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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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Davydov, D. M., de la Coba, P., Contreras‐Merino, A. M., & del Paso, G. A. R. (2024) · Scientific Reports · doi:10.1038/s41598-024-52419-3 · Cited by 9
“Therefore, it indicates cumulative (mal)adaptive stressor arousal-related endocrine activity over relatively longer periods (several months) rather than current (mal) adaptive stress or arousal responses to occasional or acute challenges 50,51 .”
InfluentialSchaefer, J. K., Engert, V., Valk, S. L., Singer, T., & Puhlmann, L. M. C. (2024) · Brain Behavior & Immunity - Health · doi:10.1016/j.bbih.2024.100781 · Cited by 11
“In initial sanity checks, we also confirmed the significance of several common associations not directly related to our conceptual research model, such as negative associations of age with latent CT factors and HCV, and positive associations between BMI and inflammation (see Supplementary Tables S8 and S9).”
BackgroundInfluentialChildren’s hair cortisol as a biomarker of stress at school: a follow-up study
Groeneveld, M. G., Savas, M., van Rossum, E. F. C., & Vermeer, H. J. (2020) · Stress · doi:10.1080/10253890.2020.1725467 · Cited by 11
Buse, J., Rothe, J., Uhlmann, A., Bodmer, B., Kirschbaum, C., Hoekstra, P. J., Dietrich, A., Roessner, V., EMTICS collaborative group, Apter, A., et al. (2021) · European Child & Adolescent Psychiatry · doi:10.1007/s00787-020-01714-1 · Cited by 9
“For example, a meta-analysis of 66 studies with 124 divers subsamples [15] showed no consistent association between HCC and perceived stress.”
BackgroundSelf-citationAssociations of Hair Cortisol Concentrations With Cardiometabolic Risk Factors in Childhood
Vehmeijer, F. O. L., Santos, S., de Rijke, Y. B., van den Akker, E. L. T., Felix, J. F., van Rossum, E. F. C., & Jaddoe, V. W. V. (2021) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/clinem/dgab379 · Cited by 10
“In our study and similarly to previous studies, hair cortisol concentrations were significantly higher among boys than girls (36, 49).”
BackgroundResultSenehi, N., Flykt, M. S., Biringen, Z. C., Laudenslager, M. L., Watamura, S. E., Garrett, B. A., Kominsky, T. K., Wurster, H. E., & Sarche, M. C. (2021) · Prevention Science · doi:10.1007/s11121-021-01307-7 · Cited by 15
“1 3 (HCC)—a biomarker of chronic activation of the HPA-axis (Stalder et al., 2017).”
InfluentialVerheyen, V. J., Rémy, S., Govarts, E., Colles, A., Koppen, G., Martín, L. R., Nielsen, F., Bruckers, L. M., Bijnens, E. M., Vos, S., et al. (2021) · Frontiers in Public Health · doi:10.3389/fpubh.2021.669022 · Cited by 11
“Human hair on the head grows at a rate of approximately 1 cm per month, HCC of 3 cm hair strands retrospectively reflect cortisol levels for the period of 3 months (26).”
BackgroundKim, J., Li, L., Korous, K. M., Valiente, C., & Tsethlikai, M. (2022) · Stress · doi:10.1080/10253890.2021.2024164 · Cited by 9
“Given that meta-analysis of research on hair cortisol found that higher levels of HCC were indicative of ongoing stress at the time of data collection (Stalder et al., 2017), teachers and school officials should do more to help reduce stress and identify culturally appropriate ways to help students regulate their beha…”
BackgroundFK506 binding protein 51: Its role in the adipose organ and beyond
Galigniana, N. M., Ruiz, M. C., & Piwien‐Pilipuk, G. (2022) · Journal of Cellular Biochemistry · doi:10.1002/jcb.30351 · Cited by 11
“23,116 117 – 119 Thus, there is an intricate relationship between FKBP51 in different areas of the brain that through the HPA axis can impinge not only in behavior and psychiatric disorders, but also in the adipose organ and metabolic homeostasis.”
Wu, Y., Berry, D. C., & Schwartz, T. A. (2019) · Health Psychology Open · doi:10.1177/2055102919829275 · Cited by 9
Otten, W., Bartels, T., Heimbürge, S., Tuchscherer, A., & Kanitz, E. (2021) · animal · doi:10.1016/j.animal.2021.100230 · Cited by 9
CortiLove: A pilot study on hair steroids in the context of being in love and separation
Renner, J., Stanulla, M., Walther, A., & Schindler‐Gmelch, L. (2021) · Comprehensive Psychoneuroendocrinology · doi:10.1016/j.cpnec.2021.100061 · Cited by 6
“The study focused on young adult cis women in order to minimize sex-specific influences on endocrine levels [27] and to take into account the expected broad diversity in the relationship life of young adults.”
