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Stress-related and basic determinants of hair cortisol in humans: A meta-analysis
Abstract
The analysis of hair cortisol concentrations (HCC) is a relatively new strategy to measure long-term cumulative cortisol levels, which is increasingly used in psychoneuroendocrinological research. Here, we conduct a first comprehensive meta-analysis of HCC research based on aggregated data from a total of 124 (sub)samples (66 independent studies; total N=10,289). We seek to answer two central questions: (i) Which covariates and basic features of HCC need to be considered in future research? (ii) What are the main determinants of HCC in terms of chronic stress exposure and mental health? Concerning basic characteristics, our findings identify several covariates to be considered (age, sex, hair washing frequency, hair treatment, oral contraceptive use), confirm a decline of HCC from the first to the second proximal 3cm hair segment, and show positive associations between HCC and short-term salivary cortisol measures. Regarding chronic stress, we show that stress-exposed groups on a whole exhibit 22% increased HCC. This long-term cortisol hypersecretion emerges particularly when stress is still ongoing at the time of study (+43% HCC) but is not present in conditions of past/absent stress (-9% HCC, n.s.). We also report evidence for 17%-reduced HCC in anxiety disorders, such as PTSD. Interestingly, no consistent associations with mood disorders and self-reports of perceived stress, depressiveness or social support are found. However, our findings reveal positive associations of HCC with stress-related anthropometric (body mass index, waist-to-hip ratio) and hemodynamic measures (systolic blood pressure). These meta-analytic results are discussed in the light of their practical implications and important areas for future inquiry are outlined.
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“Meta-analytic and descriptive reviews show that chronic stress is associated with elevated long-term cortisol secretion (Stalder et al., 2017; Staufenbiel et al., 2013), with stressor duration and recency since stressor onset being important factors in shaping basal cortisol levels (Miller et al., 2007).”
From More than a feeling: A unified view of stress measurement for population science (2018) · cites this paper as Stalder et al., 2017
In the citing paper
“Elevated hair cortisol levels in stressed populations have previously been found (reviewed in Stalder et al., 2017; Staufenbiel et al., 2013).”
From Chronic Stress, Hair Cortisol and Depression: A Prospective and Longitudinal Study of Medical Internship (2018) · cites this paper as Stalder et al., 2017
In the citing paper
“However, the first meta-analytic review, which included primarily cross-sectional studies, did not show consistent links with self-reported depressiveness (Stalder et al., 2017).”
From Chronic Stress, Hair Cortisol and Depression: A Prospective and Longitudinal Study of Medical Internship (2018) · cites this paper as Stalder et al., 2017
In the citing paper
“Cross-sectional studies have shown elevated hair cortisol in stressed populations (Stalder et al., 2017; Staufenbiel et al., 2013)”
From Chronic Stress, Hair Cortisol and Depression: A Prospective and Longitudinal Study of Medical Internship (2018) · cites this paper as Stalder et al., 2017
In the citing paper
“Our results are consistent with a recent meta-analysis that found no clear relationships between hair cortisol and self-reported depressiveness (Stalder et al., 2017).”
From Chronic Stress, Hair Cortisol and Depression: A Prospective and Longitudinal Study of Medical Internship (2018) · cites this paper as Stalder et al., 2017
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Hair cortisol levels in women with medically unexplained symptoms
Fischer, S., Skoluda, N., Ali, N., Nater, U. M., & Mewes, R. (2021) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2021.12.044 · Cited by 14
Touskova, T. P., Bob, P., Bares, Z., Vaníčková, Z., Nývlt, D., & Raboch, J. (2022) · Journal of International Medical Research · doi:10.1177/03000605221089883 · Cited by 17
“retrospective analysis of cortisol concentrations for a maximum of 3 to 6 months.(17) Hair samples for all participants were collected before (on the day of departure from the home country) and after 8 weeks of the expedition and WHM practice.”
BackgroundBiological factors and consequences of pregnancy-related anxiety – What do we know so far?
Mikolajkow, A., & Małyszczak, K. (2022) · Psychiatria Polska · doi:10.12740/pp/144138 · Cited by 16
“Contrarily, some results implicate a negative association of cortisol levels and anxiety symptoms [75, 76] or no association whatsoever [77].”
Looze, C. D., McCrory, C., O’Halloran, A. M., Polidoro, S., Kenny, R. A., & Feeney, J. C. (2023) · Brain Behavior and Immunity · doi:10.1016/j.bbi.2023.10.017 · Cited by 13
Bayot, M., Brianda, M. E., Waillet, N. V. D. S., Mikolajczak, M., Shankland, R., & Roskam, I. (2024) · Children · doi:10.3390/children11020168 · Cited by 14
“Hair cortisol levels, which provide an indication of chronic stress over the previous three months [24], were measured through hair samples of approximately 150 strands of hair collected from the posterior vertex of the head [48].”
