It’s a Sunday morning, and in the tradition of Sunday mornings, I rejoice in having nowhere to go and nowhere to be. I start to fall back asleep when my eyes suddenly open. I‘I’m awake! I need to take a cortisol test! Dragging myself out of bed, I open a plastic-wrapped kit that looks suspiciously like a pregnancy test, pop it in my mouth (saliva, not urine, is the relevant bodily fluid in this case), and swipe to the corresponding app on my phone (there’s always an app, right?).
The cortisol test I try is most accurate when done as soon as possible after waking up to accurately assess the “diurnal curve” — a peak followed by a gradual decline — that the hormone should follow throughout the day. As I looked through the various tips and guidelines on the app that morning, I saw sleep as one of the main factors in keeping cortisol levels on track. Looking at my bed, I actually wish I was still sleeping. But if I was sleeping, of course I wouldn’t follow.
For the past year or so, I’ve been listening to incessant discussions about cortisol, the most well-known hormone associated with stress. On social media, influencers and fitness experts are racking up millions of views and likes on videos blaming cortisol for a range of problems from belly fat to hair loss to “moon face.”
“Do you often wake up tired? perfectly toned millennials with titles like “wellness professional” ask me from my screen. (Yes.) “Do you often feel stressed?” » (Yes.) “Do you wish you could lose weight more easily? (I mean, sure.) “Do you have brain fog?” (I have a good list of emails that I forget to respond to, and the number of times I find myself saying, “It’s on the tip of my tongue” seems to increase daily, so, yeah again?).
Could imbalanced cortisol levels be causing all the symptoms I thought were the hallmarks of adult life in 2026? Why not try to find out?
A few weeks ago, I ordered a daily at-home cortisol test kit sold by Eli (cortisol tests are their flagship product; testosterone tests are “coming soon”), which costs $199 for 24 tests and a three-month subscription to their platform. The adorable “Hormometer” arrived shortly after. I downloaded the app and started testing twice a day as recommended. The process, guided by the app, is relatively simple: complete the saliva test by sucking for 60 seconds, wait 20 minutes, scan the test, get the results. At the end of this process, the app displays my results on a graph showing the ideal diurnal curve and tells me how many nanograms of cortisol are in a milliliter of my saliva, a measurement that Eli says is 97 percent accurate. If the measurement is above or below “ideal”, the app provides a brief overview of what that might mean, for example, I might have slept poorly or had too much caffeine. To what extent could this exercise Really tell me about my health? It’s not clear.
The problem with cortisol is that it is more than a stress hormone. It is an active part of metabolism, your circadian rhythm, inflammation control, blood sugar and blood pressure. Disruptions in cortisol regulation have been associated with a host of neurodegenerative disorders and depression. Although your cortisol levels can be affected by stress, “it’s not a stress indicator that tells us whether you’re stressed at that moment,” said Rachna Relwani, an endocrinologist and assistant professor of medicine at NYU. “A high result does not necessarily mean you are stressed, and a normal result does not mean you are not stressed.” Bottom line: Cortisol’s role in our biological mechanics is complex, and cortisol levels aren’t really something that clinicians typically think about in isolation.
Still, Relwani said more patients are coming to her after having their cortisol tested at outside clinics or with direct-to-consumer tests like the ones I was doing. Unless a test indicates the very rare but serious Cushing’s syndrome, identified by sustained high cortisol levels, she won’t necessarily need to do anything with the results they show her. (And even then, she would want to do her own tests: Many at-home tests, she added, are not regulated by solid data to support their conclusions.) When a patient has taken one of these tests, the main thing they tell them is that they are concerned enough about their health to order and take a test themselves. Then she will start from scratch, ask how the patient feels, and make clinical decisions from there.
“I think in general, people are looking for answers to why they don’t feel well,” Relwani said. Because cortisol is something that can be measured quite easily and quantifiably, and research shows that high levels of cortisol can being the hallmark of a multitude of problems, it is an attractive candidate. But several experts say influencers promoting cortisol testing are looking at the problem the other way around.
“Patients with serious psychiatric illnesses, patients with alcohol and substance use disorders, patients with severe sleep apnea, if you test their cortisol, it will be abnormally high,” said Susan Seav, a clinical assistant professor in Stanford’s division of endocrinology. She cited anorexia and intense stress, such as divorce, as other possible triggers. But cortisol levels aren’t really the problem here, nor is how these problems are diagnosed. In neither case would she recommend surgical removal of an endocrine gland or prescribing cortisol-lowering medications (as she would for Cushing’s disease or rare tumors, such as those that form on the adrenal glands, which can secrete cortisol). Instead, medical professionals would treat the underlying disorder.
Katie Whitson, a registered dietitian at Health Loft, said that for those who come to her with concerns about their cortisol, instead of getting tested, she recommends tracking their daily routines. Do they eat regularly? Exercise? Do they have an established social circle? Could they meditate at the end of the day? “We all want concrete answers,” Whitson said. But instead of worrying about measuring our cortisol, she advised instead thinking about what might be affecting it and making adjustments. Fatigue, stress, weight gain, brain fog: all of these things that influencers and testing companies say may be linked to high cortisol are things you can just address directly.
The first thing, advises Whitson, is to make sure you’re getting enough carbs, every few hours. Although we tend to think that carbs promote fat storage, Whitson said that when harnessed correctly, that’s not true. We need carbohydrates for our brain, as well as our central nervous system, to function properly and for our red blood cells to function, not to mention our muscles, the most important of which is our heart.
“Do you make sure to prioritize breakfast in the morning? Or do you walk out the door with a coffee?” asked Whitson. If brain fog and anxiety are concerns, simply regulating nutritional intake can solve this problem, no matter what your cortisol tests say. (If the problem persists? It might be a good time to see a doctor.)
Although the experts aren’t happy about it, I technically found a few useful in my adventure in at-home cortisol testing. Since using the hormone monitors, I have had red eyes, drank caffeine late in the afternoon, and drank more than the recommended daily allowance of a glass of wine in the evening, all of which correspond to “out of range” cortisol readings. If I had been asked, I probably would have told you that I was feeling a little tired, nervous, or off-kilter, so none of this reading was that revealing. Yet with the nudge to consider my choices, I found myself pausing and wondering if I really wanted to pour myself more coffee in the afternoon, or if I could settle for herbal tea or water instead.
It’s clear that tests like Eli’s hormonometers are part of a larger movement happening today. Many people rely on biometric readers displaying sleep, heart rate, recovery, etc. Seemingly healthy people use glucometers, testosterone and estrogen monitors, and DEXA scans, all promoted to anyone seeking “longevity.” I record my workouts, check my daily step average, and try to gamify myself by increasing my daily water intake like the best of them, but the question remains: what has knowing my cortisol levels actually done for me? It’s not really a medical test, but rather a reminder, a coach, or maybe even a sort of horoscope.
The tests are offered on a subscription basis, but after counting the first three-month package…
Gn Health
