ADHD, autism and hormones: what happens as our hormones change?

There is growing awareness that hormones can interact with ADHD symptoms, particularly across hormonal changes associated with menstruation, pregnancy and menopause. The strongest emerging evidence concerns fluctuations in oestrogen and their potential relationship with attention, executive functioning, emotional regulation, and mood.

If you have ADHD or are autistic, understanding the possible relationship between hormones and neurodivergence can provide another piece of the puzzle, particularly when symptoms seem to change at different times of your life.

ADHD and female sex hormones

Research increasingly suggests that ADHD symptoms can fluctuate alongside hormonal changes. A 2025 systematic review of research on ADHD and sex hormones in females found that the evidence was largely suggestive of a relationship between hormonal changes and ADHD symptoms, particularly around puberty and the menstrual cycle [1].

One proposed mechanism is that changes in oestrogen may influence dopamine pathways involved in attention, motivation and executive functioning. Some research suggests that periods of falling oestrogen may coincide with increased difficulties with attention, executive functioning and emotional regulation in some women with ADHD [2].

This does not mean that everyone with ADHD will experience noticeable hormonal effects, or that hormones explain every change in ADHD symptoms. However, it does suggest that hormonal patterns may be worth considering if your ADHD symptoms fluctuate across your menstrual cycle or during transitions such as perimenopause.

ADHD and perimenopause

There is now emerging evidence that women with ADHD may experience a greater severity and intensity of perimenopausal symptoms.

A 2025 population-based cohort study found that women with ADHD reported perimenopausal symptoms at younger ages than women without ADHD. The researchers found different age patterns in symptom scores between the two groups, with the highest scores occurring earlier among women with ADHD. The study also found that severe perimenopausal symptoms were more commonly reported by women with ADHD [3].

Although this study focused only on reported symptoms, rather than biology and biological age, the findings fit with a growing body of literature suggesting that the menopause transition can be particularly challenging for some women with ADHD. Recent reviews describe difficulties such as increased inattention, emotional dysregulation, anxiety, sleep disruption and subjective cognitive difficulties during this stage of life, though research remains limited [4].

If you have ADHD and you find that symptoms that previously felt manageable suddenly become much harder to manage in midlife, it may be worth considering whether hormonal changes, sleep, stress, physical health or other factors are contributing, rather than assuming that you have simply become ‘worse' at coping.

What about autistic women?

There is a lot less research on autism and menopause, but this is beginning to change. In a 2025 systematic review, researchers found some quantitative evidence suggesting that autistic people may experience more severe menopause symptoms than non-autistic comparison groups. They also found reports of significant effects on mental health, daily activities, work and relationships [5].

A separate 2025 study found that autistic participants reported significantly more challenging psychological and physical menopause symptoms than non-autistic participants, although there was no difference in other symptoms such as hot flushes [6].

However, the current evidence is not sufficient to say that autism causes a more severe menopause transition. We can say that some autistic people report a more difficult experience of menopause.

If you are autistic and experiencing changes associated with menopause, it may be helpful to remember that an increase in anxiety, overwhelm, shutdowns, emotional dysregulation or executive-function difficulties in midlife may not just be a psychological change – hormonal and physical factors may also play a part.

What happens to men as they age?

Unlike women, men do not generally experience a single, clearly defined transition equivalent to menopause. Testosterone tends to decline gradually with age, and the amount of change can vary between individuals.

Poor sleep, obesity, metabolic health problems, stress and some medical conditions can be associated with lower testosterone, while those same factors can also affect attention, motivation and executive functioning.

At the moment, the evidence is not strong enough to say whether normal age-related testosterone decline causes ADHD symptoms to worsen or affects autistic traits and experiences, and more research is needed.

Why might relatively small hormonal changes feel overwhelming?

For someone whose cognitive, sensory or emotional regulation systems are already under considerable demand, even small changes in sleep, energy, mood or executive functioning can feel significant in daily life.

For example, someone with ADHD may already be relying heavily on routines, external reminders, medication, exercise, sleep and carefully constructed environments to manage executive-function demands. If sleep deteriorates or concentration becomes more difficult, the person's existing strategies may suddenly stop working as effectively.

An autistic person who relies on predictable routines and has significant sensory sensitivities may find that additional fatigue, sleep disruption or physical symptoms reduce their capacity to cope with everyday sensory and social demands.

This does not mean that hormones are the cause. It means that hormonal changes may be one factor worth considering alongside psychological, social, environmental and physical factors.

What about trans and gender-diverse people?