BackgroundInfluentialCoping with the multifaceted and multifunctional role of cortisol in the brain
de Kloet, E. R. (2024) · Neuroscience Applied · doi:10.1016/j.nsa.2024.104047 · Cited by 18
“CORT measured in hair from the forehead can indicate the cumulative production of CORT over several weeks (Foley and Kirschbaum, 2010), (Stalder et al., 2017).”
Huthsteiner, K., Finke, J. B., Peters, E. M. J., Kleinke, K., Klucken, T., & Tobias Stalder, A. (2025) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2025.107457 · Cited by 14
“The inconsistent association between self-reported perceived stress and hair glucocorticoids echoes findings of previous research and emphasizes the relevance and transparent documentation of defined stress conditions for hair cortisol interpretation (meta-analysis: Stalder et al., 2017).”
InfluentialSelf-citationBarrech, A., Seubert, C., Glaser, J., & Gündel, H. (2018) · International Archives of Occupational and Environmental Health · doi:10.1007/s00420-018-1302-y · Cited by 15
Parity‐related variation in cortisol concentrations in hair during pregnancy
Marteinsdóttir, Í., Sydsjö, G., Faresjö, Å., Theodorsson, E., & Josefsson, A. (2020) · BJOG An International Journal of Obstetrics & Gynaecology · doi:10.1111/1471-0528.16542 · Cited by 12
“26 However, in our previous studies ( A Faresj € o, unpublished data) frequent washing with shampoo, and the use of hair-spray, gel and wax did not affect HCC levels, in line with a prior report.”
Associations of Hair Cortisol Concentrations with General and Organ Fat Measures in Childhood
Vehmeijer, F. O. L., Santos, S., Gaillard, R., de Rijke, Y. B., Voortman, T., van den Akker, E. L. T., Felix, J. F., van Rossum, E. F. C., & Jaddoe, V. W. V. (2020) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/clinem/dgaa785 · Cited by 15
Freihaut, P., Göritz, A. S., Rockstroh, C., & Blum, J. (2021) · Behavior Research Methods · doi:10.3758/s13428-021-01568-8 · Cited by 14
Klinger-König, J., Frenzel, S., Hannemann, A., Wittfeld, K., Bülow, R., Friedrich, N., Nauck, M. A., Völzke, H., & Grabe, H. J. (2021) · Neurobiology of Stress · doi:10.1016/j.ynstr.2021.100416 · Cited by 16
“As demonstrated before and replicated here, serum cortisol concentrations were higher in men than in women (Stalder et al., 2017).”
BackgroundResultInfluentialHu, X., Wang, Y., Pruessner, J. C., & Yang, J. (2018) · Hormones and Behavior · doi:10.1016/j.yhbeh.2018.10.006 · Cited by 14
Condon, E. M., Tobón, A. L., Mayes, L. C., & Sadler, L. S. (2020) · Maternal and Child Health Journal · doi:10.1007/s10995-020-02926-2 · Cited by 16
Prenatal maternal stress and child hair cortisol four years later: Evidence from a low-income sample
Alen, N. V., Hostinar, C. E., Mahrer, N. E., Martin, S. R., Guardino, C. M., Shalowitz, M. U., Ramey, S. L., & Schetter, C. D. (2020) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2020.104707 · Cited by 14
Hair Cortisol Is Associated With Social Support and Symptoms in Schizophrenia
Yang, F., Cao, X., Sun, X., Wen, H., Qiu, J., & Xiao, H. (2020) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2020.572656 · Cited by 16
Hearing and early life adversity: effects of developmental stress on sensory processing
Rosen, M. J., & Huyck, J. J. (2025) · Neuropsychopharmacology · doi:10.1038/s41386-025-02203-2 · Cited by 14
“Hair cortisol concentration is a commonly used measure of chronic stress that assesses the HPA axis [103] and has been shown to be elevated in children from families with low parental education, but not necessarily low familial income [104, 105].”
Bethancourt, H. J., Ulrich, M., Almeida, D. M., & Rosinger, A. Y. (2021) · Obesity · doi:10.1002/oby.23137 · Cited by 13
Jaramillo, I., Karl, M., Bergunde, L., Mack, J. T., Weise, V., Weidner, K., Gao, W., Steudte‐Schmiedgen, S., & Garthus‐Niegel, S. (2023) · Journal of Affective Disorders · doi:10.1016/j.jad.2023.07.034 · Cited by 14
Self-citationEffects of cortisol on cognitive and emotional disorders after stroke: A scoping review
Wang, T., Li, X., Jia, Y., Zhang, Y., & Meng, D. (2024) · Heliyon · doi:10.1016/j.heliyon.2024.e40278 · Cited by 13
“Salivary cortisol is not affected by serum corticosteroid-binding globulin, salivary flow rate, patient age, sex, body mass index and smoking status [33,16], Moreover, it has the advantages of being non-invasive and easy to sample.”
Maternal separation in childhood and hair cortisol concentrations in late adulthood
Bevan, K., & Meena Kumari, B. (2021) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2021.105253 · Cited by 14
The emergence of resilience: Recovery trajectories in sleep functioning after a major stressor.
