Cited by 855Stress Responses and CortisolAdrenal Hormones and DisordersAnimal Behavior and Welfare Studies

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Stress-related and basic determinants of hair cortisol in humans: A meta-analysis

Stalder, Tobias, Steudte-Schmiedgen, Susann, Alexander, Nina, Klucken, Tim, Vater, Annika, Wichmann, Susann, Kirschbaum, Clemens, Miller, Robert·2017·Psychoneuroendocrinology

DOI 10.1016/j.psyneuen.2016.12.017

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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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What is hair cortisol analysis and how can it aid endocrinologists?
Kirschbaum, C. (2024) · Expert Review of Endocrinology & Metabolism · doi:10.1080/17446651.2024.2365786 · Cited by 6
“…to use the method may be due to fears that factors, such as hair color, cosmetic hair treatments, or the frequency of hair washes could distort the HF. Fortunately, none of these (and other variables) affect HF to a significant extent that would prohibit its use as a diagnostic tool [11].”
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“It was assumed that significant differences in the obtained results might occur due to numerous confounding factors reported in hair samples 32 , which could not have been sufficiently controlled in this study.”
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van Harskamp, D., Ackermans, M. T., Wickenhagen, W. V., Heijboer, A. C., & van Goudoever, J. B. (2025) · Analytical and Bioanalytical Chemistry · doi:10.1007/s00216-025-05878-0 · Cited by 5
“However, it is argued that hair cortisol analysis is only reliable in the first 6 cm of the proximal segment [10], and some limit this to the first proximal 3 cm segment [11–13].”
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Muentner, L., Fanning, K. A., Pritzl, K., Kapoor, A., Weymouth, L., Krishnan, C. A., & Poehlmann, J. (2025) · Developmental Psychobiology · doi:10.1002/dev.70076 · Cited by 6
“For instance, there is evidence of elevated hair cortisol levels among NICU infants put on mechanical ventilation, elementary school girls who experienced adversity, and individuals exposed to chronic stress (Stalder et al. 2017; Vanaelst et al. 2013; Yamada et al. 2007).”
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“Although cortisol effects were not statistically significant in this meta-analysis, dysregulation of cortisol rhythms has been linked to long-term health consequences such as depression, metabolic syn - drome, and immune dysfunction (Stalder et al., 2017).”
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“The measurement of cortisol from hair is the more common and widely validated of these approaches, while measurement of nail cortisol is a more recent development (Chen et al. 2023; Meyer and Novak 2021; Stalder et al. 2017).”
Influential
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“…other hand, investigations focusing on self-reported chronic stress mostly fail to find a consistent significant relation with HCC (Boesch et al. 2015; Stalder et al. 2017; La Marca et al. 2023). future research therefore needs to try to include more objective or objectifiable stress indicators.”
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“An alternative cortisol measure, retrieved from hair samples, is argued to be more stable over time and less malleable by situational factors, in addition to reflecting cumulative cortisol secretion over the previous three months (Stalder et al., 2017).”
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Determination of nicotine and cotinine in human hair using online solid phase extraction coupled with liquid chromatography-tandem mass spectrometry and their relation to hair cortisol and cortisone
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“Notably, researchers found a negative impact of post-traumatic stress disorder on cortisol in hair and no effect of perceived stress, depressiveness or social support [63].”
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“This is in accordance with several studies showing that the content of cortisol in hair is higher in individuals exposed to stress and stress-related disorders (12, 17-24).”
Result
Child maltreatment affects fathers’ response to infant crying, not mediated by cortisol or testosterone
Verhees, M. W. F. T., van IJzendoorn, M. H., Dijk, K. A., Lotz, A. M., de Waal, N., & Bakermans‐Kranenburg, M. J. (2021) · Comprehensive Psychoneuroendocrinology · doi:10.1016/j.cpnec.2021.100083 · Cited by 6
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Human defensive freezing is associated with acute threat coping, long term hair cortisol levels and trait anxietyPreprint
Hashemi, M. M., Zhang, W., Kaldewaij, R., Koch, S. B. J., Jonker, R., Figner, B., Klumpers, F., & Karin Roelofs, A. (2019) · bioRxiv (Cold Spring Harbor Laboratory) · doi:10.1101/554840 · Cited by 5
“14 age, gender, hair washing frequency as well as hair treatment (Greff et al., 2018; Stalder et al., 2017), we ran additional partial correlation analyses to control for all these confounding variables.”
