reduces deep, restorative sleep.
Suppressed Immunity: Just like in women, high cortisol can increase susceptibility to illness and delay healing.
Testing and Addressing Cortisol Imbalance
Cortisol is best measured by using blood, saliva, and urine. It is one of those hormones that needs multiple levels of evaluation to get a clear picture of what is going on! We recommend comprehensive testing that assesses the full daily rhythm of cortisol output, not just a single snapshot.
Treatment is personalized but may include:
Synergistic hormone optimization with thyroid, estrogen, progesterone, and/or testosterone therapy if applicable
Adaptogenic herbs (like ashwagandha, Rhodiola, or holy basil)
Stress reduction techniques (breathwork, mindfulness, therapy, time in nature)
Balanced blood sugar and anti-inflammatory nutrition
Sleep optimization
Gentle exercise and strength training
Hormone support when appropriate (thyroid, estrogen, progesterone, testosterone)
Final Thoughts
Cortisol is not inherently bad, in fact, we need it to function. But in today’s demanding world, many people are living in a constant state of stress without realizing the toll it takes. Because the signs of cortisol imbalance often masquerade as "normal aging," they are frequently dismissed or overlooked.
By understanding how cortisol presents differently in women and men, and how it interacts with other hormones, we can help patients reclaim their energy, mood, metabolism, and overall wellbeing through a functional, root-cause approach.
If you're feeling off and suspect stress is playing a role, reach out to explore how we can support your hormone health from the inside out.
To your health,
Dr. Lauren Hutson & the Austin Medicine Team
Meet the Author
Dr. Lauren Hutson is an experienced Primary Care Provider with degrees in Neuroscience and Biology from the University of Texas at Austin. She completed her residency at Baylor Scott & White, Texas A&M, with ABIM certification in Internal Medicine and has developed a strong focus on preventive care and chronic illness management. During the COVID-19 pandemic, she provided critical care as a Hospitalist in New Mexico, exemplifying her commitment to saving lives.
Dr. Hutson is also trained in Functional Medicine, is ABHRT and SSRP certified, and holds ABCN certification pending- these tools help exemplify her passion for root cause approach and healing the body as a whole. She practices medicine at the cellular level, focusing on enhancing longevity and optimizing long-term health by addressing root causes. She believes that all disease can start in the gut, and is authoring a book on gut health to share her insights on the microbiome’s role in overall wellness and also a recent course for the initiation of how to be your healthiest version of yourself ( self-paced) direct from Dr. Hutson herself!
Her front-line experiences during the pandemic inspired her to emphasize preventive health and health span over lifespan, investing in personalized strategies that empower patients to live healthier, longer, and more vibrant lives.