Gucciardi, D. F., Lang, J. W. B., Lines, R. L. J., Chapman, M. T., Ducker, K. J., Peeling, P., Crane, M. F., Ntoumanis, N., Parker, S. K., Thøgersen‐Ntoumani, C., et al. (2021) · Sport Exercise and Performance Psychology · doi:10.1037/spy0000268 · Cited by 15
“Hair cortisol concentration is widely utilized for assessments of chronic activation of the hypothalamic– pituitary–adrenal (HPA) axis, as triggered by physical and cognitive stressors (Skoluda et al., 2012; Stalder et al., 2017).”
BackgroundMethodInfluentialCoping with stress before and after mild traumatic brain injury: a pilot hair cortisol study
Spikman, J. M., van der Horn, H. J., Scheenen, M. E., de Koning, M. E., Savas, M., Langerak, T., van Rossum, E. F. C., & van der Naalt, J. (2021) · Brain Injury · doi:10.1080/02699052.2021.1901143 · Cited by 14
“A metaanalysis of Stalder and colleagues concluded that stressexposure in general was likely to result in higher hair cortisol, in particular when the stress was still ongoing, but that anxiety induced disorders such as PTSD were more likely to result in lower levels of hair cortisol (40).”
BackgroundRunze, J., Pappa, I., van IJzendoorn, M. H., & Bakermans‐Kranenburg, M. J. (2022) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph192215026 · Cited by 18
“However, hair cortisol is subject to confounding factors such as hair washing frequency, which can introduce a large amount of measurement error [38].”
BackgroundAndreasen, J. J., Tobiasen, B. B., Jensen, R. C., Boye, H., Jensen, T. K., Bilenberg, N., Andersen, M., & Glintborg, D. (2023) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2023.106293 · Cited by 13
del Paso, G. A. R., Garcia‐Hernandez, A., Contreras‐Merino, A. M., Galvez-Sánchez, C. M., de la Coba, P., Montoro, C. I., & Davydov, D. M. (2023) · European Journal of Pain · doi:10.1002/ejp.2223 · Cited by 16
“The sample size was calculated based on an estimated effect size of 0.50 obtained in a previous study (Stalder et al., 2017); for an alpha level of 0.05 and beta error of 20%, 35 participants per group appeared optimal.”
MethodInfluentialEmotions and Steroid Secretion in Aging Men: A Multi—Study Report
Walther, A., Waldvogel, P., Noser, E., Schoch-Ruppen, J., & Ehlert, U. (2017) · Frontiers in Psychology · doi:10.3389/fpsyg.2017.01722 · Cited by 11
“We controlled for these covariates as they were previously reported to significantly influence steroid measurements in saliva or hair (Walther et al., 2016; Stalder et al., 2017).”
MethodTrauma-related but not PTSD-related increases in hair cortisol concentrations in military personnel
Schumacher, S., Engel, S., Klusmann, H., Niemeyer, H., Kuester, A., Burchert, S., Skoluda, N., Rau, H., Nater, U. M., Willmund, G., et al. (2022) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2022.02.031 · Cited by 13
Brückner, H., Ell, J., Kalon, L., Strahler, J., Ducki, A., Riemann, D. W., Buntrock, C., Spiegelhalder, K., & Lehr, D. (2025) · International Journal of Nursing Studies · doi:10.1016/j.ijnurstu.2025.105112 · Cited by 14
Gao, W., Valdimarsdóttir, U. A., Hauksdóttir, A., Torfadottir, J. E., & Kirschbaum, C. (2022) · Clinica Chimica Acta · doi:10.1016/j.cca.2022.09.026 · Cited by 12
Self-citationHair cortisol concentration associates with insomnia and stress symptoms in breast cancer survivors
Ahabrach, H., Mlili, N. E., Mafla-España, M. A., & Cauli, O. (2023) · International Journal of Psychophysiology · doi:10.1016/j.ijpsycho.2023.07.006 · Cited by 12
Genetically predicted plasma cortisol and common chronic diseases: A Mendelian randomization study
Lee, W., Larsson, S. C., Wood, A., Angelantonio, E. D., Butterworth, A. S., Burgess, S., & Allara, E. (2023) · Clinical Endocrinology · doi:10.1111/cen.14966 · Cited by 14
“This aligns with studies that have shown strong associations between increased long ‐ term cortisol levels, measured in scalp hair and central obesity, 35,36 and observational associations between central obesity and hypertension.”
Petrowski, K., Wichmann, S., Pyrc, J., Steudte‐Schmiedgen, S., & Kirschbaum, C. (2020) · Stress · doi:10.1080/10253890.2020.1714585 · Cited by 14
Self-citationObesity and Hair Cortisol: Relationships Varied Between Low-Income Preschoolers and Mothers
Ling, J., Xu, D., Robbins, L. B., & Kao, T. A. (2020) · Maternal and Child Health Journal · doi:10.1007/s10995-020-03008-z · Cited by 13
“Hair cortisol concentration (HCC) has emerged as a promising biological measure of chronic stress in both children and adults (Bates et al. 2017; Stalder et al. 2017).”