Method
Is Smart Working Beneficial for Workers' Well-being? A Longitudinal Investigation of Smart Working, Workload and Hair Cortisol/Dehydroepiandrosterone Sulfate during the COVID-19 PandemicPreprint
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“Consistent with these ﬁ ndings, a meta-analysis (64) did not ﬁ nd signi ﬁ cant associations of HCC with measures of the CAR or overall postawakening cortisol secretion.”
Supervisor support and virtual leadership moderate the association between technostress creators and strain in remote work: Evidence based on hair cortisol and occupational physician’s hetero-evaluations
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“The models were estimated controlling for sex and age [49], as previous studies have shown an association between HCC and these demographic characteristics [50,51].”
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“An increment of 9.8% in hair cortisol levels is associated with a 2.5 kg/m 2 higher BMI [147].”
Influential
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“In addition, we checked for the influence of potential covariates (i.e., BMI, age, hair treatment, hair-washing frequency, and sex; Stalder et al., 2017).”
InfluentialSelf-citation
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“Median log HCC was higher in children than in mothers, as expected due to known age differences in cortisol levels.(48) Mother and child log HCC were moderately positively correlated (r = 0.”
Background
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Cantave, C. Y., Brendgen, M. R., LUPIEN, S. J., Dionne, G., Vitaro, F., Boivin, M., & Ouellet‐Morin, I. (2023) · Journal of Child Psychology and Psychiatry · doi:10.1111/jcpp.13893 · Cited by 4
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“Therefore, we included only sex, age and BMI as covariates – the effect of which has been confirmed in various studies [27, 28].”
BackgroundResultInfluential
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Sobol, M., Błachnio, A., Plucińska, E., Hryhorchuk, I., Meisner, M., Wdowiak, A., Wdowiak, N., Szczepaniak, P., & Jankowski, K. S. (2024) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2024.107115 · Cited by 5
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“…glucocorticoid concentrations (GCs) has been proposed as a valid and reliable method for the assessment of cumulative glucocorticoid levels integrated over periods of several months [37], which should not be affected by situational variability (e.g., due to acute stress, diurnal rhythmicity; [37]).”
Self-citation
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“This dissociation between subjective stress appraisals and physiological stress markers is a common empirical phenomenon (Becker et al. 2023; Stalder et al. 2017).”
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“[ 26 – 28] Hair cortisol levels have been linked to stress exposures and single diseases, but not to the development or progression of MLTC. [29,30] To address these gaps in the literature, we aimed to quantify the association between stress (measured using the biomarker cortisol) and the risk of…”
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Bilodeau-Houle, A., Raymond, C., & Marin, M. (2024) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2024.107019 · Cited by 4
“Finally, we cannot rule out a potential washout effect of cortisol (i.e., a decline in cortisol concentrations from proximal to distal hair segments) that can occur due to repeated hair washing (Stalder et al., 2017).”
BackgroundInfluential
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Behavioural Endocrinology in the Social Sciences
Botzet, L. J., Kordsmeyer, T. L., Ostermann, S., Ruß, J., & Penke, L. (2024) · KZfSS Kölner Zeitschrift für Soziologie und Sozialpsychologie · doi:10.1007/s11577-024-00945-3 · Cited by 7
“However, HCC is higher in groups experiencing chronic stressors such as caregiving stress, especially when stress is ongoing while the sample was taken (Stalder et al. 2017).”
