Cortisol Reality Check: Separating Fact From Dangerous Misinformation

Cortisol gets blamed for almost everything online, but the real science is more nuanced.

In this episode of the Docs Who Lift podcast, Dr. Spencer Nadolsky and Dr. Carl Nadolsky sit down with endocrinologist and adrenal specialist Dr. Richard Auchus to break down what cortisol actually does, why your levels naturally fluctuate throughout the day, and what truly matters when someone is worried about “high” or “low” cortisol.

We cover:

What the adrenal glands do and why cortisol is more than just a “stress hormone”

Why circadian rhythm and sleep are central to healthy cortisol patterns

The difference between true adrenal disease vs cortisol changes from sleep issues, chronic illness, medications, or stress

How endocrinologists actually evaluate Cushing syndrome and adrenal insufficiency (and why random cortisol testing is misleading)

The reality of “adrenal fatigue” and why unvalidated testing can create confusion

Mild autonomous cortisol secretion (MACS), adrenal nodules, and what clinicians look for

The CATALYST trial, what it suggests, and what we still do not know

If you want more evidence-based conversations that cut through the noise, subscribe for weekly episodes.

#cortisol #endocrinology #weightloss #diabetes #sleep

00:00 Intro and guest (Dr. Richard Auchus)
03:30 Cortisol 101: what it does and why the daily rhythm matters
08:45 Cortisol testing myths: “adrenal fatigue,” random labs, DUTCH style testing
12:50 When cortisol is truly too low or too high (adrenal insufficiency vs Cushing)
20:15 Cushing workup explained: the 3 validated tests and what they mean
24:20 Mild cortisol excess and adrenal incidentalomas (MACS)
30:25 Clinical red flags that raise suspicion (BP, diabetes, osteoporosis, weakness)
34:20 Non-neoplastic hypercortisolism: sleep, stress, chronic illness effects
38:00 CATALYST trial: what it found, what it doesn’t prove, and what’s next
57:00 Mammoth testosterone story + wrap-up