BackgroundTeychenne, M. J., Olstad, D. L., Turner, A. I., Costigan, S. A., & Ball, K. (2018) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph15040586 · Cited by 12
Smith, J., Johnson, K. A., Whittle, S., Allen, N. B., & Simmons, J. G. (2018) · Developmental Psychobiology · doi:10.1002/dev.21807 · Cited by 12
Dauegaard, S., Olsen, N. J., Heitmann, B. L., & Larsen, S. C. (2020) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2020.104836 · Cited by 12
Hair sampling for cortisol analysis with mother-toddler dyads living in low-income homes
Bates, R. A., Salsberry, P. J., Ford, J. L., Pickler, R. H., Dynia, J. M., & Justice, L. M. (2020) · Infant Behavior and Development · doi:10.1016/j.infbeh.2020.101499 · Cited by 12
“, 2014), hair care practices (Stalder et al., 2017), age (Bates, Salsberry, & Ford, 2017; Gray et al.”
BackgroundRaymond, C., Bilodeau-Houle, A., Zerroug, Y., Provencher, J., Beaudin, M., & Marin, M. (2022) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2022.105888 · Cited by 13
Biomarkers of stress and disease
Ali, N., Tschenett, H., & Nater, U. M. (2022) · Elsevier eBooks · doi:10.1016/b978-0-323-91497-0.00231-9 · Cited by 12
Cortisol: Analytical and clinical determinants
Vega‐Beyhart, A., Castro, M. A., Hanzu, F. A., & Casals, G. (2022) · Advances in clinical chemistry · doi:10.1016/bs.acc.2022.11.005 · Cited by 12
Measuring cortisol concentration in hair month-by-month two years retrospectively
Faresjö, Å., LeTran, A., Olsen, O. J., Faresjö, T., Theodorsson, E., & Jones, M. (2023) · All Life · doi:10.1080/26895293.2023.2172461 · Cited by 11
Excessive hair cortisol concentration as an indicator of psychological disorders in children
Brænden, A., Lebeña, A., Faresjö, Å., Theodorsson, E., Coldevin, M., Stubberud, J., Zeiner, P., & Melinder, A. M. D. (2023) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2023.106363 · Cited by 11
Gettler, L. T., Jankovic‐Rankovic, J., Gengo, R. G., Eick, G. N., Nash, M. P., Arumah, E. N., Boru, A. M., Ali, S. A., Urlacher, S. S., Meyer, J. S., et al. (2024) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2024.107024 · Cited by 13
Marsland, A. L., Jones, E., Reed, R. G., Walsh, C. P., Natale, B. N., Lindsay, E. K., & Ewing, L. J. (2024) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2024.107039 · Cited by 18
Perceived and endocrine acute and chronic stress indicators in fibromyalgia syndrome
Beiner, E., Hermes, M., Reichert, J., Kleinke, K., Vock, S., Löffler, A., Ader, L., Sirazitdinov, A., Keil, S., Schmidt, T., et al. (2024) · Scientific Reports · doi:10.1038/s41598-024-76635-z · Cited by 11
Ferger, M. D., Sigrist, C., Brodesser, S., Kaess, M., & Koenig, J. (2024) · Translational Psychiatry · doi:10.1038/s41398-024-03205-2 · Cited by 12
Discrimination and hair cortisol concentration among asian, latinx and white young adults
Yip, T., Smith, P., Tynes, M., Mirpuri, S., Weems, A., & Cheon, Y. M. (2021) · Comprehensive Psychoneuroendocrinology · doi:10.1016/j.cpnec.2021.100047 · Cited by 11
“This is an open access a immediate environmental influences or diurnal patterns that influence heart rate and salivary cortisol [20].”
