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ADHD and being trans
(self.trans)
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this post was submitted on 28 Feb 2024
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Trans fem here, and HRT somehow made my ADHD worse, which was interesting...
There’s a lot of research suggesting cis women with ADHD have symptoms (and metabolism of stimulant medications) fluctuate with hormone cycles. It’s not talked about enough that HRT would cause similar issues for trans fem folks. There isn’t great research on just how those effects would show up for trans people, but it’s reasonable to assume they would.
Conversely, estrogen and the like can mitigate psychotic symptoms so maybe that’s a side bonus?
Me, currently awake at three am on the first day of my period: did you say medication metabolism?
Ouch! Well, if you’re up, may as well read:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4195638/
Feels like it made mine worse too, but it could be that with less depression the symptoms are easier to notice. I'm also a trans man, so there are gonna be some differences with that too. I'm curious if inattentive or hyperactive symptoms went up for you. For me, I've been experiencing more hyperactive ones.
There's a section in the gender Dysphoria Bible about ADHD and HRT, but I don't know how scientifically valid it is.
This is under the androgenic puberty section:
"If you have ADHD, there may be some changes in your symptoms. Androgens amplify dopamine receptor function, so increasing testosterone can improve the activation potential for dopamine in the brain. Dopamine is a key neurotransmitter in the behavior of working memory, the short-term memory of the brain. More working memory means you may become less prone to distractions and have an easier time maintaining cognitive load.
However, estradiol encourages the production of dopamine, so as estrogen levels fall there will be less dopamine for the brain to work with. Your symptoms worsen, not improve."
From the estrogenic puberty section:
"There is a known problem with spironolactone hampering working memory due to its effects on mineralocorticoids. This can significantly worsen ADHD issues and make it much harder to maintain focus or be aware of your surroundings. I was involved in a car accident in 2017 that I blame on spiro fog."
Spiro fog huh? Now that I think about it I guess spironolactone had those sorts of effects on me too, I've just gotten used to them by now.
Oh no... I was hoping it might get better for me. Why did I not think of it getting worse! 😭
Well, it certainly depends on the individual. It'll get better for some, worse for others, or stay the same. There's no guarantee HRT will affect it at all.
Like mentioned elsewhere, folks with menstruation cycles are well known to show exacerbated ADHD symptoms with the fluctuations in hormones.
Progesterone made my ADHD a lot worse. Second biggest reason I stopped taking it once getting up to where I wanted to be in top growth. (first being that I was constantly ravenously hungry)
Going back on spironolactone has made it better though. Missing my evening doses of that and estradiol will throw me off a bit the next day.