High cortisol in men: symptoms, causes and what to know

Yes, men can have high cortisol. The medical condition of long-term cortisol excess, Cushing’s syndrome, is rarer in men than in women. A blood cortisol can also read high in a man for reasons that have nothing to do with the condition.

This page covers what is different for men. For the general picture, see high cortisol symptoms.

Cortisol

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A single blood cortisol can't diagnose or rule out Cushing's syndrome. If you take a steroid medicine, ask your prescriber how it affects results, and never stop it for a test.

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Symptoms of high cortisol in men

For both sexes, NIDDK and MedlinePlus list the general signs of too much cortisol over a long time. They include weight gain, thin arms and legs, extra fat at the base of the neck or between the shoulders, easy bruising, wide purple stretch marks and weak muscles. MedlinePlus adds severe fatigue, high blood pressure and high blood glucose.

For men, both sources add:

• A lower interest in sex.
• Erectile dysfunction.
• Lower fertility.

Each of these is common and has many causes. None points to cortisol on its own. They matter when they appear together with the more specific signs, such as easy bruising, wide purple stretch marks and muscle weakness. A primary care review calls those three “relatively specific” for Cushing’s. See cortisol and libido for the sex-drive side.

NIDDK also says not everyone with Cushing’s has these symptoms, which can make it hard to detect.

What causes high cortisol in men

The causes are the same as for women. The detail is on the page about the causes of high cortisol. In brief:

• Steroid medicines. NIDDK says the most common cause of Cushing’s syndrome is long-term, high-dose use of glucocorticoids, which treat conditions such as asthma, rheumatoid arthritis and lupus, and are also used after organ transplants. They are often injected into a joint to treat pain, and that counts too.
• Tumors. Pituitary tumors cause 8 out of 10 cases that aren’t due to medicine, according to NIDDK. Tumors outside the pituitary, most often in the lungs, and tumors on an adrenal gland are the other causes.
• Conditions that raise cortisol without being Cushing’s. MedlinePlus names depression, anxiety, alcohol use disorder, poorly controlled diabetes and obesity. A primary care review adds physical stress such as surgery or hospital stays, malnutrition and vigorous chronic exercise. See alcohol and cortisol and exercise and cortisol.

That list matters because a high result in a man is more likely to come from one of these than from a tumor. NIDDK puts estimates of endogenous Cushing’s at about 40 to 70 people per million.

When doctors think of Cushing’s in men

The primary care review says doctors should consider testing in people with several progressive features of Cushing’s, and in people with problems that are unusual for their age, such as osteoporosis or high blood pressure at a young age. It also says Cushing’s is more common in people with uncontrolled type 2 diabetes, high blood pressure or early-onset osteoporosis. NIDDK says it may be the cause in some people who have type 2 diabetes with persistently high blood glucose, along with high blood pressure.

None of this means those conditions come from cortisol. The same review cites estimates that Cushing’s goes undiagnosed in 2 to 3 percent of people with diabetes and 0.5 to 1 percent of people with high blood pressure, so for most people with those conditions the cause is something else. What it does mean is that a clinician looking at a man with several of them, plus the specific signs, may decide to test.

Do men normally have higher cortisol?

On average, the daily output looks higher in men. The Endocrine Reviews paper says men have higher mean peak, lowest-point and morning-rise cortisol than premenopausal women. It also says sex-specific normal values for healthy people remain undefined, so a “normal range for men” isn’t settled. Use the range printed on your own lab report. Normal cortisol levels in women and men covers the published ranges.

How it is checked

A blood cortisol alone can’t settle the question. Cortisol changes through the day, and stress, exercise and steroid medicines change it too. NIDDK says doctors usually do two of these: a 24-hour urine test, a late-night saliva test, and a low-dose dexamethasone suppression test. A laboratory review in Diagnostics adds that the late-night saliva test can be thrown off by depression and by shift work, and the primary care review adds disturbed sleep, smoking and chewing tobacco. The page on testing for high cortisol explains each.

Tell the clinician every steroid you use, including pills, injections, inhalers and creams. If you take one, don’t stop or change it on your own. MedlinePlus says stopping suddenly can lower cortisol too far. Ask your prescriber.

A blood cortisol can still give you a number to bring to the visit, with the time of day it was taken. It is not a diagnosis either way.

Questions people ask

Can men have high cortisol?

Yes. Men can have Cushing’s syndrome, and men can also have a high blood result for ordinary reasons, such as stress, exercise or a steroid medicine.

Does high cortisol lower sex drive in men?

NIDDK and MedlinePlus list a lower interest in sex among the symptoms of Cushing’s syndrome in men. The sources we checked don’t show that everyday stress-level cortisol does it. Low sex drive has many causes, so it needs its own look. See cortisol and libido.

What causes high cortisol levels in men?

Steroid medicines are the most common cause of true cortisol excess. After that come tumors of the pituitary, the adrenal glands or elsewhere. A high result can also come from conditions such as depression, alcohol use disorder and poorly controlled diabetes.

Keep reading

• High cortisol symptoms

  The signs doctors link to too much cortisol, and what they are not.

• Causes of high cortisol

  Medicines, conditions and normal ups and downs.

• Normal cortisol levels in women and men

  Published ranges and why labs differ.

• Cortisol and libido

  What is known about cortisol and sex drive.

• Testing for high cortisol

  Which test answers which question.