BackgroundMethodInfluentialThe predictive role of hair cortisol concentrations for treatment outcome in PTSD inpatients
Hummel, K. V., Schellong, J., Trautmann, S., Kummer, S., Hürrig, S., Klose, M., Croy, I., Weidner, K., Kirschbaum, C., & Steudte‐Schmiedgen, S. (2021) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2021.105326 · Cited by 11
Self-citationLanghammer, T., Hilbert, K., Praxl, B., Kirschbaum, C., Ertle, A., Asbrand, J., & Lueken, U. (2021) · Mental Health & Prevention · doi:10.1016/j.mhp.2021.200221 · Cited by 12
Self-citationPsychological Treatment Effects Unrelated to Hair-Cortisol and Hair-BDNF Levels in Chronic Tinnitus
Basso, L., Boecking, B., Neff, P. K. A., Brüeggemann, P., Mazurek, B., & Peters, E. M. J. (2022) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2022.764368 · Cited by 11
Chen, Y., Petzold, M., Rüetschi, U., Dahlstrand, J., Löfstedt, P., Corell, M., & Friberg, P. (2022) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2022.105908 · Cited by 11
The different areas of chronic stress and food addiction: Results from the LIFE‐Adult‐Study
Hussenoeder, F. S., Conrad, I., Löbner, M., Engel, C., Reyes, N., Yahiaoui‐Doktor, M., Glaesmer, H., Hinz, A., Witte, A. V., Schroeter, M. L., et al. (2023) · Stress and Health · doi:10.1002/smi.3348 · Cited by 11
Decoding the impact of adverse childhood experiences on the progression of schizophrenia
Hirt, V., Schalinski, I., & Rockstroh, B. S. (2019) · Mental Health & Prevention · doi:10.1016/j.mhp.2019.01.002 · Cited by 11
Söder, E., Krkovic, K., & Lincoln, T. M. (2020) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2020.104684 · Cited by 14
Elnazer, H. Y., Lau, L. C. K., Amaro, H., & Baldwin, D. S. (2020) · Acta Neuropsychiatrica · doi:10.1017/neu.2020.35 · Cited by 11
van der Wal, R. A. B., Bijleveld, E., van Herwaarden, A. E., Bucx, M. J. L., Prins, J. B., & Scheffer, G. (2020) · European Journal of Anaesthesiology · doi:10.1097/eja.0000000000001393 · Cited by 11
Relationship between proximity and physiological stress levels in hunter-gatherers: The Hadza
Fedurek, P., Lacroix, L., Aktipis, A., Cronk, L., Makambi, J. E., Mabulla, I. A., Lehmann, J., & Berbesque, J. C. (2022) · Hormones and Behavior · doi:10.1016/j.yhbeh.2022.105294 · Cited by 11
Müller, S., Moser, D., Frach, L., Wimberger, P., Nitzsche, K. I., Li, S., Kirschbaum, C., & Alexander, N. (2022) · Translational Psychiatry · doi:10.1038/s41398-022-01828-x · Cited by 9
“Addressing the gap, we aimed to determine both acute cortisol stress reactivity and hair cortisol concentrations (hairC), which have been proven a reliable and valid marker of long-term HPA-axis activity over a period of approximately three months [30].”
BackgroundSelf-citationChronic stress is associated with specific path integration deficits
Akan, O., Bierbrauer, A., Kunz, L., Gajewski, P. D., Getzmann, S., Hengstler, J. G., Wascher, E., Axmacher, N., & Wolf, O. T. (2023) · Behavioural Brain Research · doi:10.1016/j.bbr.2023.114305 · Cited by 14
“[74] reported significant positive associations between HCC and salivary cortisol data as well as between HCC and chronic stress, reflecting the observation that stress-exposed groups exhibited”
BackgroundResultInfluentialPeng, F., Palazzi, P., Mezzache, S., Adelin, É., Bourokba, N., Bastien, P., & Appenzeller, B. M. R. (2024) · Environmental Pollution · doi:10.1016/j.envpol.2024.123839 · Cited by 10
Hair cortisol levels are associated with overweight and obesity in the ELSA-Brasil cohort
Rodrigues, K. L., Scaranni, P. D. O. D. S., Pereira, E. N. G. D. S., Silva, V. V. D. D., Silvares, R. R., de Araujo, B. P., Castilho, C., Schmidt, M. I., da Fonseca, M. D. J. M., Griep, R. H., et al. (2024) · Frontiers in Endocrinology · doi:10.3389/fendo.2024.1361715 · Cited by 10
“Hair cortisol analysis is being increasingly optimized and applied in both research and medicine (26 – 28) as it provides an objective and unique biomarker for analyzing endogenous cortisol levels and shows that the deposition of compounds and their metabolites in hair during growth allows…”
Qi, D., Wang, W., Chu, L., Wu, Y., Wang, W., Zhu, M., Yuan, L., Gao, W., & Deng, H. (2024) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2024.107049 · Cited by 11
Tsethlikai, M., Korous, K. M., & Kim, J. (2024) · Child Development · doi:10.1111/cdev.14149 · Cited by 10
Specht, L., Freiberg, A., Mojahed, A., Garthus‐Niegel, S., & Schellong, J. (2024) · Neuroscience & Biobehavioral Reviews · doi:10.1016/j.neubiorev.2024.105866 · Cited by 14
“In the face of chronic stress, hypersecretion may emerge particularly when the stressor is still ongoing (Stalder et al., 2017).”
BackgroundResultChronic stress and hair cortisol concentration in mothers: A two‐study investigation
Rinne, G. R., Guardino, C. M., Soriano, M., & Schetter, C. D. (2024) · Stress and Health · doi:10.1002/smi.3493 · Cited by 10
“In contrast, HCC provides a stable retrospective measure of basal cortisol output over the course of several months and, therefore, may be more appropriate to capture the effects of chronic stress on HPA output (D’Anna Hernandez et al., 2011; Russell et al., 2012; Stalder et al., 2017).”
