What is ‘cortisol face’ and why is TikTok obsessed with it?

Does your face get puffy sometimes? Do you occasionally experience the emotion known as “stress”? According to some of the planet’s foremost medical thinkers (TikTok influencers), these are not simply inevitable consequences of existence; they are signs that you may have so-called “cortisol face”.

Cortisol is the body’s main stress hormone. According to hundreds of clips on social media, an excess of stress – and, by extension, an excess of cortisol – results in a round, puffy face. “You’re not ugly, you just have cortisol face,” is a popular refrain in these videos. In posts, users share before and after images of themselves in which they go from having a round, full face to a lean one – all jutting cheekbones and sharp jawlines.

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“The reason you’re getting a double chin, you have puffy eyelids, and your cheeks are sagging is because your high cortisol is silently changing the way your face looks,” one video claims.

Besides the explicit fat-shaming in these messages, the science doesn’t quite hold up. “‘Cortisol face’ is not a recognized medical term,” explains Dr Priya Jaisinghani, an endocrinologist at New York University’s Langone Health.

Prolonged high levels of cortisol can have adverse health effects. Over time, an excess of cortisol can lead to Cushing’s syndrome, a condition that can result in high blood pressure, bone loss and occasionally type 2 diabetes. But Cushing’s syndrome is relatively rare, experts say.

We asked experts for the truth behind this new wellness term.

What is cortisol and how does it affect our health?

“Cortisol is a steroid hormone produced by the adrenal glands,” says Dr Adam Friedman, professor and chair of dermatology at the George Washington University school of medicine and health sciences. He explains that it plays an essential role in a number of the body’s functions, including regulating metabolism, managing our immune and stress responses and maintaining blood pressure.

“Without the right amount of cortisol we can’t survive,” says Friedman. But too much of it “is a bad thing”.

Doctors can ascertain 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 Fleseriu, director of the pituitary center at Oregon Health & Science University: exogenous (the result of a factor outside the body) and endogenous (the result of a factor inside the body).

Exogenous Cushing’s syndrome is typically the result of steroid treatments, specifically glucocorticoid medications like cortisone and prednisone. These can raise levels of cortisol in the body.

This is far 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 is unlikely to do so “to the extent seen in medical syndrome like Cushing’s”.

“Cushing’s syndrome is rare,” says Fleseriu, who estimates there are four to five cases of endogenous Cushing’s per million people per year worldwide.

Is cortisol face real?

Sort of, but not in the way it’s generally discussed on TikTok. As Jaisinghani says, it’s not a medical term.

Weight gain in the face and neck is a common symptom of Cushing’s syndrome, but that alone is not enough for a diagnosis, says Fleseriu. “The clinical diagnosis of Cushing’s is very challenging,” she explains. When determining whether a patient has the condition or not, Fleseriu says she looks for “more than one symptom”.

Other symptoms of Cushing’s include pink and purple stretch marks on the stomach, high blood pressure, thin skin that bruises easily, a lump of fat between the shoulders and weight gain in the face and torso while limbs and extremities remain thin.

How does one regulate their cortisol levels?

The risk of developing Cushing’s syndrome is relatively low. But Jaisinghani says people can manage their stress and cortisol levels by tending to their overall health. She suggests “maintaining a nutrient-dense diet, ensuring adequate and high-quality sleep, staying well-hydrated and incorporating stress reduction strategies”.

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If one is diagnosed with Cushing’s syndrome, treatments vary. If it’s exogenous, Fleseriu warns that it is important not to stop or reduce the use of glucocorticoid medications without the supervision of a doctor. “Stopping steroids immediately could put them in adrenal crisis,” she explains.

In the case of endogenous Cushing’s, patients may take medication, or undergo surgery or radiation to remove any tumors. Generally, these treatments are successful. “We can induce remission in almost everybody right now,” Fleseriu says.

If you do think your cortisol levels are high, don’t turn to TikTok for answers. “If you are concerned about your cortisol levels, it’s important to consult with your doctor,” Jaisinghani says.