BackgroundMazgelytė, E., Burokienė, N., Vysocka, A., Narkevičius, M., Petrėnas, T., Kaminskas, A., Songailienė, J., Utkus, A., & Karčiauskaitė, D. (2022) · Journal of Cardiovascular Development and Disease · doi:10.3390/jcdd9030070 · Cited by 8
“A metaanalysis based on findings from 124 (sub)samples [47] identified that only systolic blood pressure was positively associated with hair cortisol concentration, but the relationship between hair cortisol and diastolic blood pressure was overall non-significant.”
BackgroundPeloso, A., Tihy, M., Moeckli, B., Rubbia‐Brandt, L., & Toso, C. (2022) · Nutrients · doi:10.3390/nu14245340 · Cited by 8
“On the other hand, Cortisol is chronically elevated in obese patients and plays an important role in the hormonal regulation of the adipose tissue [76].”
BackgroundAssociations between hair cortisol and blood pressure: a systematic review and meta-analysis
Pageau, L. M., Ng, T. J., Ling, J., Given, B. A., Robbins, L. B., Deka, P., & Schlegel, E. C. (2023) · Journal of Hypertension · doi:10.1097/hjh.0000000000003412 · Cited by 13
Bates, R. A., & Dynia, J. M. (2023) · Psychology in the Schools · doi:10.1002/pits.23118 · Cited by 15
Chronic Stress Related to Cancer Incidence, including the Role of Metabolic Syndrome Components
Pham, A. T., van Dijk, B. A. C., van der Valk, E. S., van der Vegt, B., van Rossum, E. F. C., & de Bock, G. H. (2024) · Cancers · doi:10.3390/cancers16112044 · Cited by 9
“Also, previous investigations have indicated that men had larger quantities of hair glucorticoids compared to women [21,22,47,56–58].”
BackgroundResultSchnall, R., Liu, J., Cordoba, E., Brin, M., Garofalo, R., Kuhns, L. M., Jandev, V., Careem, F. R., Hidoyatov, M., Padilla, J. J., et al. (2024) · Nursing Research · doi:10.1097/nnr.0000000000000757 · Cited by 8
“In a recent meta-analysis regarding chronic stress, stress-exposed groups exhibited 22% increased hair cortisol concentrations; however, these findings were limited to hair cortisol (Stalder et al., 2017).”
The researcher's guide to selecting biomarkers in mental health studies
Verhoeven, J. E., Wolkowitz, O. M., Satz, I. B., Conklin, Q. A., Lamers, F., Lavebratt, C., Lin, J., Lindqvist, D., Mayer, S. E., Melas, P. A., et al. (2024) · BioEssays · doi:10.1002/bies.202300246 · Cited by 10
“[275] HCC can be reliably measured in scalp-close samples of up to 4–6 cm of hair length.”
A Dual Biomarker Approach to Stress: Hair and Salivary Cortisol Measurement in Students via LC‐MS/MS
Hakeem, M. K., Sallabi, S., Ahmed, R., Hamdan, H., Mameri, A., Alkaabi, M., Alsereidi, A., Elangovan, S. K., & Shah, I. (2025) · Analytical Science Advances · doi:10.1002/ansa.70003 · Cited by 11
“The hair samples taken from within 1 cm of the scalp provide insights into the cortisol release that occurred in the past month, as hair grows approximately 1 cm each month [37].”
Seasonal variation in hair cortisol concentration: A systematic review
Feneberg, A. C., Fischer, S., & Skoluda, N. (2025) · Frontiers in Neuroendocrinology · doi:10.1016/j.yfrne.2025.101199 · Cited by 8
“…examine cortisol secretion over periods between 1 and 3 months, while a potential wash-out effect (i.e., decline in HCC) should be considered for longer periods (Stalder et al., 2017) and with hair collected most frequently from the posterior vertex region of the head (Huthsteiner et al., 2025).”
InfluentialCantave, C. Y., Ouellet‐Morin, I., Giguère, C., LUPIEN, S. J., Juster, R., Geoffrion, S., & Marin, M. (2021) · Psychosomatic Medicine · doi:10.1097/psy.0000000000001016 · Cited by 10
“This finding echoes previous evidence from several studies using short-term assessments of symptoms, as well as chronic measures of the HPA axis (19,33).”