Differences in hair cortisol to cortisone ratio between depressed and non-depressed adolescent women
Zerroug, Y., Marin, M., Porter-Vignola, É., Garel, P., & Herba, C. M. (2025) · Stress · doi:10.1080/10253890.2025.2459726 · Cited by 11
“Glucocorticoids (cortisol and cortisone) can be quantified in hair, due to their diffusion from the bloodstream into hair follicle cells (Gerritsen et al., 2019; Greff et al., 2019; Meyer & Novak, 2021; Short et al., 2016; Stalder et al., 2017; Vives et al., 2015).”
Influentialvan der Lubbe, A., Swaab, H., Vermeiren, R. R. J. M., van Rossum, E. F. C., van Balkom, I. D. C., & Ester, W. A. (2025) · Journal of Autism and Developmental Disorders · doi:10.1007/s10803-025-06736-9 · Cited by 16
“However, previous studies have consequently demonstrated a correlation between HCC and stress exposure, such as unemployment and post-traumatic stress disorder (Stalder et al., 2017; Staufenbiel et al., 2012).”
Blecker, M. K., Klusmann, H., Engel, S., Haering, S., Meyer, C., Skoluda, N., Nater, U. M., Knaevelsrud, C., & Schumacher, S. (2025) · Journal of Affective Disorders · doi:10.1016/j.jad.2025.119914 · Cited by 11
Bryson, H., Middleton, M., Huque, M. H., Mensah, F. K., Goldfeld, S. R., & Price, A. M. H. (2020) · Journal of Affective Disorders · doi:10.1016/j.jad.2020.12.144 · Cited by 10
Ostinelli, G., Scovronec, A., Iceta, S., Ouellette, A., Lemieux, S., Biertho, L. D., Bégin, C., Michaud, A., & Tchernof, A. (2021) · Obesity · doi:10.1002/oby.23125 · Cited by 10
Hair Cortisol Concentration as a Biomarker of Symptoms of Depression in the Perinatal Period
Cauli, O., Mlili, N. E., & Ahabrach, H. (2022) · CNS & Neurological Disorders - Drug Targets · doi:10.2174/1871527321666220316122605 · Cited by 10
Status does not predict stress among Hadza hunter-gatherer men
Fedurek, P., Lehmann, J., Lacroix, L. P., Aktipis, A., Cronk, L., Makambi, E. J., Mabulla, I. A., & Berbesque, J. C. (2023) · Scientific Reports · doi:10.1038/s41598-023-28119-9 · Cited by 11
Wang, Z., Luo, C.-L., Zhou, E. W., Sandhu, A. F., Yuan, X.-J., Williams, G. E., Cheng, J., Sinha, B., Akbar, M., Bhattacharya, P., et al. (2023) · International Journal of Molecular Sciences · doi:10.3390/ijms24108805 · Cited by 11
“On the contrary, hair cortisol concentration (HCC) analysis [116,117] offers the most reliable method for measuring the long-term activity of the HPA axis through a retrospective assessment of cumulative cortisol exposure over time for both basic research and clinical purposes [118].”
MethodHeming, M., Angerer, P., Apolinário-Hagen, J., Nater, U. M., Skoluda, N., & Weber, J. (2023) · Journal of Occupational Medicine and Toxicology · doi:10.1186/s12995-023-00373-7 · Cited by 11
“So far, research on HCC and its association with psychosocial stress is growing but entails mixed findings [11, 15, 19].”
BackgroundMethodFalco, A., Girardi, D., Elfering, A., Peric, T., Pividori, I., & Corso, L. D. (2023) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph20136220 · Cited by 12
Johnson‐Ferguson, L., Shanahan, L., Bechtiger, L., Steinhoff, A., Zimmermann, J., Baumgartner, M. R., Binz, T. M., Eisner, M., Ribeaud, D., & Quednow, B. B. (2023) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2023.106369 · Cited by 10
Bergunde, L., Karl, M., Schälicke, S., Weise, V., Mack, J. T., von Soest, T., Gao, W., Weidner, K., Garthus‐Niegel, S., & Steudte‐Schmiedgen, S. (2023) · Translational Psychiatry · doi:10.1038/s41398-023-02610-3 · Cited by 9
“Then, multiple regression analyses were conducted to examine relationships between lifetime trauma and HEC, lifetime trauma and CB-PTSS, and HEC and CB-PTSS.”
BackgroundMethodSelf-citationTorres, S. J., Grimes, C. A., Nowson, C. A., Jayasinghe, S. U., Bruce, C. R., Mason, S. A., He, F. J., & Turner, A. I. (2018) · British Journal Of Nutrition · doi:10.1017/s0007114518003148 · Cited by 10
“Differences between studies may reflect inter-laboratory differences in methodologies, which has been reported in the analysis of hair cortisol concentrations((31)).”
BackgroundLiu, C. H., Fink, G., Brentani, H., & Brentani, A. (2020) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2020.104675 · Cited by 10
Steudte‐Schmiedgen, S., Fay, E., Capitão, L. P., Kirschbaum, C., & Reinecke, A. (2021) · Journal of Psychopharmacology · doi:10.1177/02698811211001087 · Cited by 10
“An important advancement in this respect is hair steroid analysis, which represents a marker of long-term GC secretion integrated over periods of several months (Stalder et al., 2017).”
