Articles & Research
5
 min read
June 25, 2025

Hair Cortisol: A Long-Term Stress Marker for High-Performing Professionals

Chronic stress is a pervasive factor in modern professional life, influencing cognitive performance, physiological resilience, and long-term health outcomes. While acute stress responses are necessary for peak performance, sustained dysregulation of the body's stress system blunts health and performance (Chrousos, 2009). To accurately assess and manage these risks, it is essential to track stress biomarkers that provide a comprehensive, long-term perspective, rather than just momentary snapshots of physiological states.

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The Science Behind Hair Cortisol as a Long-Term Stress Marker

Hair Cortisol - The ‘HbA1c’ of Stress Measurement

HbA1c is a biomarker used in diabetes management to reflect average blood sugar levels over the past two to three months, providing a more reliable assessment of glucose regulation than single blood sugar measurements.

Similarly, hair cortisol offers insights into retrospective stress levels over weeks or months, capturing cumulative exposure rather than transient fluctuations seen in saliva, blood, or urine tests (Raul et al., 2004).

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Why We need Long-Term Cortisol Measurements

Cortisol is the primary effector hormone of the hypothalamic-pituitary-adrenal (HPA) axis, influencing nearly every nucleated cell in the body.

It plays a key role in metabolism, immune function and stress adaptation (Kirschbaum, 2024). Given its widespread effects, it’s not surprising that dysregulation in cortisol levels is associated with various conditions, including cardiovascular disease, osteoporosis, sleep apnea, and mental health disorders (Chrousos, 2009). Low cortisol levels have even been reported to be the single most important biomarker for long COVID (Klein, 2023).

Traditional cortisol measurements from saliva, blood, or urine provide snapshots, reflecting stress levels over minutes to hours. These measures are highly sensitive to fluctuations due to factors like sleep-wake cycles, food intake, exercise, and acute stressors, making them unreliable indicators of long-term HPA axis activity (Kirschbaum, 2024).

In contrast, hair cortisol offers an integrated, retrospective measure of systemic cortisol levels over an extended period of time (Davenport et al., 2006; Manenschijn et al., 2011).

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Hair as an Endocrine History Book

Human scalp hair grows at an average rate of approximately 1 cm per month. As hair forms, cortisol and other hormones are  incorporated into the hair matrix by passive diffusion from the bloodstream.

Studies have shown, that hair cortisol levels correlate well with physiological levels and provide useful prognostic information (Davenport et al., 2006; Rakotoniaina et al., 2017). By analyzing consecutive, scalp proximal hair segments, researchers can reconstruct an individual’s stress history, much like reading rings in a tree trunk.

This perspective is invaluable for detecting prolonged elevated or suppressed cortisol levels, which might not be evident from snapshot measurements.

For instance, retrospective analysis of hair cortisol has been used to assess stress levels before major health events, such as myocardial infarctions, demonstrating its predictive value for serious health risks (Pereg et al., 2011).

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Key Advantages of Hair Cortisol Analysis

  1. Long-Term Integration – Hair cortisol reflects cumulative hormone exposure over weeks or months, overcoming the variability of saliva, blood, or urine measurements (Stalder & Kirschbaum, 2012).
  2. Non-Invasiveness and Convenience – Hair samples can be conveniently collected, transported, and stored without the need for refrigeration or immediate processing (Kirschbaum, 2024).
  3. Retrospective Insights – The ability to analyze specific hair segments allows for stress pattern analysis over time, providing unique insight into past stress exposure (Rakotoniaina et al., 2017).
  4. Enhanced Reliability – Unlike momentary cortisol spikes seen in saliva or blood, hair cortisol provides a more stable and reliable measure of chronic stress (Stalder et al., 2017).

How we Use Hair Cortisol at Sapiens

Hair Cortisol is a good marker of strain (high cortisol) as well as fatigue (low hair cortisol). Based on the allostatic load model, fatigue often is a result of long-term chronic stress exposure.

For the Sapiens diagnostics we are triangulating hair cortisol with further stress-related hair hormones (Cortisone, DHEA, Testosterone), as well as hair endocannabinoids as resilience factors. Also, we are always taking daily cortisol profiles (2-3 days with multiple time points of saliva analysis on each day) to also understand the circadian rhythm of cortisol expression.

We are comparing hair and saliva stress hormones and resilience factors to reference data from large scientific studies to identify typical patterns in your age group and biological sex.

