What is the Connection Between Cortisol and Testosterone?

Cortisol and testosterone are closely connected in both men and women, although testosterone tends to be associated more with men. When cortisol levels rise, testosterone levels tend to decrease. This can cause a number of health problems if the spike in cortisol levels is prolonged, and it is also a concern for athletes in training, as testosterone helps people build muscle, and cortisol actually breaks it down. Levels of these hormones can be measured in a doctor's office if there is a concern about a hormone imbalance.

Cortisol is secreted by the adrenal gland, while testosterone is made in small amounts in this gland and in larger amounts in the gonads. The body produces more cortisol in response to stress. At the same time, it reduces testosterone production, dedicating energy to the production of cortisol so that enough will be available. Cortisol and testosterone levels tend to change together, a reflection of the interconnected systems in the body.

In ordinary conditions, after a brief burst of stress, people return to a more normal state. Both cortisol levels and testosterone levels readjust because the stressor is gone, with cortisol dropping to a more normal level and testosterone rising. In cases where people cannot escape stress, as for example when people are on the battlefield or are struggling with a hostile work environment, cortisol levels remain elevated and the production of testosterone continues to be suppressed.

In the short term, this can cause symptoms like a decreased sex drive. Over the long term, mood disorders can develop and people may lose muscle mass and tone. In people who are still growing, a prolonged cortisol and testosterone imbalance can cause developmental delays, including a small size and delayed onset of puberty. Children growing up in stressful environments often have a number of medical problems related to chronic stress and can experience comorbidities like poor nutrition, making it even harder for them to develop normally.

If a test reveals abnormal cortisol and testosterone levels, the first recommendation may be stress relief to see if the patient's levels can be brought into alignment that way. Stress relief can include breathing and meditation exercises, changing work or home environments, and backing off on athletic training. If these measures are not successful, evaluation by an endocrinologist to learn more about why the patient's hormone levels are skewed is necessary, and other treatment options including drug therapy may be explored to address the issue.