BackgroundResultTorrecilla, P., & Neus Barrantes-vidal, A. (2021) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2021.746155 · Cited by 9
Connors, K. M., Flores‐Torres, M. H., Cortés-Valencia, A., Barrientos‐Gutiérrez, T., Cantú-Brito, C. G., Rodríguez, B. L., Lajous, M., Valdimarsdóttir, U. A., & Catzín‐Kuhlmann, A. (2022) · Annals of Epidemiology · doi:10.1016/j.annepidem.2022.03.001 · Cited by 8
Chen, E. Y., Homolka, C. R., Meyer, J. S., & Gettler, L. T. (2023) · Adaptive Human Behavior and Physiology · doi:10.1007/s40750-023-00218-x · Cited by 8
“Meta-analyses have shown hair cortisol to be 22% higher among stressexposed groups, particularly those with ongoing stress, similar to our study sample, although no consistent meta-analytic associations were found with social support or perceived stress (Stalder et al., 2017).”
BackgroundResultRomero, E., León, E. G. D., Morán-Pinzón, J., Salado‐Castillo, R., & Castillo-Pimentel, A. (2023) · Physiology International · doi:10.1556/2060.2023.00178 · Cited by 9
Ruiz, M., Groessing, A., Guran, C.-N. A., Koçan, A. U., Mikuš, N., Nater, U. M., Kouwer, K., Posserud, M.-B. R., Salomon-Gimmon, M., Todorova, B., et al. (2023) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2023.1256771 · Cited by 11
Downes, N., Kallas, K.-A., Moirangthem, S., Maguet, C., Marr, K., Tafflet, M., Kirschbaum, C., Heude, B., Koehl, M., & van der Waerden, J. E. B. (2024) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2024.106957 · Cited by 8
Self-citationLamothe, M., Rondeau, É., Duval, M., McDuff, P., Pastore, Y. D., & Sultan, S. (2020) · Complementary Therapies in Clinical Practice · doi:10.1016/j.ctcp.2020.101249 · Cited by 10
Szép, A., Skoluda, N., Schloß, S., Becker, K., Pauli‐Pott, U., & Nater, U. M. (2021) · Journal of Neural Transmission · doi:10.1007/s00702-021-02377-1 · Cited by 10
Abdulateef, D. S. (2021) · Scientific Reports · doi:10.1038/s41598-021-02223-0 · Cited by 9
Serum Cortisol, 25 (OH)D, and Cardiovascular Risk Factors in Patients with Type 2 Diabetes Mellitus
Jin, Y., Wei, D., Liu, P., Chen, F., Li, R., Zhang, J., Zhang, R., Liu, Z., Huo, W., Li, L., et al. (2022) · International Journal of Endocrinology · doi:10.1155/2022/5680170 · Cited by 8
“FPG, total cholesterol (TC), triglycerides (TG), high-density lipoprotein cholesterol (HDL-C), and low-density lipoprotein cholesterol (LDL-C) were detected by using an automatic biochemical analyzer (ROCHE Cobas C501).”
BackgroundResultInfluentialMichaud, D. S., Thomson, E. M., van Oosterhout, P., & McNamee, J. P. (2022) · The Journal of the Acoustical Society of America · doi:10.1121/10.0012887 · Cited by 10
Wettstein, A., Schneider, S., Jenni, G., Holtforth, M. G., Tschacher, W., & Marca, R. L. (2022) · Frontiers in Psychology · doi:10.3389/fpsyg.2022.1046573 · Cited by 11
Bärtl, C., Kreuzpointner, L., Wüst, S., & Kudielka, B. M. (2023) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2023.106026 · Cited by 8
Association between early life adversity and allostatic load in girls with precocious puberty
Li, J., Yu, Y., Yuan, J., Liu, D., Fang, J., Wu, P., Zhou, Y., Wang, Y., & Sun, Y. (2023) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2023.106101 · Cited by 8
Goldberg, X., Espelt, C., Nadal, R. A., Alon, Y., Palao, D. J., Bar‐Haim, Y., & Armario, A. (2023) · Psychological Medicine · doi:10.1017/s0033291723000910 · Cited by 8
“Hair levels of glucocorticoids (mainly cortisol in humans) have been recently incorporated as an integrated measure of hormone release over periods of months and found to be elevated while under continuous stress (Stalder et al., 2017).”