Lastly, we are interpreting these biological stress hormone results with scientifically validated questionnaires of perceived stress and fatigue.

Based on all these data points, a medical doctor or expert in out team, has a 60 minute conversation to interpret the data together with you and create a personalized protocol to reduce long-term strain or fatigue.

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Advancing Precision in Stress Diagnostics

Harnessing Insights about Chronic Stress for Sustainable Performance

In high-performance professions, the ability to sustain cognitive and physiological resilience is critical for long-term success.

By understanding long-term stress exposure, executives and high-performing teams can make data-driven decisions to optimize resilience, recovery, and overall well-being.

By incorporating hair cortisol as a validated biomarker of chronic stress exposure, Sapiens offers an evidence-based approach to assessing well-being and professional endurance.

The integration of long-term stress monitoring into our diagnostics provides individuals and organizations with a strategic advantage, with the potential to enhance decision-making, recovery, and sustainable performance outcomes.

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References

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Our workshops are customized based on your teams data. Below some example modules from previous clients

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Workshop Module 01 - Body regulation for critical work situations

Use biofeedback technology to monitor and regulate your body, emotions, and mind in high-pressure situations – see sample outline here.

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Workshop Module 02 - Address your team’s top 3 energy leaks

Identify your team's main physiological, emotional, and cognitive energy leaks and develop actionable strategies to address them.

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Workshop Module 03 - Redesign team habits for sustainable performance

Leverage stress data to identify team habits and align the team calendar to minimize strain.

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Diagnostics

Measure what anchors your performance

Our industry leading stress diagnostics creates a complete picture of your energy leaks, resilience factors, chronic stress levels and stress drivers. You receive a simple diagnostics kit at-home which includes hair steroid analysis, ECG monitoring, circadian saliva profile and a self-assessment. You receive a personal report and in a 1:1 debrief with your coach you interpret the 250+ data points  to set personal priorities and action plan to raise your performance and health while reducing your stress.

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Integrate the most effective interventions into your busy schedule

At the end of the 3 to 6-month period, we will repeat the full-spectrum stress diagnostics, using all relevant biomarkers to pinpoint which experiments impacted your goals most. This includes a 3-month retrospective assessment of chronic stress through hair cortisol and cortisone levels, offering insight into the overall effects on chronic stress levels. 

With your coach, you will develop a personalized work and lifestyle playbook for achieving your goals with sustainable performance habits and a backup plan for managing periods of high stress or increased workload.

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Do N=1 experiments

Find the interventions that work best for you

Using your aspirations, internal obstacles, and stress diagnostics report, we will design small, actionable experiments, which you will implement in two-week cycles with the help of your coach. Each experiment includes specific metrics to assess its impact, following an ‘N-of-1 clinical trial’ approach for tailored evaluation.

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Example: If you aspire to reduce stress, your experiment program could look like this.

Weeks 1 & 2: Work-Home Transition

Goal: Create a structured work-to-home transition to improve recovery after work hours.

Biomarkers: Recovery rate percentage after work measured by ECG monitor and evening cortisol levels.

‍Weeks 3 & 4: Sleep Quality

Goal: Improve sleep quality by establishing an evening ritual and eating the last meal at least 4 hours before bed.

Biomarkers: Resting heart rate before bedtime and recovery rate percentage during sleep, tracked by ECG monitor.

‍Weeks 5 & 6: Weekend Recovery

Goal: Maximize nervous system recovery over the weekend by fully disconnecting from work.

Biomarkers: The recovery rate percentage during weekends is measured with an ECG monitor and the weekend email open rate.

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Measure biomarkers

Measure your baseline and track intervention results

Once your goals are set, we identify relevant biomarkers to guide your journey. Often, we use our stress diagnostics kit, which measures over 13 biomarkers and includes multiple self-assessments, generating 200+ data points. This assessment establishes a baseline and pinpoints specific areas for intervention. You can view an example report here.

We also use lab blood tests, sensor analytics, and additional assessments to establish a baseline and identify key areas for targeted intervention. Here is how we make different goals measurable:

Reducing Stress

  • Hair steroid analysis for a 3-month retrospective of cortisone, cortisol, DHEA, and testosterone levels;
  • ECG monitoring to assess nervous system recovery during and after work hours;
  • Sleep tracking and analysis for quality and duration;
  • Self-assessment of stress levels using scientifically validated tools.