Influential
Conceptual disorganization and dissociative symptoms in women with first episode psychosis
Touskova, T. P., Bob, P., Pěč, O., Raboch, J., & Lysaker, P. H. (2018) · Schizophrenia Research · doi:10.1016/j.schres.2018.02.014 · Cited by 4
Effekt von Humortraining auf Stress, Heiterkeit und Depression bei Patienten mit koronarer Herzkrankheit und therapierefraktärer Angina pectoris
Voss, M., Wild, B., von Hirschhausen, E., Fuchs, T. A., & Ong, P. (2019) · Herz · doi:10.1007/s00059-019-4813-8 · Cited by 4
No Association of Antenatal Synthetic Glucocorticoid Exposure and Hair Steroid Levels in Children and Adolescents
Ilg, L., Kirschbaum, C., Li, S., Wimberger, P., Nitzsche, K. I., Rosenlöcher, F., & Alexander, N. (2019) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/clinem/dgz064 · Cited by 4
Self-citation
Impact of a nutritional supplement during gestation and early childhood on child salivary cortisol, hair cortisol, and telomere length at 4–6 years of age: a follow-up of a randomized controlled trial
Oaks, B. M., Adu‐Afarwuah, S., Kumordzie, S. M., Laudenslager, M. L., Smith, D. L., Lin, J., Young, R. R., Arnold, C. D., Bentil, H., Okronipa, H., et al. (2020) · Stress · doi:10.1080/10253890.2020.1728528 · Cited by 4
“Typically, hair is estimated to grow 1 cm/month (Stalder et al., 2017); however, slower hair growth rate has been observed for persons of African descent (at an average rate of 0.80 cm/month) (Loussouarn, 2001).”
BackgroundInfluential
Polygenic interactions with adiposity rebound in the prediction of thelarche
Fang, J., Gong, C., Su, P., Wan, Y., Zhang, Z., Tao, F., & Sun, Y. (2020) · Pediatric Research · doi:10.1038/s41390-020-1001-8 · Cited by 5
Hair cortisol concentrations among urban and rural-dwelling mother–child dyads, La Romana, Dominican Republic
Gherlone, N., Hill, D. R., Feinn, R., & Hollenbach, J. P. (2020) · Stress · doi:10.1080/10253890.2020.1846028 · Cited by 4
“HCC can be used as a retrospective biomarker of cumulative cortisol exposure over a period of months rather than at a single time point (Stalder et al., 2017; Staufenbiel et al., 2013).”
Background
Prenatal Alcohol Exposure and Hypothalamic-Pituitary-Adrenal Axis Activity of the Offspring in Humans: a Systematic Review
Díaz-Miranda, E., Nadal, R. A., Armario, A., & Labad, J. (2021) · Current Addiction Reports · doi:10.1007/s40429-020-00349-1 · Cited by 4
Phenotypical predictors of pregnancy-related restless legs syndrome and their association with basal ganglia and the limbic circuits
Chechko, N., Lefort‐Besnard, J., Goecke, T. W., Frensch, M., Schnakenberg, P., Stickel, S., & Bzdok, D. (2021) · Scientific Reports · doi:10.1038/s41598-021-89360-8 · Cited by 4
Investigating the influence of shift work rosters on stress measured as cortisol in hair during the SARS-CoV-2 pandemic
Casjens, S., Tisch, A., Brenscheidt, F., Beermann, B., Brüning, T., Behrens, T., & Rabstein, S. (2022) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2022.105858 · Cited by 4
The use of biochemical indexes in hair for clinical studies of psychiatric diseases: What can we learn about mental disease from hair?
Ren, S., Sun, Z., & Yang, J. (2023) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2023.01.004 · Cited by 4
Maternal Hair Cortisol Concentrations and its Association with Increased Insulin Resistance in Mid-Pregnancy
Juvinao-Quintero, D. L., Larrabure-Torrealva, G. T., Sánchez, S. E., Kirschbaum, C., Williams, M. A., & Gelaye, B. (2022) · Annals of Epidemiology · doi:10.1016/j.annepidem.2023.02.011 · Cited by 4
“…concentrations measured in hair offer a non-invasive, longer retrospective assessment (weeks to months) of cortisol synthesis and secretion (8) compared to cortisol measured in other body fluids, and it has been established as a suitable biomarker of chronic stress and HPA axis dysregulation (7).”