BackgroundCharacterization of hair cortisol concentration pre-conception and during pregnancy
Juvinao-Quintero, D. L., Künzel, R. G., Larrabure-Torrealva, G. T., Duncan, L. E., Kirschbaum, C., Sánchez, S. E., & Gelaye, B. (2023) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2024.107089 · Cited by 9
Self-citationCantave, C. Y., Brendgen, M. R., LUPIEN, S. J., Dionne, G., Vitaro, F., Boivin, M., & Ouellet‐Morin, I. (2022) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2022.105889 · Cited by 8
Xiang, L., Zeng, X., Luo, Y., Tan, S., Wang, F., & Mao, X. (2023) · The International Journal of Psychiatry in Medicine · doi:10.1177/00912174231178108 · Cited by 10
“27 Lehrer ’ s study, which included adults with a mean age of 45.29, and used the BRS scale, found that resilience can regulate the correlation between perceived stress and HCC, but there was no signi fi cant relationship between resilience and HCC. 28 However, another study conducted on 151 pregnant and puerperium wom…”
MethodInfluentialGifford, R. M., O’Leary, T. J., Knight, R. L., Wardle, S. L., Doig, C. L., Anderson, R. A., Greeves, J. P., Reynolds, R. M., & Woods, D. R. (2024) · Journal of Applied Physiology · doi:10.1152/japplphysiol.00691.2024 · Cited by 7
Longitudinal associations between well‐being, hair cortisol, and self‐reported health
Lawes, M., & Eid, M. (2024) · Applied Psychology Health and Well-Being · doi:10.1111/aphw.12628 · Cited by 7
“In contrast, persistent cortisol output as a result of chronic stress has been shown to be associated with numerous negative health outcomes such as cardiovascular disease, obesity, and type 2 diabetes (Stalder et al., 2017).”
InfluentialAn overview of work-related stress assessment
Lavreysen, O., Bakusic, J., Abatzi, T.-A., Geerts, A., Mateusen, M., Bashkin, O., Bjelajac, A. K., Dopelt, K., du Prel, J., Franić, Z., et al. (2025) · Journal of Affective Disorders · doi:10.1016/j.jad.2025.04.076 · Cited by 8
Kim, S. J., Karayeva, E., Negrete, M. A., Bendinskas, K. G., Winn, R. A., & Matthews, A. K. (2025) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2025.107478 · Cited by 8
“…hair sample is a viable approach for community-based research because cortisol in the hair remains within the hair shaft as it grows from the skull, with hair cortisol concentrations (HCC) less affected by the acute stressors that tend to change rapidly (Stalder et al., 2017; Wright et al., 2015).”
Champagne, F. A., Courtney, K., Bellatin, A., Miller, M., & Widom, C. S. (2025) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2025.107561 · Cited by 8
“In the current study, we assessed HCC in a group of children with documented cases of childhood For individuals without documented childhood maltreatment, more stressful life events and traumas were associated with higher hair cortisol levels (β = 0.07, SE = 0.01, p < .001). r n Among those with…”
InfluentialAnand, C., Hengst, K., Gellner, R., & Englert, H. S. (2022) · Chronic Stress · doi:10.1177/24705470221099206 · Cited by 7
Mithen, L. M., Weaver, N., Walker, F. R., & Inder, K. (2023) · BMJ Open · doi:10.1136/bmjopen-2023-072668 · Cited by 11
Negative associations between maternal prenatal hair cortisol and child socioemotional problems
Mustonen, P., Kortesluoma, S., Scheinin, N. M., Perasto, L., Kataja, E., Tervahartiala, K., Tuulari, J. J., Coimbra, B., Carter, A. S., Rodrigues, A. J., et al. (2024) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2023.106955 · Cited by 7
“…of covariates was based on known determinants for HCC (age, sex, BMI, waist-to-hip ratio, systolic blood pressure, and frequency of hair washing; Stalder et al., 2017) and prenatal factors associated with child neurodevelopment as measured by brain metrics (maternal mental health, SSRI or…”
MethodMorassut, R. E., Langlois, C., Alyass, A., Ishola, A. F., Yazdi, F., Mayhew, A., Reddon, H., MacKillop, J., Pigeyre, M., & Meyre, D. (2017) · BMJ Open · doi:10.1136/bmjopen-2017-019365 · Cited by 7
“Stress Hair cortisol concentration (pg/mg) will be measured as a biochemical marker for exposure to physical stressors and ongoing chronic stress.(68) Hair strands will be cut as close to the scalp as possible from the posterior vertex position.”
