About 4 to 5 percent of the population in the United States has been diagnosed with ADHD. As an increasingly prevalent disorder among U.S. adults and children, many wonder whether there are suitable treatments that counteract the symptoms.
Treating ADHD with HRT, or Hormone Replacement Therapy might present promising results. Although the studies are currently ongoing, many researchers believe that implementing a correct dosage in patients, particularly women, may help prevent symptoms of ADHD.
In this article, I will detail the role of hormones for ADHD patients and what we can expect from hormone replacement therapy.
The connection between ADHD and hormones stems from the development of the condition and how it affects people. Let’s have a brief look at ADHD and where hormones come into the picture.
What Is ADHD?
ADHD stands for Attention Deficit Hyperactivity Disorder. To simplify the condition, many regard ADHD as the lack of attention some people exhibit or hyperactivity and impulsivity. However, ADHD is much more than that.
While studies show that some children do grow out of ADHD, there are plenty who don’t. They carry the symptoms and suffer from them well into their adult years without knowing why they behave differently than others.
Core Symptoms of ADHD
The most common symptoms of ADHD include:
- Difficulty concentrating
- Impulsive actions
- Lack of time management
- Difficulty following directions
All of these occur because of a neurodevelopmental disorder that affects people, mostly from their childhood. Many children present ADHD symptoms during their toddler and pre-pubescent years.
But a majority of patients go undiagnosed because many children during their early years behave similarly. Many perfectly healthy children have limited attention spans and are naturally hyperactive and energetic.
That’s why parents must keep an eye on other symptoms related to ADHD in their children’s behavior. They must also be vigilant if their children are particularly vulnerable to developing ADHD.
Potential Causes of ADHD
So far, we don’t have a specific answer for what causes ADHD. However, we have found various factors in common, such as:
- A genetic link: A blood relative may pass on ADHD or other mental health disorder.
- An environmental factor: Exposure to toxins such as lead through paint or pipes.
- A health factor: Drug or alcohol use during pregnancy.
- A premature birth.
ADHD is more widespread in boys rather than girls. However, this is also not yet confirmed because girls have so far been underrepresented in ADHD studies. ADHD symptoms in girls and women are far less apparent and display differently, which leads to thousands of undiagnosed cases each year.
Why ADHD Symptoms Differ in Men and Women
There are significant differences between men and women when it comes to showing signs of ADHD.
Research explains that boys often show externalized symptoms, such as impulsivity and running recklessly. All these signs are physically aggressive. But with girls, they often tend to be less physically aggressive than most because that is how each gender is brought up.
Boys are encouraged to be boisterous. As such, they exhibit more aggressive action such as hyperactivity, yelling, and display disruptive behavior. Girls are often taught to keep control of their actions, and often display internalized behavior. Because of this lack of outward behavior, girls and women show symptoms such as depression and anxiety.
Girls are also taught to be “people pleasers” and to “fit in”. Because these girls know that showing any signs of difference will displease their elders and friends, they suppress the symptoms they feel, and that includes depression.
This suppression and the ensuing anxiety then leads to further destructive behavior, such as eating disorders and self-degradation. As these girls grow and begin their journey through adulthood, these symptoms worsen.
However, without proper care or even awareness of the situation, most don’t take anything to control their health. And some who do seek medical help don’t get any useful answers.
This is because there’s a dearth of information related to symptoms in women. Any information that we do have is helpful. However, many women go their entire lives without getting a proper diagnosis.
This tendency to exhibit behavior differently has given women more problems, which is why women have been diagnosed with ADHD far less than men. There are no “lesser cases” among women than men. There are simply more “undiagnosed” cases among women than with men.
Are Hormones Connected to ADHD?
The underrepresentation of women in ADHD trials and studies and the subsequent race to research ADHD symptoms in the other sex has led to discovering the connection between hormones and ADHD.
