Let's get into cortisol.
I'm going to share excerpts from Chapter 5 of my book, "The Period Literacy Handbook", to describe what cortisol is below.
"Cortisol is ... a major player in the body's physiological stress response orchestrated by the HPA, hypothalamic-pituitary-adrenal, axis. Cortisol gets blamed for pretty much anything and everything, when it's simply trying to do its job.
I get it, we live in a culture of hustling and grinding; chronic stress, burnout, metabolic conditions, lack of social infrastructure, climate anxiety, injustice, and busyness are rife. We definitely want to address these factors as much as possible to have hormone harmony ... However, we also have to understand the importance of cortisol and what it does for us.
Cortisol is crucial to survival and life. It's needed not only for your stress response but also for regulating your metabolism, getting you out of bed in the morning, making sure that your immune system is functioning well, regulating your mood, and controlling your inflammatory responses.
Cortisol levels are typically high in the morning and low at night; this is part of your normal biological clock called the circadian rhythm. It naturally fluctuates throughout the day and is supposed to be made in higher quantities when you encounter a transient physical or mental-emotional stressor, like exercise, a presentation, not eating enough, a difficult conversation, someone chasing you, etc. It has a catabolic response in these situations so you have access to cellular energy, i.e., glucose, to react appropriately."
"Moon facies" is a term that has been used to describe facial swelling and shape change with more facial fat to resemble a full moon due to high body fat and/or elevated cortisol levels. This can be seen in Cushing's syndrome, with other signs and symptoms including elevated blood pressure, red striae on the abdomen, hirsutism, acne, hair thinning, and more. This is often a consequence of steroid medications or tumours of the adrenal or pituitary glands.
"Cortisol face" has been taken out of context online recently (as many nuanced topics are), with many influencers erroneously referring to water retention, lacklustre skin, and the increased facial volume of youth as "cortisol face". Genetically, we all have different facial features and deposit fat more readily in certain areas over others (including the face).
As we age, we lose facial volume quite naturally. We can also retain water due to myriad reasons like salt and potassium intake, exercise, sleep, carb/sugar intake, stress, menstrual cycle phase, alcohol, etc; this can change from day to day. There are also medical conditions that can lead to changes in fluid dynamics and metabolism such as hypothyroidism and diabetes.
I don't know about you, but my face looks different based on so many factors within the same day: hair, make-up, lighting, angle, clothes, morning vs. evening, jaw tension, etc.
The "before" pictures sharing how someone "cured" their "cortisol face" often is younger version of themselves with more facial volume, sometimes in bad lighting and no make-up, often with a higher degree of body fat, and perhaps dealing with unmanaged stress (which impacts behaviour, which often influences factors contributing to water retention like salt, sugar, alcohol intake, exercise, sleep, self-care, and how we look at ourselves).
The "after" pictures are often them a bit older so they've lost a bit of facial volume (some of them with cosmetic procedures even!), they've made lifestyle changes so water retention is lower, oftentimes they've lost weight, and the angle/lighting/hair/make-up is different.
Of course, some of these people might be sharing very real cortisol issues or Cushing's syndrome that they've managed. However, a lot of this type of content is misleading. So, please beware!
Even when we're super stressed out, cortisol levels are usually normal upon testing. This is because the body has a feedback mechanism in place to regulate how much of a certain hormone it's making. Cortisol naturally fluctuates–that's how most hormones work to keep you and your body doing its thing!
This doesn't mean that we forget about your stress and don't manage it if your levels are fine but you're feeling not-so-fine! We still work on supporting you, your body, and your mental health (obviously!).
Now, there are times when cortisol testing is clinically very much indicated and the results direct us to the next steps, especially if you have some of the other symptoms listed above. Please go see your MD and ND for that.
Many influencers (who often sell things) are using "before" and "after" pictures to "fix" your "cortisol face". (I know, that's a LOT of quotation marks!) The changes in the before and after pics often have to do with facial volume changes with age, lifestyle modification, weight loss, lighting and make-up, and/or fluid dynamics.