Braig, S., Stalder, T., Kirschbaum, C., Rothenbacher, D., & Genuneit, J. (2018) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2018.11.031 · Cited by 7
Self-citationHair cortisol concentrations predict change in girls’ depressive symptoms
Sandstrom, A., Daoust, A. R., Russell, E., Koren, G., & Hayden, E. P. (2020) · European Journal of Developmental Psychology · doi:10.1080/17405629.2020.1774359 · Cited by 7
Sleep and stress in mother–toddler dyads living in low‐income homes
Bates, R. A., Singletary, B., Yacques, A., & Justice, L. M. (2020) · Developmental Psychobiology · doi:10.1002/dev.22077 · Cited by 7
Hair Cortisol and Self-Injurious Behavior Among Children With Autism Spectrum Disorder
Courtemanche, A. B., Black, W. R., & Meyer, J. S. (2021) · American Journal on Intellectual and Developmental Disabilities · doi:10.1352/1944-7558-126.2.158 · Cited by 8
Carlitz, E. H. D., Lindholm, A. K., Gao, W., Kirschbaum, C., & König, B. (2022) · Hormones and Behavior · doi:10.1016/j.yhbeh.2021.105102 · Cited by 7
Self-citationLarsson, G., Smaliukienė, R., Mažeikienė, A., Vaičaitienė, R., Bekešienė, S., Mazgelytė, E., & Karčiauskaitė, D. (2022) · Military Psychology · doi:10.1080/08995605.2021.2018902 · Cited by 9
“The lack of coherence between biological and self-reported stress measures is in line with previous studies which failed to find the aforementioned association (Stalder et al., 2017).”
ResultThe Association of Lifestyle and Mood with Long-Term Levels of Cortisol: A Systematic Review
Jia, R., Carlisle, S., & Vedhara, K. (2022) · Cogent Psychology · doi:10.1080/23311908.2022.2036487 · Cited by 8
Schneider, S., Wettstein, A., Tschacher, W., Torchetti, L., Jenni, G., Kühne, F., Holtforth, M. G., & Marca, R. L. (2022) · Frontiers in Psychology · doi:10.3389/fpsyg.2022.907056 · Cited by 7
Biomarkers of chronic occupational stress (literature review)
Bezrukova, G. A., & Mikerov, A. N. (2022) · Hygiene and Sanitation · doi:10.47470/0016-9900-2022-101-6-649-654 · Cited by 7
Obstetric risk in pregnancy interacts with hair cortisone levels to reduce gestational length
Musana, J. W., Cohen, C. R., Kuppermann, M., Gerona, R. R. L., Wanyoro, A. K., Aguilar, D., Santos, N., Temmerman, M., & Weiss, S. J. (2022) · Frontiers in Global Women s Health · doi:10.3389/fgwh.2022.878538 · Cited by 7
“This provided a retrospective assessment of persistent rather than acute or transient stress (56, 57).”
BackgroundRothe, J., Buse, J., Uhlmann, A., Bodmer, B., Kirschbaum, C., Hoekstra, P. J., Dietrich, A., & Roessner, V. (2023) · Biomedicines · doi:10.3390/biomedicines11061561 · Cited by 7
“In this context, however, it must be considered that results on the relationship between HCC and psychosocial stress in humans are also inconsistent (for a meta-analysis see [33]), which could relate to different types of measured psychosocial stress (e.”
ResultSelf-citationMurnane, P. M., Miller, J. D., Tuthill, E. L., Collins, S. M., Neilands, T. B., Onono, M. A., Cohen, C. R., Weiser, S. D., Laudenslager, M. L., & Young, S. L. (2019) · AIDS and Behavior · doi:10.1007/s10461-019-02676-5 · Cited by 7
Alexithymic Traits and Hair Cortisol Concentrations in Pregnant Women
Kajanoja, J., Karukivi, M., Mustonen, P., Scheinin, N. M., Kortesluoma, S., Rodrigues, A. J., Karlsson, H., & Karlsson, L. (2020) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2020.00421 · Cited by 7
Hair cortisol in patients with a depressive episode treated with electroconvulsive therapy
Baeten, R., van Rossum, E. F. C., de Rijke, Y. B., Sabbe, B., van Rossum, E. F. C., Belge, J., Fransén, E., Schrijvers, D. L., Birkenhäger, T. K., & van Diermen, L. (2020) · Journal of Affective Disorders · doi:10.1016/j.jad.2020.05.042 · Cited by 7
Vepsäläinen, H., Hautaniemi, H., Sääksjärvi, K., Leppänen, M. H., Nissinen, K., Suhonen, E., Saha, M., Lehto, E., Ray, C., Sajaniemi, N. K., et al. (2020) · Appetite · doi:10.1016/j.appet.2020.104993 · Cited by 7
“In addition, a plethora of factors can influence HCC: the rate of hair growth, cortisol metabolism in the hair follicle and puberty, to name only a few (Vanaelst et al., 2012a; Stalder et al., 2017).”