Estrogen and steroid hormones are connected to ADHD in that these hormones can produce many ADHD symptoms. This group of hormones are chemical messengers within the body that regulate various processes, including the function and development of the reproductive system.
Unlike boys and men, girls and women do not present the same symptoms of ADHD. Instead, girls may experience symptoms such as:
- Low self-esteem
- Self-degradation and self-blame
- Eating disorders
Many girls with ADHD even get misdiagnosed as bipolar or with a primary depressive disorder. These girls are then tested using the same drugs that are given to boys. But, they remain ineffective.
One particular estrogen hormone, estradiol, impacts brain chemistry. It’s shown to significantly influence cognition, memory, brain plasticity, and brain performance. Estrogen binds to steroid receptors throughout the body, triggering the release of various other vital hormones such as dopamine, serotonin, and other neurotransmitters.
A lack of estradiol in the system dramatically affects normal body function. This generally occurs in women experiencing menopause or problems with their periods.
When their estrogen levels fall low, such as during the luteal phase of the menstrual cycle or (peri)menopause, that’s when hormone replacement therapy is used to treat these low levels of estradiol.
Low Estrogen and ADHD
The average woman’s estrogen levels rise and fall with her menstrual cycle. But these remain in your body from birth, and often decrease post-menopause.
For a prepubescent female, estradiol levels remain undetectable or within 20 pg/ml (0.02ng/ml). Once she enters the puberty stage, her estradiol levels rise and remain below 350 pg/ml (0.35 ng/ml). As she ages and goes into the premenopausal stage, the estradiol levels remain between 15-350 pg/ml (0.015-0.35 ng/ml), and dio to below 10 pg/ml (0.01 ng/ml) once she goes through menopause.
Estrogen and other hormone levels fluctuate greatly during puberty, all the way till menopause.
For any woman who experiences symptoms of ADHD, this rise and fall of estrogen affects their ADHD levels too and increases their intensity as the years go by. Estrogen levels affect one’s cognitive function. These levels modulate the release of dopamine, norepinephrine, and serotonin neurotransmitters.
When these levels fluctuate, women experience increased feelings of depression, moodiness, and irritability. They also have problems sleeping, experience anxiety, forgetfulness, fatigue, and memory loss.
Clearly, estrogen levels do affect one’s ADHD symptoms. Using hormone replacement therapy can improve one’s estrogen levels and manage their symptoms more easily.
ADHD and Periods
Periods are already a stressful time of the month for most women. However, for those with ADHD, these days get worse as they age.
According to a study conducted on the association between psychiatric disorders and menstrual cycle characteristics, women with irregular cycles are three times more likely to have ADHD.
Keep in mind, estrogen levels control your reproductive system as well as hormone release in the brain. Because of the inconsistent increase and decreases caused by their hormonal cycle, women experience intense and severe symptoms.
Without treatment, these problems often become worse. Even with medication, nothing solves the issue at the root. As a result, these symptoms persist.
ADHD and Menopause
While hormone replacement therapy is not widely used for managing ADHD symptoms, it is a common therapy option for women with menopausal symptoms.
Menopausal symptoms include:
- Hot flashes
- Weight gain
- Slowed metabolism
- Night sweats
- Vaginal dryness
- Irregular periods
- Hair thinning
- Dry skin
- Loss of breast fullness
But putting aside these physical symptoms, there are many mental symptoms of menopause, such as:
- Lack of motivation
- Problem focusing
- Difficulty concentrating
Estrogen levels during menopause drop, causing various symptoms that are common with ADHD. Clinical studies are now using ADHD medication to help women feel better during their postmenopausal years.
A study presented by researchers from the University of Pennsylvania found that using psychostimulants to aid postmenopausal women resulted in better memory and recall. It also led to increased concentration, organization, and improved attention. None of these women had a history of ADHD, and none were more than five years past menopause.
