The role of testosterone in perimenopausal women and its impact on ADHD symptoms

When we talk about hormones and their effects on ADHD, much of the conversation centres around oestrogen and progesterone. But there's another key player that often gets overlooked—testosterone. While typically associated with men, testosterone plays a vital role in women’s health and wellbeing, particularly during perimenopause. For women with ADHD, testosterone levels—and their fluctuations—can have a profound impact on symptoms.

Testosterone and perimenopause: what happens?

Testosterone is produced in small amounts by women’s ovaries and adrenal glands, and although its levels are much lower than in men, it’s essential for energy, focus, and maintaining muscle mass. As women transition into perimenopause, testosterone production declines steadily. Research shows that by the time a woman reaches menopause, her testosterone levels may be half of what they were in her 20s.

This decline coincides with the hormonal rollercoaster of perimenopause, where fluctuating oestrogen and progesterone levels exacerbate many common ADHD challenges, such as brain fog, poor executive function, and emotional dysregulation. With testosterone also dropping, women with ADHD often report worsened focus, motivation, and mood stability during this time.

Testosterone and ADHD symptoms

So, why does testosterone matter for ADHD? Testosterone interacts with the brain's dopamine system—a critical neurotransmitter for focus and reward processing. Studies suggest that testosterone helps regulate dopamine activity, which is often impaired in individuals with ADHD.

Lower testosterone levels during perimenopause may lead to:

• Increased mental fatigue and reduced energy levels.

• Worsening of executive dysfunction, including poor organisation, task initiation, and follow-through.

• Greater difficulty in maintaining focus and concentration.

• Reduced resilience to stress, potentially leading to more frequent emotional dysregulation.

The evidence: research and case studies

Research on testosterone’s role in ADHD, particularly in perimenopausal women, is still in its early stages. However, there is some compelling evidence worth highlighting:

1. Dopamine regulation and testosterone
   A study published in Frontiers in Neuroendocrinology highlights the role of testosterone in modulating dopamine receptors in the brain. Dopamine regulation is vital for managing ADHD symptoms, and declining testosterone levels could contribute to worsened attention, focus, and reward processing.

2. Testosterone replacement therapy (TRT) and cognitive function
   A small-scale study by Davison et al. (2005) explored the use of testosterone replacement therapy (TRT) in postmenopausal women. Results indicated improvements in mood, energy levels, and cognitive functioning, particularly in areas like working memory and attention. While the study didn’t specifically address ADHD, the findings suggest potential benefits for women experiencing cognitive challenges during menopause.

3. Testosterone and emotional regulation
   A 2018 paper in Menopause: The Journal of the North American Menopause Society suggested that testosterone supplementation may improve emotional stability and reduce symptoms of anxiety and depression in postmenopausal women. Emotional regulation is a key challenge for many with ADHD, and testosterone may offer indirect benefits in this area.

Is testosterone replacement therapy (TRT) the answer?

For some perimenopausal women, testosterone replacement therapy (TRT) can be part of a holistic approach to managing hormonal changes. TRT is typically offered as part of hormone replacement therapy (HRT) and aims to restore testosterone levels to a healthy range.

However, it’s essential to approach TRT carefully:

• Consult an expert. Working with a healthcare professional experienced in hormone therapy is crucial to ensure the treatment is safe and effective.

• Monitor symptoms. Women who choose TRT often report improvements in energy, focus, and mood, but it's not a one-size-fits-all solution.

• Consider the whole picture. Testosterone works in conjunction with oestrogen and progesterone, so an imbalance in one hormone can still lead to symptoms.

Practical advice for women with ADHD

If you suspect low testosterone is contributing to worsening ADHD symptoms during perimenopause, here are some steps you can take:

1. Speak to your GP or a specialist. Ask for hormone testing to evaluate your testosterone, oestrogen, and progesterone levels.

2. Track your symptoms. Use an app like Dr. Louise Newson’s Balance app to track hormone-related symptoms alongside your ADHD challenges. This can help you spot patterns and make informed decisions about treatment.

3. Explore HRT options. Many women with ADHD find that a tailored HRT plan, including testosterone if appropriate, can significantly improve their quality of life.

4. ADHD-specific support. ADHD coaching can provide strategies to manage symptoms like executive dysfunction and emotional dysregulation during this time of hormonal change.

The interaction between hormones and ADHD is complex, and testosterone’s role is only just beginning to be understood. For perimenopausal women, declining testosterone levels can intensify ADHD symptoms, making life even more challenging. However, with the right support—whether through HRT, lifestyle changes, or ADHD coaching—it is possible to navigate these changes and thrive.

If this resonates with you, consider speaking with a specialist or exploring support options tailored to your unique needs. As more research emerges, we can continue to better understand the role of testosterone and advocate for holistic approaches to managing ADHD in perimenopausal women.

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