Self-citation
Hair cortisol concentrations and daily life stress in 7-year-old children at familial high-risk of schizophrenia or bipolar disorder. The Danish High Risk and Resilience Study – VIA 7
Brandt, J. M., Hemager, N., Ellersgaard, D., Gregersen, M., Søndergaard, A., Ohland, J., Spang, K. S., Christiani, C. J., Burton, B. K., Greve, A. N., et al. (2023) · Progress in Neuro-Psychopharmacology and Biological Psychiatry · doi:10.1016/j.pnpbp.2023.110750 · Cited by 4
Educational intervention on perceived stress among adults with type 2 diabetes and metabolic syndrome: a non-randomized clinical trial
de Araújo, W. A., Santos, I. S. C., Rosa, R. S., Cruz, D. P., Souza, C. S., Boery, R. N. S. D. O., Pires, C. G. D. S., Souza, A. D. S., & Rocha, R. M. (2024) · Investigación y Educación en Enfermería · doi:10.17533/udea.iee.v42n1e03 · Cited by 4
“(1,22,23) Studies also indicate that an individual’s inability to deal with stress directly impacts the quality of life and health conditions at different stages of life, as well as favor the emergence of a cluster of risk factors for MS. (8) The perception of chronic stress was significantly…”
Background
Psychological and Sociodemographic Variables related to Cortisol in Hair in Spanish Healthy Population
García, L. A., Pérez, R. G., Extremera, A. H., García‐León, M. Á., & Peralta‐Ramírez, M. I. (2020) · The Spanish Journal of Psychology · doi:10.1017/sjp.2020.16 · Cited by 4
Grand Challenge in Adrenal Endocrinology: Is the Legacy of the Past a Challenge for the Future of Precision Medicine?
Chiodini, I., & Gennari, L. (2021) · Frontiers in Endocrinology · doi:10.3389/fendo.2021.747006 · Cited by 4
Planten voor een prima binnenklimaat : Industriele spoor
Hermans, T., de Vries, S., Jeurissen, L., Kraan, J., Oppedijk, B. J., & van Duijn, B. (2019) · doi:10.18174/494867 · Cited by 4
University Exams and Psychosocial Stress: Effects on Cortisol Rhythmicity in StudentsPreprint
Borghi, F., da Silva, P. C., Farias-Silva, E., Canova, F. B., de Souza, A. L., Arouca, A. B., & Kassisse, D. M. G. (2021) · bioRxiv (Cold Spring Harbor Laboratory) · doi:10.1101/2021.02.23.432585 · Cited by 4
Beyond Allostatic Load: Focused Biological Measures of Chronic Stress in African American Older Adults
Wright, K., Lin, C. J., Cothran, F. A., & Williams, K. P. (2021) · Research in Gerontological Nursing · doi:10.3928/19404921-20210825-01 · Cited by 4
Toddler hair cortisol levels are associated with maternal prenatal depression
Thayer, Z. M., Nemeth, K. L., Beauregard, J. A., & Gildner, T. E. (2024) · American Journal of Human Biology · doi:10.1002/ajhb.24127 · Cited by 3
“Hair cortisol concentration (HCC) exhibits substantial intraindividual stability but has been shown to rise significantly in response to ongoing chronic stress (Meyer & Novak, 2021; Stalder et al., 2017).”
Network analysis of the hair-based nine hormones from four neuroendocrine systems
Hou, X., Ding, X., Zhao, L., Gao, W., Qi, D., & Deng, H. (2024) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2024.107262 · Cited by 3
More or less? Effects of different levels of automation of a software agent on information overload, workload, and stress perceptions
Graf, B., Müller, R., Ellwart, T., & Antoni, C. H. (2025) · Computers in Human Behavior Reports · doi:10.1016/j.chbr.2025.100727 · Cited by 3
Trajectories of physiological and perceived stress among South African youth: the role of developmentally nurturing relationships
Abbasi‐Asl, R., Keces, N., Mackin, M., Lerner, R. M., Dowling, E. M., Tirrell, J. M., Zhang, R., Olander, K., Hasse, A., Larkan, A., et al. (2025) · International Journal of Adolescence and Youth · doi:10.1080/02673843.2025.2540057 · Cited by 3
“In addition, although saliva is the most commonly used method to assess short-term fluctuations in cortisol output (e.g. Brummett et al., 2009; Polk et al., 2005), it is strongly influenced by situation-specific factors (Stalder et al., 2017).”