Chronic stress and executive functioning: A specification-curve analysis
Möschl, M., Schmidt, K., Enge, S., Weckesser, L. J., & Miller, R. E. (2021) · Physiology & Behavior · doi:10.1016/j.physbeh.2021.113639 · Cited by 9
Self-citationYang, F., Hong, X., Tao, J., Chen, Y., Zhang, Y., & Xiao, H. (2021) · Brain and Behavior · doi:10.1002/brb3.2412 · Cited by 7
Increased neural reactivity to emotional pictures in men with high hair testosterone concentrations
Klein, S., Kruse, O., León, I. T., Stalder, T., Stark, R. M., & Klucken, T. (2019) · Social Cognitive and Affective Neuroscience · doi:10.1093/scan/nsz067 · Cited by 8
“High testosterone levels have also been linked with increased reactivity to negative faces in prefrontal regions, in particular the OFC (Hermans et al., 2008) and the ventromedial prefrontal cortex ( Stanton et al., 2009).”
BackgroundResultSelf-citationSalminen, L. E., Sämann, P. G., Zheng, Y., Dennis, E. L., Clarke‐Rubright, E. K., Jahanshad, N., Iglesias, J. E., Whelan, C. D., Bruce, S. E., Hayes, J. P., et al. (2019) · bioRxiv (Cold Spring Harbor Laboratory) · doi:10.1101/739094 · Cited by 8
“Chronic stress, however, disrupts hippocampal feedback control of the hypothalamus, leading to prolonged HPA activation and epigenetic changes (8, 12, 13).”
BackgroundAre hair cortisol levels dependent on hair growth rate? A pilot study in rhesus macaques
Dettmer, A. M., Novak, M. A., & Meyer, J. S. (2023) · General and Comparative Endocrinology · doi:10.1016/j.ygcen.2023.114308 · Cited by 6
Gallistl, M., Linz, R., Puhlmann, L. M. C., Singer, T., & Engert, V. (2024) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2024.107051 · Cited by 6
Buckert, M., Streibel, C., Hartmann, M., Monzer, N., Kopf, S., Szendrödi, J., & Wild, B. (2024) · Frontiers in Public Health · doi:10.3389/fpubh.2024.1289689 · Cited by 8
Pérez‐Luño, A., Wiklund, J., Stephan, U., & Lerner, D. (2025) · BRQ Business Research Quarterly · doi:10.1177/23409444251338294 · Cited by 6
“…insolvency experience lower psychological well-being (measured by the WHO-5; Brähler et al., 2007), greater vital exhaustion (Kopp et al., 1998; Schnorpfeil et al., 2002), and higher stress hormone levels, particularly cortisol and cortisone (Stalder et al., 2017), alongside poorer risk adjustment.”
Walther, A., Eggenberger, L., Debelak, R., Kirschbaum, C., Häberling, I. S., Osuna, E., Strumberger, M. A., Walitza, S., Baumgartner, J., Herter‐Aeberli, I., et al. (2025) · Translational Psychiatry · doi:10.1038/s41398-025-03401-8 · Cited by 8
Self-citationBergquist, S. H., Wang, D., Pearce, B. D., Smith, A. K., Hankus, A. N., Roberts, D. L., & Moore, M. A. (2025) · JMIR Formative Research · doi:10.2196/63811 · Cited by 8
“Previous reports have shown that salivary cortisol has a higher correlation to HCC when the time period of collection is 30 days [30] rather than 1 or 2 sampling days [12].”
InfluentialFazekas, C., Goswami, N., Matzer, F., Avian, A., Lodron, J., Rijksen, M., Hanfstingl, B., Kavcic, V., Groselj‐Strele, A., Sourij, H., et al. (2025) · Psychotherapy and Psychosomatics · doi:10.1159/000547858 · Cited by 6
Hair cortisol, perceived stress, and resilience as predictors of coronary arterial disease
Bergquist, S. H., Wang, D., Roberts, D. L., & Moore, M. A. (2021) · Stress and Health · doi:10.1002/smi.3106 · Cited by 6
Current and Cumulative Stress Experiences: A Model for Arab American Young Adults
Albdour, M. M., Templin, T., Zilioli, S., Hong, J. S., & Lumley, M. A. (2022) · Journal of the American Psychiatric Nurses Association · doi:10.1177/10783903221110235 · Cited by 7
“Similar findings were reported by a recent meta-analysis (Stalder et al., 2017) where individuals exposed to current stressors had 22% higher hair cortisol concentrations than their non-stressed counterparts.”