Most research into hormones and neurodivergence has not specifically considered the experiences of trans and gender-diverse people. This means we know much less about how hormonal changes may interact with ADHD and autism for trans and gender-diverse people.

Some trans people take gender-affirming hormone therapy (GAHT), while others do not. Hormone regimens vary, and a person's hormone levels may also be affected by puberty suppression, gonadectomy, changes in medication, interruptions in treatment or age-related hormonal changes.

There is currently very limited research specifically examining how hormonal changes associated with gender-affirming hormone therapy affect ADHD symptoms or autistic experiences. A 2024 systematic review of the ADHD/transgender literature found that the research base itself remains small, with major gaps in research into the actual experiences and needs of transgender and gender-diverse people with ADHD [7].

Regarding autistic trans and gender-diverse adults, a recent study found that autistic participants could experience practical difficulties adhering to hormone treatment because of sensory sensitivities and executive-function challenges. This does not suggest or show that hormones change autistic traits, but it highlights the importance of considering neurodivergence when supporting someone through gender-affirming healthcare [8].

What does this mean for counselling?

If you are neurodivergent, your counsellor should be aware that hormonal changes may impact your experience – not that hormones explain everything, just that they may be part of the overall picture.

It may be useful to ask yourself questions such as:

• Have your ADHD or autistic experiences changed recently?
• Did the change happen alongside changes in menstrual cycle, reproductive stage or hormone treatment?
• Have your sleep, energy, mood or sensory sensitivities changed?
• Are strategies that previously worked becoming less effective?
• Have you noticed any patterns over time?
• Are there physical symptoms that might benefit from a discussion with a GP or other appropriate healthcare professional?
• Could medication, sleep, stress, physical health or changes in your environment be contributing?

Understanding the possible interactions can be validating and helpful in finding ways forward, even without definitive scientific understanding.

We are still learning, so how should we go forward?

Research in this area is growing rapidly, but significant gaps remain. For now, awareness of your body and self may be the most helpful approach. If you notice changes in how you experience your neurodivergence alongside hormonal changes, it can help to track what is happening and discuss it with the appropriate healthcare professionals.

Counsellors can support you and help you decide whether and how to make changes in your life to better support whatever changes you're going through.

If something has become harder, it doesn't necessarily mean you have become less capable. Sometimes the conditions under which you are trying to function have changed. Understanding what has changed can be the first step towards working out what support you need now.

References

[1] Osianlis E, Thomas EHX, Jenkins LM, Gurvich C. ‘ADHD and sex hormones in females: A systematic review’. Journal of Attention Disorders. 2025. https://pubmed.ncbi.nlm.nih.gov/40251875/

[2] Eng AG, Nirjar U, Elkins AR, et al. ‘Attention-deficit/hyperactivity disorder and the menstrual cycle: Theory and evidence’. Hormones and Behavior. 2024. https://pubmed.ncbi.nlm.nih.gov/38039899/

[3] Jakobsdóttir Smári U, Valdimarsdottir UA, Wynchank D, et al. ‘Perimenopausal symptoms in women with and without ADHD: A population-based cohort study’. European Psychiatry. 2025. https://pmc.ncbi.nlm.nih.gov/articles/PMC12538516/

[4] Kooij JJS, de Jong M, Agnew-Blais J, et al. ‘Research advances and future directions in female ADHD: The lifelong interplay of hormonal fluctuations with mood, cognition, and disease’. Frontiers in Global Women's Health. 2025. https://pubmed.ncbi.nlm.nih.gov/40692967/

[5] Grant A, Axbey H, Holloway W, et al. ‘Autism and the menopause transition: A mixed-methods systematic review’. Autism in Adulthood. 2025. https://pubmed.ncbi.nlm.nih.gov/41210301/

[6] Charlton RA, Happé FG, Shand AJ, Mandy W, Stewart GR. ‘Self-reported psychological, somatic, and vasomotor symptoms at different stages of the menopause for autistic and non-autistic people’. Journal of Women's Health. 2025. https://pubmed.ncbi.nlm.nih.gov/39960820/

[7] Goetz TG, Adams N. ‘The transgender and gender diverse and attention deficit hyperactivity disorder nexus: A systematic review’. Journal of Gay & Lesbian Mental Health. 2024. https://pubmed.ncbi.nlm.nih.gov/38577478/

[8] Miller SL, Bourke-Taylor H, Dixon K, Luo J, Upreti R. ‘Transgender and gender diverse autistic adults' experiences undergoing gender-affirming hormone therapy as prescribed’. Journal of Clinical Endocrinology & Metabolism. 2026. https://pubmed.ncbi.nlm.nih.gov/42708518/