Reducing Fragmentation

  • Workstyle metrics, such as task or app switches per day and email frequency;
  • EEG monitoring to track brainwave activity during work hours;
  • Cognitive assessments, including attention network and memory tests.

Building Stronger Health

  • Comprehensive laboratory blood tests;
  • Regular at-home blood tests for key markers (e.g., inflammation levels);
  • Continuous blood glucose monitoring.

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Clarify goals

Clarify your goals and uncover what is holding you back

The first step of your coaching journey is to understand your work and life aspirations, identify current obstacles, and set measurable goals regarding your health and performance.


Set your aspiration

What areas of your health, energy, and performance would you like to improve to live and work better? Consider goals like:

  • Reducing procrastination
  • Enhancing creativity
  • Lowering fatigue
  • Minimizing health risks from chronic stress
  • Preventing burnout


Uncover your internal obstacles and leverage personal motivators

You’ve likely worked on your goals and aspirations before, but staying committed can be challenging as life gets busier. Together, we will explore what truly matters to you, uncover stress habits that might hold you back, and build on the strengths and insights you already have. This will allow you to create sustainable and long-lasting change for yourself.


Set measurable goals

You will break down your aspirations with your coach into smaller, measurable goals. For example, if you aspire to be more present with others and minimize mental fragmentation, we’ll translate these into clear, actionable steps:

Be more present with people 

  • How can I block distracting thoughts while I am in a conversation?
  • How can I better remember what people told me two weeks after our conversation?

Reduce fragmentation 

  • How can I get into a daily deep-work mode for 90 minutes?
  • How can I limit social media distractions to 15 minutes per day?

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Health

Strengthening health and longevity

“I used to worry about burnout, but now I know how to maintain high productivity without compromising my health.”

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Together with medical doctors, we support clients in improving their overall health, including gut, metabolic, and musculoskeletal health. This leads to improved well-being and quality of life.

For employers, improved employee health leads to greater engagement and significantly reduced sick days.

How we measure health levels

While increased energy is a subjective experience reported by our clients, we track the underlying contributors through measurable biomarkers:

Energy levels

  • Energy assessment: We evaluate 70 symptoms across 15 common areas of potential energy drains, including hydration, gut health, and fragmentation.

Metabolic health

  • Glucose: Continuous Glucose Monitors (CGMs) track blood glucose fluctuations, which we combine with ECG monitoring to assess how stress levels may influence eating behaviors and blood glucose stability.
  • Inflammation: We measure inflammation levels using blood markers like hs-CRP through lab-based and at-home blood tests.
  • Blood sugar levels: We evaluate metabolic health markers, including HbA1C and the HOMA-Index, to evaluate average blood sugar levels and insulin sensitivity.

Micro-nutrients

  • Nutrition levels: We assess vitamin and mineral levels through blood tests at partner laboratories to ensure the body has the essential nutrients required to cope with the demands of high workloads and stress effectively.

Comprehensive health assessments

  • Heath audit: For selected clients, we collaborate with third-party laboratories to provide comprehensive blood tests and health assessments.

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Energy

Reducing stress frees up energy

“I no longer feel fatigued when finishing the work day, which allows me to be more present with my kids.”

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Many clients report feeling less scattered and fatigued after their workday, which allows them to be more present with their families and enjoy their free time.

Corporations report significant boosts in employee energy following our programs, resulting in improved emotional regulation, stronger team collaboration, and increased productivity.

How we measure energy levels

While increased energy is a subjective experience reported by our clients, we track the underlying contributors through measurable biomarkers:

Day-time recovery

  • Morning Ramp-Up and Evening Down-Regulation: Our partner laboratory analyzes cortisol and alpha-amylase levels from saliva samples collected at precise time points over multiple workdays.
  • Nervous System Recovery: We measure recovery levels via ECG monitoring over a full workweek, assessing recovery during working hours and the ability to “switch off” after work.

Sleep quality

  • Sleep Recovery: We assess the percentage of recovery during sleep through ECG monitoring and identify specific factors influencing sleep quality.

Cognitive energy

  • Cognitive performance assessment: We test cognitive performance factors, including memory, reaction time, and executive control, to evaluate and enhance clients' cognitive energy levels.

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Resilience

Stress resilience improves impact

“I remain much calmer under pressure and am less likely to react in ways I later regret.”