BackgroundResultWindhorst, D. A., Velderman, M. K., van der Pal, S. M., & de Weerth, C. (2023) · BMC Complementary Medicine and Therapies · doi:10.1186/s12906-023-04039-z · Cited by 9
Zapater‐Fajarí, M., Crespo-Sanmiguel, I., Montoliu, T., Hidalgo, V., & Salvador, A. (2024) · Hormones and Behavior · doi:10.1016/j.yhbeh.2023.105474 · Cited by 6
“Finally, we expected to find higher HC and HDHEA and a lower HC:HDHEA ratio in men (Bürgin et al., 2020; Goldman and Glei, 2007; Stalder et al., 2017).”
BackgroundInfluentialNyström‐Hansen, M., Andersen, M., Davidsen, K. A., Røhder, K., Trier, C. H., Nayberg, E., Lyons‐Ruth, K., & Harder, S. K. (2024) · Archives of Women s Mental Health · doi:10.1007/s00737-024-01434-4 · Cited by 6
“Similarly, meta-analytic estimates (Stalder et al. 2017) concerning the influences of hair washing frequency, and hair treatment suggested that although it is good practice to adjust for these factors, under most circumstances their influences would be practically negligible.”
BackgroundMariño-Narváez, C., Puertas‐Gonzalez, J. A., Romero‐Gonzalez, B., Cruz-Martínez, M., González-Pérez, R., Juncosa-Castro, Y., & Peralta‐Ramírez, M. I. (2024) · Development and Psychopathology · doi:10.1017/s0954579424000786 · Cited by 7
Hair cortisol determinants in 11-year-old children: Environmental, social and individual factors
Arregi, A., Vegas, Ó., Lertxundi, A., García‐Baquero, G., Ibarluzea, J. M., Andiarena, A., Babarro, I., Subiza‐Pérez, M., & Lertxundi, N. (2024) · Hormones and Behavior · doi:10.1016/j.yhbeh.2024.105575 · Cited by 7
“In contrast, hair cortisol analysis provides information on HPA activity over several months as the average hair growth is 1 cm per month (Stalder et al., 2017).”
Wekenborg, M., Förster, K., Schweden, F., Weidemann, R. R., von Bechtolsheim, F., Kirschbaum, C., Weitz, J., & Ditzen, B. (2024) · Journal of Medical Internet Research · doi:10.2196/49581 · Cited by 10
“…revealed divergence between questionnaire-based measures and cortisol with respect to both hair F (for review, refer to the study by Stalder et al [29]) as well as other, more traditional cortisol measures, such as the cortisol awakening response [47], and cortisol (stress) reactivity [48,49].”
BackgroundSelf-citationPuhlmann, L. M. C., Vrtička, P., Linz, R., Valk, S. L., Papassotiriou, I., Chrousos, G. P., Engert, V., & Singer, T. (2024) · Biological Psychiatry Global Open Science · doi:10.1016/j.bpsgos.2024.100414 · Cited by 7
“HCC and HEC indicate systemic glucocorticoid exposure and chronic stress (60,61).”
Pividori, I., Peric, T., Comin, A., Cotticelli, A., Corazzin, M., Prandi, A., & Mascolo, M. D. (2024) · Life · doi:10.3390/life14121582 · Cited by 6
Bahmani, D. S., Brand, S., Meinlschmidt, G., Tegethoff, M., Kurath, J., Bürki, N., Hösli, I., & Mikoteit, T. (2025) · Biological Psychiatry Global Open Science · doi:10.1016/j.bpsgos.2025.100454 · Cited by 7
“Next, the inconsistent results in the HPA-AA-PPD link research may also be partially attributed to discrepancies in the time of assessment [see (29,30,38,82)].”
Doyle, J. A., Brindle, E., & Bolden, T. S. (2019) · American Journal of Human Biology · doi:10.1002/ajhb.23222 · Cited by 6
“The body of published HCC studies, however, either focus exclusively on Europeans or European-descendant populations, or have not included assessments of the racial/ethnic composition of their sample (Stalder et al., 2017; Vliegenthart et al., 2016).”