BackgroundSelf-citationBig five traits and interpersonal goals during stressors as predictors of hair cortisol
Erickson, T. M., Jacobson, S. V., Banning, R. L., Quach, C. M., & Reas, H. E. (2021) · Comprehensive Psychoneuroendocrinology · doi:10.1016/j.cpnec.2021.100084 · Cited by 10
“and in HCC [43] may be problematic, we also tested for curvilinear effects.”
BackgroundInfluentialSchmid‐Zalaudek, K., Fredriksen, P. M., Fabiani, E., Fredriksen, M. V., Brix, B., Rössler, A., Jantscher, A., & Goswami, N. (2021) · Stress · doi:10.1080/10253890.2021.1985107 · Cited by 11
“…et al., 2012; Russell et al., 2012; Stalder & Kirschbaum, 2012; Stalder et al., 2017) and, even more reliable, of intra-individual changes in distinct segments (Dettenborn et al., 2012; Groeneveld et al., 2020, 2013; Manenschijn et al., 2011; Stalder & Kirschbaum, 2012; Stalder et al., 2017).”
BackgroundLifetime exposure to violence and other life stressors and hair cortisol concentration in women
Lynch, R., Aspelund, T., Kormáksson, M., Flores‐Torres, M. H., Hauksdóttir, A., Arnberg, F. K., Lajous, M., Kirschbaum, C., & Valdimarsdóttir, U. A. (2021) · Stress · doi:10.1080/10253890.2021.2011204 · Cited by 13
“…covariates to include in our models, we calculated the differences in hair cortisol concentration across covariate levels in the study population which indicated smoking as a potential confounder while other suggested covariates, including hair washing and dying (Stalder et al., 2017), were not.”
Self-citationSmy, L., Shaw, K., Amstutz, U., Staub, M., Chaudhry, S. A., Smith, A., Carleton, B., & Koren, G. (2018) · Clinical Biochemistry · doi:10.1016/j.clinbiochem.2018.04.006 · Cited by 10
Maternal Sociodemographic Factors and Antenatal Stress
Andhavarapu, M., Orwa, J., Temmerman, M., & Musana, J. W. (2021) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph18136812 · Cited by 11
“Age [37,38] p [51] [57] P rity p [41,42] ? ? Marital status [ –40] * [52] ? In ome [37,38] p [15,52] ?”
BackgroundMethodInfluentialEffect of cosmetic hair treatment and natural hair colour on hair testosterone concentrations
Preinbergs, J. K., Poromaa, I. S., Theodorsson, E., Ström, J. O., & Ingberg, E. (2023) · PLoS ONE · doi:10.1371/journal.pone.0291812 · Cited by 9
“…interest, and factors that affect hair cortisol levels include age, sex, BMI, certain medication and illnesses, hair washing frequency, hair treatments with chemicals or heat, exposure to sunlight or ultraviolet light, and perhaps also smoking, alcohol use, and socioeconomic status [8, 9, 16–19].”
Bergunde, L., Karl, M., Borrmeister, M., Jaramillo, I., Weise, V., Mack, J. T., Weidner, K., Gao, W., Steudte‐Schmiedgen, S., & Garthus‐Niegel, S. (2024) · European Journal of Psychotraumatology · doi:10.1080/20008066.2024.2317674 · Cited by 9
“Exclusion criteria for this study comprised multiples and preterm delivery, too early maternal hair sampling (within 7 weeks after delivery), factors compromising hair analysis (e.g. too low hair mass), and factors impacting GC secretion (e.g. smoking; Stalder et al., 2017).”
BackgroundMethodInfluentialSelf-citationLong-Term Glucocorticoid Exposure and Incident Cardiovascular Diseases—The Lifelines Cohort
van der Valk, E. S., Mohseni, M., Iyer, A. M., den Hurk, M. J. B. V., Lengton, R., Kuckuck, S., Wester, V. L., Leenen, P. J. M., Dik, W. A., Visser, J. A., et al. (2024) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/clinem/dgae081 · Cited by 9
Hair cortisol and changes in cortisol dynamics in chronic kidney disease
Boswell, L., Vega‐Beyhart, A., Blasco, M., Quintana, L. F., Rodrı́guez, G., Díaz-Catalán, D., Vilardell, C., Claro, M. I., Mora, M., Amor, A. J., et al. (2024) · Frontiers in Endocrinology · doi:10.3389/fendo.2024.1282564 · Cited by 9
“Its validity, reliability, and correlation with the classic biochemical tests of the HPA axis have been thoroughly studied in healthy volunteers, CS, and adrenal insuf fi ciency (10 – 13 , 15 – 17).”