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We help our clients measurably reduce chronic stress, enhancing their ability to adapt to stressors. As a result, they report significant improvements in creativity, empathy, and complex decision-making.

Organizations we work with benefit not only from reduced absenteeism and lower talent turnover, but more importantly, from heightened leadership impact and improved overall employee performance.

How we measure stress and stress resilience

Clients who join our 3- to 6-month programs typically achieve measurable improvements in the following stress-related markers:

Chronic stress

  • ‍Biological Stress Markers: We measure key indicators such as cortisone, cortisol, DHEA, and partially testosterone through hair analysis;
  • Self-Perceived Chronic Stress: Assessed using the scientifically validated Perceived Stress Scale (PSS).

‍Resilience

  • Biological Resilience Factors: Assessed through ECG monitoring and HRV (Heart Rate Variability) analysis, along with hair-based measurements of endocannabinoids and DHEA;
  • Self-Perceived Resilience: Evaluated using the Brief Resilience Scale and Brief Resilience Coping Scales, both validated by scientific research.

The figures provided reflect sample results achieved by small client groups during our programs. A comprehensive research study involving all participants is currently underway, with results expected to be published soon.

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Self-assessment

Identify and address your top 3 energy drains.

In less than 5 minutes, you can find what limits your resilience and contributes to chronic stress. You will receive a report and a toolkit with personalized strategies to address your top 3 energy drains delivered to your inbox for free.

Boost your performance with 5 science-backed tips tailored to your intense schedule

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Get 25 proven strategies for resilience

In less than 5 minutes, you can find what limits your resilience and contributes to chronic stress. You will receive a report and a toolkit with personalized strategies to address your top 3 energy drains delivered to your inbox for free.

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02 - Reinforce

Synchronize your work and lifestyle with your natural rhythms

Adopt small lifestyle tweaks in your most impactful intervention areas such as calendar management, recovery, movement, nutrition, self-regulation, and cognitive regeneration.


Review your daily work and lifestyle routines based on your body data

Once our clients have mastered to recognize and regulate their state and reduced their primary energy drains, we can focus on optimizing their overall energy levels and health.

We begin by assessing how current routines impact resilience, stress, and personal goals. Then we identify small adjustments in different intervention areas to shift from a stress-inducing lifestyle to one that aligns daily routines with each person’s biology and natural rhythms.

Get the right experts for personalized interventions

The health and lifestyle tips from your favorite Instagram influencer often aren’t suited to your unique biology.

We connect you with PhD-level experts to help you optimize six key lifestyle factors that most influence chronic stress and resilience, targeting intervention areas where small, immediate changes can lead to significant results.

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04 - Reduce

Reduce your top energy drains

Identify hidden stressors and tackle root causes through science-based, data-driven experiments.


No relentless self-optimization, but self-synchronization 

Our clients are senior executives and high performers who already have what it takes to excel in the most demanding business environments. Yet, many find themselves unintentionally getting in their own way.

Their intense workstyles and periods of pressure often lead to stress-driven habits, like late-night sugar intake, excessive caffeine, irregular sleep, or moving too little. These stress habits create internal stressors or energy drains, such as suboptimal metabolic health, circadian rhythm misalignment, nutrient deficiencies, muscle imbalances, and chronic tension.

Over time, these energy drains elevate cortisol levels and fuel chronic stress, creating a vicious cycle of job strain, stress habits, and escalating energy depletion.

Identify energy drains that contribute most to chronic stress

We have identified the 15 most prevalent energy drains among our high-performing executive clients.

Using self-assessments, consultations with our team of medical professionals, and detailed diagnostics, we pinpoint your personal energy drains that have the most impact on your chronic stress.

Address your major energy drains one step at a time

Rather than offering generic health advice or overwhelming you with self-improvement tips, we provide highly personalized support, addressing your top energy drains with small, targeted interventions.

‍Example: One client identified ‘blood sugar dysregulation’ as a major driver of chronic stress, causing significant fluctuations in energy and focus throughout the workday.

To address this, we implemented a series of small, measurable experiments, using a continuous glucose monitor and ECG to assess both blood sugar and acute stress levels. For this client, we created the following program:

  • Weeks 1 & 2: Shift from a carbohydrate-based to a protein-based breakfast.
  • Weeks 3 & 4: Take a 5-minute walk after a carb-heavy lunch.
  • Weeks 5 & 6: Replace sweet snacks with savory options, keeping ready-packed nuts and vegetables on hand.