Effects of digital transformation on stress-relevant working conditions and employees’ psychophysiological stress: A longitudinal, quasi-experimental control group study
Wekenborg, M., Harzbecker, J., Bechmann, N., Sbiera, S., Gilbert, S., & Schwerdtfeger, A. R. (2025) · Computers in Human Behavior Reports · doi:10.1016/j.chbr.2025.100839 · Cited by 3
Hair testosterone and cortisol interactively predict problematic pornography use in a male sample
Burkardt, T. M., Stark, R. M., Stalder, T., Wolf, O. T., Klucken, T., Brand, M., & Müller, S. M. (2026) · Journal of Behavioral Addictions · doi:10.1556/2006.2025.00489 · Cited by 3
“However, we consider it unlikely that this has had a strong in ﬂ uence on the present results given that meta-analytic evidence indicates only small effect sizes for associations between hair cortisol and such covariates (Stalder et al., 2017).”
Self-citation
Betriebsärztlicher Instrumentenkoffer „Digital vernetze Arbeit“ – Betreuung und Beratung von Unternehmen und Beschäftigten
Heiden, B., & Herbig, B. (2023) · Springer eBooks · doi:10.1007/978-3-658-40615-8_11 · Cited by 3
Glee in Threes: Positive Affect Synchrony in Parent-Infant Triads is Moderated by Maternal Hair Cortisol and Parenting Stress
León, G. A., Morris, A. R., Gilbertson, C. H., Turner, A., Betron, H., Ortega, L. D., Guillemette, S., Kuhil, S., Wang, J., Demenko, V., et al. (2023) · Infant Behavior and Development · doi:10.1016/j.infbeh.2024.101976 · Cited by 4
Coping strategies mediated the relationship between perceived stress and hair cortisol among socioeconomically marginalized parents
Ling, J., Chen, S., & Marina, M. M. (2024) · Health Psychology and Behavioral Medicine · doi:10.1080/21642850.2024.2399211 · Cited by 8
“More-over, steroid medications and chronic illnesses can affect the hypothalamic-pituitary-adrenal (HPA) axis, leading to higher or lower levels of hair cortisol (Degroote et al., 2023; Stalder et al., 2017).”
Background
Social support moderates the link between chronic peer victimization in school and later cortisol secretion
Brendgen, M. R., Ouellet‐Morin, I., Cantave, C. Y., Vitaro, F., Dionne, G., & Boivin, M. (2024) · International Journal of Behavioral Development · doi:10.1177/01650254241273136 · Cited by 4
Links between ethnic discrimination, mental health, protective factors, and hair cortisol concentrations in asylum seekers living in Germany
Giesebrecht, J., Reich, H., Weise, C., Nater, U. M., & Mewes, R. (2024) · European Journal of Psychotraumatology · doi:10.1080/20008066.2024.2400835 · Cited by 3
“The ongoing stress within forcibly displaced people may moderate the impact of chronic stress on HCC (Stalder et al., 2017).”