BackgroundPeng, F., Palazzi, P., Mezzache, S., Adelin, É., Bourokba, N., Bastien, P., & Appenzeller, B. M. R. (2024) · Environmental Health Perspectives · doi:10.1289/ehp14378 · Cited by 9
Wach, D., Schermuly, C. C., Kirschbaum, C., & Wegge, J. (2024) · BRQ Business Research Quarterly · doi:10.1177/23409444241301063 · Cited by 9
“For our analyses, we calculated HGC as the sum of HCC and HEC (Stalder et al., 2017).”
InfluentialSelf-citationVargas, S. M., Parra, L. A., Yu, S. H., Flores, A., Rivas, W. A., Payat, S., Mistry, R., Griffith, K., Williams, C. R., Gamez, D., et al. (2025) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2025.107429 · Cited by 9
“Finally, several hair characteristics that we did not capture, such as hair type, external exposure, and processing, may have influenced cortisol concentrations due to their differential impacts on lipid absorption (Moody et al., 2022; Stalder et al., 2017).”
Sáez-Sanz, N., Sanchez-Lara, E., González-Pérez, R., Caracuel, A., & Peralta‐Ramírez, M. I. (2025) · Brain Sciences · doi:10.3390/brainsci15040383 · Cited by 9
“In contrast, studying cortisol concentrations in hair allows for assessing chronic hypothalamic–pituitary axis activation in the past three months, providing a more stable measure of cortisol fluctuations [29,30].”
Arregi, A., Robinson, O., Aasvang, G. M., Andrušaitytė, S., Dėdelė, A., Evandt, J., García‐Baquero, G., Krog, N. H., Guxens, M., Jaddoe, V. W. V., et al. (2025) · Environmental Research · doi:10.1016/j.envres.2025.121541 · Cited by 9
Zubizarreta, S. C.-P., Isaksson, J., Faresjö, Å., Faresjö, T., Carracedo, Á., Fernández‐Prieto, M., Bölte, S., & Remnélius, K. L. (2025) · Molecular Autism · doi:10.1186/s13229-025-00695-9 · Cited by 9
“Also, HCC is associated with stressors such as chronic pain, chronic conditions, major life stressors (e.g., serious illness, death of a close relative), and long-term unemployment, supporting the use of HCC as a biomarker of long-term stress [20, 31, 32].”
Impact of underlying stress in infertility
Santa-Cruz, D. C., & Agudo, D. (2020) · Current Opinion in Obstetrics & Gynecology · doi:10.1097/gco.0000000000000628 · Cited by 9
Wuttke, A., Henrici, C., Skoluda, N., Nater, U. M., Endres, K., & Fellgiebel, A. (2022) · Journal of Alzheimer s Disease · doi:10.3233/jad-210618 · Cited by 9
“Concerning psychobiological stress measures, we added age, gender, and BMI as methodological con-trol variables in all models due to their known association with HCC [44], sCort secretion [45, 46], and activity of sAA.”
Duplessis-Marcotte, F., Lapointe, R., LUPIEN, S. J., & Marin, M. (2023) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2023.106051 · Cited by 13
Raymond, C., Pichette, F., Beaudin, M., Cernik, R., & Marin, M. (2023) · Journal of Affective Disorders · doi:10.1016/j.jad.2023.02.154 · Cited by 12
Metadata
- Authors
- Stalder, T., Steudte-Schmiedgen, S., Alexander, N., Klucken, T., Vater, A., Wichmann, S., Kirschbaum, C., & Miller, R.
- Affiliations
- Universität Hamburg (DE)
- University of Siegen (DE)
- Technische Universität Dresden (DE)
- MSB Medical School Berlin (DE)
- Venue
- Psychoneuroendocrinology
- Publisher
- Elsevier BV
- Published
- 2017-03
- Volume
- 77
- Pages
- 261-274
- ISSN
- 0306-4530 (ISSN-L)
- OpenAlex
- W2512922965
- Semantic Scholar
- 78b482bd463a2e29e2aae66b9cf8e24a66b06fe6
- Cited by
- 855
- References
- 154
- Citations by year
- 2026: 83 · 2025: 100 · 2024: 123 · 2023: 101 · 2022: 88 · 2021: 111 · 2020: 95 · 2019: 74 · 2018: 56 · 2017: 23
- FWCI
- 5.97
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Psychoneuroendocrinology (publishedVersion)
- PubMed (publishedVersion)
- Funders
- German Research Foundation (1213/5-1, 940/2)
- Topics
- Life Sciences › Neuroscience › Behavioral Neuroscience › Stress Responses and Cortisol
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Adrenal Hormones and Disorders
- Life Sciences › Agricultural and Biological Sciences › Animal Science and Zoology › Animal Behavior and Welfare Studies
- Keywords
- hair cortisol, chronic stress, cortisol hypersecretion, salivary cortisol, anxiety disorders, post-traumatic stress disorder, mood disorders, perceived stress, body mass index, waist-to-hip ratio, systolic blood pressure, hair treatment, oral contraceptive use
- MeSH terms
- Hair, Hemodynamics, Humans, Hydrocortisone, Stress, Psychological
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