Cortisol may contribute to obesity by interacting with regulators of weight and food intake. Leptin, the satiety hormone is secreted by fat cells in order to inform the brain of fat levels in the body and to control eating. High levels of leptin result in an inhibition of hunger.  A study that removed the adrenal gland in mice with low levels of leptin found that these mice lost weight, suggesting that glucocorticoids may contribute to leptin metabolism (Dubuc & Wilden, 1986). Another study found that administration of a steroid medication, dexamethasone, increased leptin levels when administered after eating in both average and obese patients (Laferrère, et al., 2002; Laferrère, Fried, Osborne, & Pi-Sunyer, 2000; Dagogo-Jack, Selke, Melson, & Newcomer, 1997). Ghrelin, the hunger hormone, induces feelings of hunger and promotes food intake. This hormone has been found to have an inverse relationship with cortisol during fasting, suggesting that cortisol may be used to mediate the effects of ghrelin. However, more research is needed before any solid conclusions can be drawn. Based on the previous evidence, it’s not a surprise that researchers have been investigating the link between stress and hunger. This association is also likely due to the fact that dysregulation of the HPA has been associated with multiple eating disorders such as binge eating disorder, bulimia and anorexia.

While cortisol dysregulation gets the most attention for its link to weight and stress, it is also connected to medical conditions like hypertension, reproduction issues, PTSD, addiction, depression, and autism. Hypertension A primary function of cortisol is regulation of blood pressure. Thus, when cortisol is dysregulated, blood pressure is often affected. In cases of Cushing’s syndrome, when there is an excess of glucocorticoids, a common response (nearly 80% of cases) is the development of hypertension (high blood pressure) . Nearly 30% of hypertension cases are thought to occur in response to cortisol dysregulation, specifically, This increase in cortisol related to hypertension is due to stimulation by ACTH. Reproduction Cortisol is not only involved in fat tissues, but it can also play a role in the function of reproductive organs.  The ovaries have GRs and they are influenced directly by the HPA through glucocorticoids, primarily cortisol (Andersen C. , 2002). In addition to the cortisol-binding protein (CBP), sex-hormone-binding globulin (SHBG) may also bind to cortisol. However, this interaction is not nearly as strong as the bond between CBP and cortisol. Like in other tissues, cortisol expression is regulated by 11β-HSD enzymes, which fluctuate over the course of the menstrual cycle. Post-traumatic Stress Disorder Being the stress hormone , it may come as no surprise that cortisol levels are altered in individuals with post-traumatic stress disorder (PTSD).

Testing for Cortisol Testing the level of cortisol in the body is used to assess the actibity of the HPA axis and as a test for many medication conditions. The most common way to test for cortisol is by collecting urine over a 24h period (known as urinary-free cortisol (UFC) and then testing the amount of cortisol in the urine. Another method is by examining the amount of cortisol in saliva. However, these methods have their drawbacks. Since cortisol levels fluctuate without the day, it can be difficult to get an idea of the overall levels of cortisol since these methods only capture one moment in time. Thus researchers and clinicians have moved toward using cortisol measurements in hair since hair can provide evidence of long term exposure to specific hormones. Cortisol as a Therapeutic Treatment As previously mentioned, glucocorticoids are often prescribed as anti-inflammatories for a variety of ailments, such as autoimmune diseases (multiple sclerosis, rheumatoid arthritis, inflammatory bowel disease, ulcerative colitis, psoriasis, and eczema). In these diseases, inflammation can become so severe that immune cells begin to attack other host cells. This can cause pain, swelling, cramping and itching. Glucocorticoids work by reducing the inflammation, which alleviates these symptoms. Glucocorticoids may also be used to treat allergies or asthma which are brought on by a strong immune response to allergens.

Testosterone deficiency or TD is exactly what it sounds like, a low amount of testostrone hormone in the body. TD increases with age, but can occur do to lifestyle choices such as steroid use as well. Testosterone levels decrease nearly 0.4% to 2% each year after the age of 30.  Approximately 20-40% of men 45 years old or older show symptoms of low serum testosterone levels. Unfortunately, due to the variety of symptoms associated with TD, diagnosing and treating the hormone imbalance can be difficult. There are several reasons for the decline in testosterone including failure of the testes to produce testosterone, dysfunction of the HPG axis or androgen target tissue, medication or illness Since there are many causes, this lead to multiple classifications of TD. Primary hypogonadism is the most common form of TD. Primary hypogonadism, also known as hypergonadotropic hypogonadism, is an inability to produce testosterone or sperm in the presence of high concentrations of gonadotropins. Causes of primary hypogonadism include infection, medication side effects, toxins, testicular atrophy or testicular removal due to trauma. Secondary hypogonadism, or hypogonadotropic hypogonadism is caused by an alteration in the HPG axis, typically due to pituitary dysfunction or GNRH deficiency. This leads to a reduced level of FSH and LH production—hormones that stimulate sperm production and testosterone release.

A promising treatment for TD is testosterone replacement therapy (TRT).  Testosterone is one of the most common medications in the United States. TRT can be administered in multiple ways, but injection is most common. Oral pills are available, but they are not a preferred method of treatment since they are not very potent and can cause liver damage. Alternative oral medications include tablets that can be applied to the gums or beneath the tongue.  Transdermal patches that can be applied to the skin are another option. However, they are not as popular due to the numerous side effects and body hair upkeep required. The most cost-effective and most used treatment is intramuscular injection. Both long and short acting injections are available. Relatively recently, subcutaneous testosterone pellets have also been approved. These are the longest acting TRT. However, the most commonly used formulation is transdermal testosterone preparations such as adhesive skin patches, topical gels or topical solutions. These therapies are applied regularly and have a quick response rate. As described above, TRT has several benefits including improving sex drive, erectile dysfunction, overall sexual dysfunction, energy level, mood, bone density, decrease body fat and increase muscle mass. Review of the dangers of TRT Just like too little testosterone can have deleterious effects on the body, so can too much testosterone.