Once we achieved stable blood sugar levels, we moved on to the next identified energy leak: optimizing micronutrient levels.

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03 - Regulate

Regulate your energy and focus to meet the demands of any task

Prepare your body and mind for critical moments by practicing micro-recovery and transition techniques.


Stress isn’t bad, but timing matters

Our nervous system controls every organ in the body and sets our overall level of activation – often referred to as ‘acute stress.’ The body shifts between calm and alert based on perceived urgency and safety.

While stress is often seen as negative, it is actually a powerful enabler of quick thinking and productivity. High activation helps you react swiftly, while low activation fosters creativity, strategic thinking, complex decision-making, and allows you to connect more empathetically and inspire those around you.

Enter the optimal state to achieve your goals

Most of our clients embrace an intense work ethos – which is one of the reasons we love working with them. However, this relentless drive can interfere with achieving an optimal state for their goals, leaving much of their biological potential untapped.

Many are on call 24/7, ready to jump into action and racing from one meeting to the next, spending most of their time in a high activation state. They focus heavily on content and leadership but often overlook the optimal state needed to reach their goals effectively.

In our programs, clients learn to regulate their state to match their objectives. For example, a high-activation or alert state (sympathetic nervous system) is perfect for tackling 50 emails in 15 minutes. However, this same state can hinder creativity or complex decision-making.

Our clients learn to shift between high and low activation states on demand, transitioning smoothly between meetings. They use tools such as breathwork, visualization, body tension adjustments, and shifting attention between external and internal focus to regulate their state.

What got you here, won’t get you there

Most of our clients face a dilemma as they advance in their careers: early on, they rose through the ranks by operating in a high-activation state – always on, moving quickly, getting things done. This fast-paced approach helped them excel in linear work.

However, to truly thrive in senior executive roles, a low-activation state is needed most of the time. This allows executives to inspire others, lead authentically, make complex and impactful decisions, foster innovation, and support their teams with empathy and client-centered insight.

By learning to down-regulate their nervous systems, our senior clients are better able to focus on what truly drives their success, creating more meaningful impact and achieving a balanced life aligned with their aspirations.

Synchronize your calendar with your circadian rhythm

To increase the likelihood of being in the optimal state for their tasks at hand, we help our clients measure their circadian rhythm through cortisol saliva tests over a workweek. We then help them align schedules and daily routines with their unique biological rhythm.

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01 - Recognize

Learn to recognize body signals early to stay ahead of stress

Gain insight into your reactions and impulses that arise under pressure by analyzing body data.


You can’t manage what you don’t measure

How you show up each day – what we call your ‘state’ – is one of the most critical success factors in demanding roles. Yet, many senior executives leave it entirely unmanaged.

Many executives rush into meetings focused solely on the work at hand rather than creating the optimal state for themselves and their teams to drive success.

Managing your state starts with awareness of your nervous system, brain, and overall biological patterns.

Shifting from narratives to body literacy

When we ask new clients, “What state are you in right now?” we often hear narratives like, “I’m having a busy time at work, I didn’t sleep well last night, or I have an important board meeting coming up.”

These narratives tend to be familiar stories rather than an accurate assessment of one’s current state. Our first step is to help clients gain a true understanding of their internal state through tapping into body data. They begin to act as ‘sommeliers’ of their own bodies, becoming highly attuned to their physical state in the present moment.

Leveraging cutting-edge diagnostics to enhance self-awareness

We use the most comprehensive stress and performance diagnostics available to assess all factors that anchor and enhance your performance:

  • Workplace stressors: Uncovering factors like a sense of control or social support.
  • Energy drains: Identifying areas such as metabolic health, dehydration, micro-nutrient deficiencies, and cognitive overload.
  • Resilience capacity and habits: Assessing your capacity to handle stress and the habits that support or detract from it.
  • Recovery: Monitoring real-time stress and recovery patterns through an ECG monitor integrated with your calendar.
  • Chronic stress: Evaluating long-term stress exposure using hair cortisol analysis.
  • Health impact of long-term stress: Gauging daily stress patterns through saliva cortisol, which is linked to mental health and overall well-being.

Most wearables and health technologies outsource self-awareness to a device. Our diagnostic solutions, however, together with the integrated coaching, are designed to empower deeper, personal self-awareness.

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