In comparison to the group who were given a placebo, these women reported better function, motivation to work, alertness, speed, and better results overall. This is not to say that all patients experienced positive results, some showed no improvements, even with the psychostimulant.
However, there is an argument that with the correct dosage, these women would have experienced a boosted memory, recall, and a better attention span.
But again, these are only a few pieces of research. While the results are promising, like any medication, there are risk factors involved. The medication did alleviate symptoms, but the patients experienced multiple side effects such as dizziness, skin numbness, headaches, and nausea.
Is HRT Effective in Treating ADHD Symptoms?
There haven’t been many studies about the effects of HRT on ADHD symptoms, but the few we have are promising. A small study from the United Kingdom does suggest that using the medication can alleviate some ADHD symptoms. However, research is ongoing for using hormone replacement therapy for ADHD.
Estrogen plays a significant role in managing the body’s central nervous system, and cardiovascular, skeletal, and reproductive systems. Regulating hormones to control ADHD is not as easy as it may sound.
Managing hormones in one’s body can lead to increases and decreases in one’s body function. That’s why hormone fluctuations are often left to the body itself, with supplements prescribed for an added boost.
To use hormone replacement therapy for ADHD may mean several years of treatment based on a strict regimen. And that’s only for women.
Contrary to popular belief, men also have estradiol and other estrogen hormones in their bodies that modulate their libido, spermatogenesis, and erectile function. A decrease in estradiol can lead to numerous body issues and internal problems too.
If we use estrogen through hormone replacement therapy, it will take time before we have definitive answers.
Are There Any Effective Treatments for ADHD?
While these treatments do not completely prevent ADHD symptoms, countless patients have experienced effective results through behavioral therapy, cognitive therapy, ADHD coaching, and music, play, or art therapy.
These therapy options work well for children and adults. However, each requires a professional at the helm who would be able to take the patient through all necessary steps. These therapies do improve your condition. But you will not be able to manage all the steps alone. So, if you’re hoping to find a free, easy option, understand that therapy does not work that way.
Something like ADHD coaching or cognitive therapy requires the help of coaches who are experienced in improving one’s social skills, learning abilities, and more. A professionally trained coach helps their client to achieve a healthy, balanced lifestyle. It’s one-on-one therapy that truly makes a difference. For anyone who requires therapy, it helps to invest some time and money to improve your mental health.
Using hormone replacement therapy to correct or treat ADHD symptoms is a possibility, but it’s a possibility for the future.
With intensive research and further case studies, there will come a time when we will be able to use hormone replacement therapy to help all patients with ADHD. For now, we must use the options at hand to give ourselves the chance to live a life free from the problems that ADHD pushes upon us.
- Mayo Clinic: Attention-deficit/hyperactivity disorder (ADHD) in children
- Medical News Today: What to know about estrogen in men
- National Library of Medicine: The role of estradiol in male reproductive function
- SottoPelle Therapy: The Link between Estradiol Deficiency and Attention Deficit Hyperactivity Disorder (ADHD)
- CHADD: Hormonal Fluctuations Affect Women’s ADHD Symptoms
- Edge Foundation: ADHD and Estrogen
- CHADD: The Complete Picture: How Estrogen Affects Women with ADHD
- Verywell Mind: Treatment for Women with ADHD
- Everyday Health: How ADHD Drugs May Ease Menopause Symptoms
- Penn Medicine News: Penn Study Shows Stimulant Drug May Help Women Cope with Post-Menopausal Memory Lapses
- WebMD: The Link Between Hormones and ADHD
- National Library of Medicine: Estrogen replacement therapy is associated with less progression of subclinical structural brain disease in normal elderly women: a pilot study
- National Library of Medicine: Potential Hormonal Mechanisms of Attention-Deficit/Hyperactivity Disorder and Major Depressive Disorder: A New Perspective
- Mayo Clinic: Menopause
- Healthline: Gender Differences in ADHD Symptoms
- Healthline: Signs and Symptoms of High Estrogen