When we talk about neurodivergence, whether it’s autism, ADHD or other forms of cognitive difference, we often focus on traits, behaviours or social experiences. What we don’t talk about nearly enough is biology. More specifically: hormones.

For many neurodivergent, hormonal shifts aren’t just background noise. They can radically shape how traits are experienced, expressed and understood, including everything from executive functioning to emotional regulation, sensory sensitivity and the ability to mask or cope.

So why is this conversation still so rare?

The hidden layer of lived experience

Many neurodivergent people report that their traits fluctuate, not randomly, but cyclically. For some, there are specific days in the month where executive dysfunction ramps up. For others, anxiety spikes or sensory overwhelm becomes almost unbearable. Tasks that feel manageable one week suddenly feel impossible the next.

This isn’t a coincidence, it’s biology. Hormones play a powerful, and overlooked, role in shaping how neurodivergence is felt and manage. Think:

• Increased masking and fatigue during certain phases of the menstrual cycle
• Shutdowns or meltdowns that align with hormonal dips
• Emotional hypersensitivity or rejection sensitivity
• Decreased ability to regulate attention, sleep or sensory input at key hormonal stages.

Though hormones impact everyone, the greatest impact appears to be on those assigned female at birth, who have both sex and reproductive hormones estrogen and progesterone, as well as small amounts of testosterone. These hormones reset every 28 days (unlike the main hormone for those assigned male at birth, testosterone, which resets every day).

Sex hormones are known to help with the production and distribution of dopamine (which support executive functioning), acetylcholine (which assists with memory) and serotonin (which regulates mood).

Image credit – Expression of key estrogen-regulated genes differs substantially across the menstrual cycle in estrogen receptor-positive primary breast cancer.

Day 1-7 is where the uterus lining is shed, and typically the person bleeds. In this phase, estrogen and progesterone levels are at their lowest.

Day 7-16 is where the uterus lining begins to build back up, ready for an egg to be released. During this time, estrogen rises in preparation.

Day 17-26 is when an egg is released, known as ovulation. At this time, estrogen is high and then rapidly drops, followed by a steady incline in progesterone. At this time, the uterus prepares to either support pregnancy or break down the egg for menstruation.

Day 27 onwards is the final stages, known as the luteal phase, where if no pregnancy occurs, progesterone and estrogen drop signalling to the body it is time for menstruation to happen. This is the time where many will experience PMS (premenstrual symptoms), such as mood swings, fatigue, irritability and low mood.

And yet, very few support systems take any of this complexity into account.

A research gap with real consequences

Despite growing anecdotal evidence, research into the intersection of neurodivergence and hormones is still limited, and often gender-biased. Historically, diagnostic criteria and clinical studies have been based on male presentations of autism and ADHD, leading to systemic underdiagnosis in people assigned female at birth. Even now, hormonal factors like puberty, menstruation, pregnancy or menopause are rarely integrated into how we assess, diagnose or support neurodivergent people. Such gap doesn’t just affect research, it affects people’s lives. Without this awareness, many people are misdiagnosed, or dismissed completely, told they’re “just emotional” or “not trying hard enough”.

In one recent study by Eng et al. (2024), the researchers found that challenges with executive functioning increases at times of rapid decline in estrogen (from Day 17 onwards). This leads to a change in functions including learning and memory, fine motor control, pain perception and mood, along with a number of other cognitive factors.

Not just a ‘women’s’ issue

While this conversation often centres on people who menstruate or experience menopause, it’s not only a “female” issue. Hormonal shifts affect all bodies, including trans and gender-diverse people, who face even greater barriers in accessing informed, affirming support and care. Furthermore, males are also impacted by hormones, with the way testosterone interacts with dopamine, though this is also surprisingly under-researched in conjunction with neurodivergence.

There has been even less research into how hormone replacement therapies (HRT) impact cognition, though a number of studies have explored the HRT can impact the effectiveness of ADHD medications, as hormones are being balanced without the need of additional dopaminergic intervention (de Jong et al., 2023).

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So where do we go from here?

This blog is the start of a deeper dive into neurodivergence and hormones, one that will move beyond generalisations and into the real, messy, nuanced ways biology, identity and systems collide. In order to support neurodivergent people well, we need to go beyond static labels and flat timelines. We need to understand rhythm, fluctuation and hormonal context. We also need to start listening, to bodies and the people who live in them.

Get in touch with us about how we can support you explore the impact of hormones and neurodivergence:

• Training and awareness courses
• Workplace Needs Assessments
• Neurodiversity coaching
• Neurodiversity consulting

References

Eng, A., Nirjar, U., Elkins, A. R., Sizemore, Y. J., Monitcello, K. N., Petersen, M. K., Miller, S. A., Barone, J., Eisenlohr-Moul, T. A. and Martel, M. M. (2024) Attention-deficit/hyperactivity disorder and the menstrual cycle: Theory and evidence. Hormones and Behaviour.

de Jong, M., Wynchank, D. S. M. R., van Andel, E., Beekman, A. T. F. and Kooij, J. J. S. (2023) Female-specific pharmacotherapy in ADHD: premenstrual adjustment of psychostimulant dosage. Frontiers in Psychiatry, Vol. 14

Next up in the series: Puberty, Masking and Misdiagnosis… Oh My! This blog will explore why adolescence is such a flashpoint for neurodivergent people, and why so many fall through the cracks during this stage.