Background
Hair cortisol sampling as a measure of physiological stress in youth with acute musculoskeletal pain
Gaultney, W. M., O’Brien, J. R., Heierle, J., Battison, E., Wilson, A. C., Rovnaghi, C. R., Anand, K. J. S., & Holley, A. L. (2024) · Comprehensive Psychoneuroendocrinology · doi:10.1016/j.cpnec.2024.100267 · Cited by 4
Evaluation of Effects of the Mindfulness Program .b for Youth:
Ashitani, M. (2024) · The Japanese Journal of Educational Psychology · doi:10.5926/jjep.72.121 · Cited by 3
Investigating the association between hair progesterone, anxiety, sleep quality, and other determinants in South African females
Kew, J., Stalder, T., Kirschbaum, C., Seedat, S., & van den Heuvel, L. L. (2024) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2024.107223 · Cited by 4
“…with hair cortisol concentrations (HCC) that are summarised in several systematic reviews and meta-analyses (Abell et al., 2016; Dettenborn et al., 2012; Kirschbaum et al., 2009; Russell et al., 2012; Stalder et al., 2017; Stalder and Kirschbaum, 2012; van den Heuvel et al., 2020a, 2020b).”
BackgroundSelf-citation
The effects of single testosterone administration and stress induction on steroid hormone levels in hair
Kutlikova, H. H., Eisenegger, C., Krumbholz, A., Riečanský, I., Lamm, C., & Quednow, B. B. (2024) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2024.107252 · Cited by 3
“A meta-analysis of hair cortisol concentrations and stress revealed that participants exposed to chronic stress exhibit 22% increased hair cortisol compared to non-stressed individuals (Stalder et al., 2017).”
Effect of Coping Strategies on Perceived Stress and Hair Cortisol Levels During the COVID‐19 Pandemic According to Sex
Arcand, M., Zerroug, Y., Peyrot, C., Cernik, R., Herba, C. M., & Marin, M. (2025) · Stress and Health · doi:10.1002/smi.70012 · Cited by 3
“Indeed, one meta‐analysis showed that men had higher HCC than women (Stalder et al. 2017), whereas others found no significant differences (Johnsen et al. 2023; W. J. Kim et al. 2021; Manenschijn et al. 2011; Raul et al. 2004).”
Influential
Possible Anti-Aging and Anti-Stress Effects of Long-Term Transcendental Meditation Practice: Differences in Gene Expression, EEG Correlates of Cognitive Function, and Hair Steroids
Wenuganen, S., Walton, K. G., Travis, F. T., Tobias Stalder, A., Wallace, R. K., Srivastava, M., & Fagan, J. B. (2025) · Biomolecules · doi:10.3390/biom15030317 · Cited by 3
“As a long-term indicator of endocrine consequences of chronic stress that may reflect allostatic load [19,43,44], the concentrations of the glucocorticoids cortisol (F) and cortisone (E) in hair were also measured in all subjects.”
Hair Cortisone Levels and the Metabolic Syndrome: Stronger Links in Younger Compared to Older Adults
Kuckuck, S., Lengton, R., März, J., van Gerwen, N., Rizopoulos, D., Hillegers, M. H. J., Kavousi, M., van den Berg, S. A. A., Giltay, E. J., Penninx, B. W. J. H., et al. (2025) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/clinem/dgaf322 · Cited by 2
The Impact of Recess on Chronic Stress Levels in Elementary School Children
Rhea, D. J., Kirby, K., Cheek, D. J., Zhang, Y., & Webb, G. K. (2025) · Children · doi:10.3390/children12070865 · Cited by 8
“Researchers have widely used HCC to approximate chronic physiological stress responses in adults [28], but the measure is only recently emerging in children and has shown varying results [24].”
Parental Stress and Scalp Hair Cortisol in Excessively Crying Infants: A Case Control Study
de Kruijff, I., Tromp, E., den Berg, M. P. L., Vlieger, A. M., Benninga, M. A., de Rijke, Y. B., & van den Akker, E. L. T. (2021) · Children · doi:10.3390/children8080662 · Cited by 4
“Flattening of the cortisol diurnal slope or dampening of the cortisol response is a wellknown phenomenon in psychological studies [9,41] and has, for example, been associated with psychosocial stress in women with preexistent psychopathology [42].”