BackgroundHu, X., Ren, X., & Yang, J. (2019) · Stress · doi:10.1080/10253890.2019.1617268 · Cited by 6
“We instructed participants to collect samples at 0, 30, 45, and 60minutes after awakening, following instructions as previously outlined (Stalder et al., 2017), to ensure adequate assessment of the CAR.”
MethodLabad, J., Melia, C. S., Segalàs, C., Alonso, P., Salvat‐Pujol, N., Real, E., Ferrer, Á., Jiménez‐Múrcia, S., Soriano‐Mas, C., Soria, V., et al. (2020) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2020.12.017 · Cited by 8
Understanding the pathology of psychiatric disorders in refugees
Bartlett, R., Sarnyai, Z., Momartin, S., Ooi, L., Schwab, S. G., & Matosin, N. (2020) · Psychiatry Research · doi:10.1016/j.psychres.2020.113661 · Cited by 7
Hagan, M. J., Coccia, M., Rivera, L. M., Epel, E. S., Aschbacher, K., Laudenslager, M. L., Lieberman, A. F., & Bush, N. R. (2021) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2021.105389 · Cited by 6
“Hair samples are increasingly being used as a measure of cortisol secretion over a prolonged period of time (several weeks to several months) that is robust to short-term environmental changes (Stalder et al., 2017).”
Theory of mind and hair cortisol in healthy young adults: the moderating effects of childhood trauma
Lee, S., Park, J. T., Bang, M., An, S. K., Namkoong, K., Park, H. Y., & Lee, E. M. (2022) · European Journal of Psychotraumatology · doi:10.1080/20008066.2022.2116826 · Cited by 8
“To adjust for potential confounders, we considered age, sex, and SAI as covariates based on a previous report of the association between HCC and these variables (Stalder et al., 2017).”
BackgroundMethodInfluentialPsychological stress factors and salivary cortisol in nursing students throughout their training
Mendes, S. S., Martino, M. M. F. D., Borghi, F., Rocha-Teles, C. M., de Souza, A. L., & Kassisse, D. M. G. (2022) · Revista da Escola de Enfermagem da USP · doi:10.1590/1980-220x-reeusp-2022-0078en · Cited by 6
“Cortisol production follows a 24-hour circadian rhythm, characterized by high levels upon awakening and a subsequent increase in the first 30 minutes, with gradual reduction throughout the day(8), both in the blood, urine, and saliva(7).”
BackgroundJohnson‐Ferguson, L., Shanahan, L., Loher, M., Bechtiger, L., Binz, T. M., Baumgartner, M. R., Ribeaud, D., Eisner, M., & Quednow, B. B. (2024) · Archives of Toxicology · doi:10.1007/s00204-024-03747-w · Cited by 6
“…contraceptive use in women (Vázquez Carrillo et al. 2022), body mass index (BMI), stressful life events, exercise hours per week, hair treatment and colour (Stalder et al. 2017), and exposure to cannabis and 3,4-methylenedioxymethampheta-mine (MDMA, “Ecstasy”) (Johnson-Ferguson et al. 2023).”
BackgroundInsight and cortisol responses in women with first episode psychosis
Touskova, T. P., Bob, P., Pěč, O., Mishara, A. L., Vaníčková, Z., Raboch, J., & Lysaker, P. H. (2018) · Schizophrenia Research · doi:10.1016/j.schres.2018.06.002 · Cited by 7
Neupert, S. D., Growney, C. M., Zhu, X., Sorensen, J. K., Smith, E. L., & Hannig, J. (2021) · Entropy · doi:10.3390/e23040428 · Cited by 5
“As described in a meta-analysis [57], HCC is a valid measure across studies, with consistently higher average levels in groups with chronic stress.”
Hong, J., Kapoor, A., DaWalt, L. S., Maltman, N., Kim, B. I., Berry‐Kravis, E., Almeida, D. M., Coe, C. L., & Seltzer, M. M. (2021) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2021.105266 · Cited by 6
Psychosocial Stress, Epileptic-Like Symptoms and Psychotic Experiences
Bob, P., Touskova, T. P., Pěč, O., Raboch, J., Boutros, N. N., & Lysaker, P. H. (2022) · Frontiers in Psychology · doi:10.3389/fpsyg.2022.804628 · Cited by 6
Santoso, C. M. A., Stückler, D., & Ihle, A. (2022) · Scientific Reports · doi:10.1038/s41598-022-25143-z · Cited by 6
Psychoactive drug influences on hair cortisol
Parrott, A. C., & Downey, L. A. (2017) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2017.02.034 · Cited by 6
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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