DIs your face puffy sometimes? Do you ever experience an emotion called “stress”? According to some of the foremost medical thinkers on the planet (TikTok influencers), these are not inevitable consequences of existence; Those are signs that you have what is called “cortisol face.”
Cortisol is the body's main stress hormone. According to hundreds of clips on social media, excess stress – and, in turn, excess cortisol – causes a round, puffy face. “You're not ugly, you just have a cortisol face” is a popular excuse in these videos. In the posts, users share before-and-after pictures of themselves, in which they go from a round, full face to a slimmer one — all cheekbones and sharp jawlines.
“The reason you have a double chin, puffy eyelids, and droopy cheeks is because your excess cortisol is quietly changing the look of your face,” the video claims.
Besides the obvious fat-shaming of these messages, science doesn't fully back them up. “'Cortisol face' is not a recognized medical term,” explains Dr. Priya Jaisingani, an endocrinologist at New York University Langone Health.
Chronically high levels of cortisol can have adverse health effects. Over time, excess cortisol can lead to Cushing's syndrome, a condition caused by high blood pressure, bone loss, and occasionally type 2 diabetes. But experts say Cushing's syndrome is relatively rare.
We asked the experts the truth behind this new health buzzword.
What is cortisol and how does it affect our health?
“Cortisol is a steroid hormone produced by the adrenal glands,” says Dr. Adam Friedman, MD, professor and chair of dermatology at the George Washington University School of Medicine and Health Sciences. He explains that it plays an important role in many body functions, including regulating metabolism, managing our immune and stress responses, and maintaining blood pressure.
“We cannot survive without the right amount of cortisol,” says Friedman. But too much of it is “bad”.
Doctors can measure your cortisol levels by testing your blood, urine, or saliva.
What is Cushing's syndrome?
There are two types of Cushing's syndrome, says Dr. Maria Flecheriu, director of the Pituitary Center in Oregon. University of Health & Sciences: Exogenous (effect of a factor outside the body) and endogenous (effect of a factor inside the body).
Exogenous Cushing's syndrome is usually the result of steroid therapy, especially glucocorticoid drugs such as cortisone and prednisone. These increase the level of cortisol in the body.
It is more common than endogenous Cushing's syndrome, which can be caused by a pituitary tumor or an adrenal gland disorder.
While day-to-day stress can contribute to weight gain, Friedman says, it's unlikely to do so “to the extent seen in clinical syndromes like Cushing's.”
“Cushing's syndrome is rare,” says Fleseriu, who estimates that there are four to five cases of endogenous Cushing's per million people worldwide per year.
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Is the cortisol face real?
Not in the way it is usually discussed on TikTok. As Jaisingani says, it is not a medical term.
Weight gain in the face and neck is a common symptom of Cushing's syndrome, but it's not enough to make the diagnosis, says Fleseriu. “The clinical diagnosis of Cushing's is very challenging,” he explains. When determining whether or not a patient has the condition, Fleseriu says to look for “more than one symptom.”
Other symptoms of Cushing's include pink and purple stretch marks on the abdomen, high blood pressure, tender skin, fatty lumps between the shoulders, and weight gain on the face and trunk.
How can one control their cortisol levels?
The risk of developing Cushing's syndrome is relatively low. But people can manage stress and cortisol levels by maintaining their overall health, says Jaisingani. “Maintaining a nutritious diet, ensuring adequate and high-quality sleep, staying well-hydrated, and incorporating stress-reduction strategies,” she recommends.
Once a person is diagnosed with Cushing's syndrome, treatments vary. If it's external, Fleseriu warns not to stop or reduce the use of glucocorticoid drugs without a doctor's supervision. “Stopping the steroids right away can put them in adrenal crisis,” he explains.
In the case of endogenous Cushings, patients can take medications or have the tumors removed with surgery or radiation. Generally, these treatments are successful. “Now almost everyone can induce remission,” says Fleseriu.
If you think your cortisol levels are high, don't use TikTok for answers. “If you're concerned about your cortisol levels, it's important to consult your doctor,” says Jaisinghani.