BackgroundInfluential
Psychobiological Evaluation of Day Clinic Treatment for People Living With Dementia – Feasibility and Pilot Analyses
Wuttke, A., Palm, S., Geschke, K., Skoluda, N., Bischoff, T., Nater, U. M., Endres, K., & Fellgiebel, A. (2022) · Frontiers in Aging Neuroscience · doi:10.3389/fnagi.2022.866437 · Cited by 3
Co-Rooming Accounts for Socioeconomic Disparities in Infant Sleep Quality among Families Living in Urban Environments
Finkel, M. A., Troller‐Renfree, S. V., Meyer, J. S., & Noble, K. G. (2022) · Children · doi:10.3390/children9101429 · Cited by 4
“HCC is a relatively new, non-invasive tool for measuring physiologic chronic stress, and is elevated in groups with ongoing stressors, but not consistently associated with self-reported measures of perceived stress [25].”
Background
Natural disasters as natural experiments: Lessons for human stress science
Adam, E. K. (2023) · Proceedings of the National Academy of Sciences · doi:10.1073/pnas.2316231120 · Cited by 3
“…suggest that some biological stress responses, such as cortisol levels, are elevated if measured shortly after the objective or perceived stressor but decline over time after stressor offset and may even drop below nor - mal levels particularly if stress exposure is severe or prolonged (4, 11, 12).”
Background
The role of personal, relational, and collective self‐esteem in predicting acute salivary cortisol response and perceived stress
Tang, X., Hu, W., Zhao, X., Liu, Y., Ren, Y., Tang, Z., & Yang, J. (2024) · Applied Psychology Health and Well-Being · doi:10.1111/aphw.12534 · Cited by 3
Hair hormone data from Syrian refugee children: Perspectives from a two-year longitudinal study
May, A. K., Smeeth, D. M., McEwen, F. S., Moghames, P., Karam, E. G., Rieder, M. J., Elzagallaai, A. A., Uum, S. H. M. V., & Pluess, M. (2024) · Comprehensive Psychoneuroendocrinology · doi:10.1016/j.cpnec.2024.100231 · Cited by 3
“Smoking may blunt hormone secretion, particularly cortisol [49], and thus should be borne in mind as a confounding issue, although meta-analysis of hair cortisol did not reveal a significant effect of habitual smoking [22].”
BackgroundResultInfluential
Parenting stress, dyadic coping and endocrine markers of stress and resilience in foster and biological mothers
Reindl, V., Lohaus, A., Heinrichs, N., & Konrad, K. (2024) · PLoS ONE · doi:10.1371/journal.pone.0310316 · Cited by 3
“…and hormonal levels, it could also suggest that significant alterations in hair hormone concentrations require chronic stress exposure above a certain intensity level, which accumulates and eventually exhausts the regulatory capacities of the HPA axis (for a more detailed discussion see [14]).”
BackgroundResult
The association between hair cortisol and burnout is moderated by age, psychosocial, and immunological markers
Gajewski, P. D., Bröde, P., Claus, M., Golka, K., Hengstler, J. G., Watzl, C., Wascher, E., & Getzmann, S. (2024) · Brain Behavior & Immunity - Health · doi:10.1016/j.bbih.2024.100909 · Cited by 14
RETRACTED: Hair Cortisol and Fe-BARQ: Evaluating Chronic Stress and Behavior in Cats with Chronic Kidney Disease
Kim, G.-H., Lee, K., Choi, H.-S., Han, J. S., & Kim, S. (2025) · Animals · doi:10.3390/ani15060889 · Cited by 3
“( b ) Correlation between responsiveness to name-calling behaviors and HCC: S10Q1, coming when The study also found no significant correlation between the number of cats in the household and HCC levels among the groups.”
Retracted

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)
ORCID: Alexander, Nina
Klucken, Tim
Kirschbaum, Clemens
Miller, Robert
Venue: Psychoneuroendocrinology
Publisher: Elsevier BV
Published: 2017-03
Volume: 77
Pages: 261-274
ISSN: 0306-4530 (ISSN-L)
DOI: 10.1016/j.psyneuen.2016.12.017
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
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
www.elsevier.com/legal/tdmrep-license (tdm)
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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Stress-related and basic determinants of hair cortisol in humans: A meta-analysis

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