ADHD, Hormones and Social Identity
Two academic papers, a shift in thinking, and why dopamine doesn't tell the whole story.
This Working Theory is for writers who explore health, productivity, identity, and the way gender shapes what it means to function. It’s for coaches, educators, and curious readers who’ve seen the infographics, read the Instagram slides, and still wonder: what does the research actually say about ADHD, dopamine and hormones? Where are the gaps? And how do we write about ADHD with care, and psychological depth?
Is this related to social identity the area I study? no but also yes, there is a strong argument that disability arises from social, structural, and attitudinal barriers, (more on this later in the article) , but when you study psychology at postgraduate level you have to learn about biology, and in my case this was dopamine and hormones, and how to critically evaluate the evidence. My working theory series brings academic papers to a wider audience, and my aim here is to give you the latest data and evidence to inform your own writing.
The field notes at the end of this article (which are for paid subsribers) give you practical tips on how to use academic papers, and this theory to inform your own writing. For more info on my research services see www.leilaainge.co.uk/insight
In writing this blog, I asked ND folk to review the article. Huge thanks to those whose thoughtful comments helped me explain the scientific methods more clearly,
, , , , any remaining typo’s and incoherence is completely my inanbility to spell after the third draft!Two academic papers, summarised.
As a British Psychological Society member I’m passionate about bringing psychology and science into everyday conversations, to explore this HUGE topic, we’re going to be looking at two academic papers: one from 2017 and one published earlier this year (2025). Reviewing these papers which are almost a decade apart is useful because we will see a shift in scientific thinking as well as scientific progress. They are also different types of academic paper and do different things!
The first, by Martel et al. (2017), is a what we call a narrative review, and this means that is is a theoretical/opinion piece that brings together existing research to offer a perspective, it doesn’t introduce any new data to the conversation but it creates a big picture. If you write about health or hormones look out for narrative views as they do the heavy lifting for you.
The paper by Martel et al. (2017) maps out how fluctuations in sex hormones, particularly estrogen and progesterone, might (key word in might!) influence ADHD symptoms by interacting with the brain’s dopamine systems. The lens this is written in is both mechanistic and biological: hormones influence neurotransmitters, which in turn affect focus, attention, and impulse control.
The second, by Osianlis et al. (2025), is a systematic review of the available literature. It goes wider, covering puberty, menstruation, pregnancy, postpartum, and calling for research into me
nopause. The framing shifts from “how hormones cause problems” to “what else is happening when hormones shift?” It's a broader, more contextualised view, and it hints at a deeper truth: that ADHD is shaped not only by biology but by how bodies are read, categorised, and supported (or not) within social systems.
These papers raise critical questions:
What makes a symptom manageable for one person and unbearable for another?
What does it mean to treat hormones as context, not cause?
And if ADHD is partly about how others interpret your behaviour, how much of it is actually social?
Why dopamine gets all the attention
Let’s pause here and ask: why does dopamine always take centre stage?
Dopamine is a neurotransmitter involved in motivation, attention, and reward-seeking behaviour. You might think of it as the brain’s “feel-good” chemical. In ADHD research, it holds particular interest because stimulant medications work by increasing dopamine availability in the brain, especially in areas responsible for executive function.
Dopamine isn’t just hanging around in the bloodstream like glucose or hormones, it’s released in tiny, localised bursts in specific parts of the brain, often for split seconds. It gets recycled or broken down quickly after doing its job which means we can’t stick a needle into someone’s brain mid-conversation to track it in real time.
This is important, and it’s part of the ‘might’ narrative, most studies rely on indirect measures, like brain scans, or animal studies with implanted sensors, or tracking behaviour linked to dopamine function. We can’t see dopamine firing live in the brains of awake, moving humans, so when someone says “low dopamine” is causing ADHD symptoms, what they usually mean is “based on behaviour and brain imaging, it looks like dopamine signalling might be less efficient.”
Dopamine chemicals, when they are available, float from one neuron , across a small synaptic gap where they bind to another neuron and most people don’t know this, they think that dopamine is directly carried across a brain wire.
Here’s a two minute youtube that helps you visualise what happens Excited Neurons!
the video shows that dopamine chemicals, when they’re available, get released into a tiny synaptic gap, a microscopic space between cells, where they float across and bind to receptors on the next neuron. Most people picture a kind of brain wiring, with dopamine zooming along like electricity but it’s not like that at all.
This matters because most articles suggest that there just isn’t enough dopamine in the ADHD brain, but that might not be the case, it doesn’t always mean there’s less dopamine, it could mean dopamine isn’t released at the right time, or that it doesn’t bind properly, or that the neuron and cells meant to receive it are unresponsive.
So when ADHD is linked to “dopamine dysregulation,” we’re not talking about a battery running low, it’s much more nuanced and it could be a whole communication system that's glitching, sending weak signals, sometimes firing too late, sometimes not reabsorbing dopamine efficiently. That’s why a stimulant doesn’t simply “add” dopamine. We think it helps existing dopamine hang around longer in the gap, giving the message a better chance of being heard.
Understanding this nuance stops us from treating dopamine like fuel injection. And for writers trying to explain ADHD, hormones, or brain chemistry, that distinction is everything and will elevate your work.
So yes, dopamine gets all the attention, and in the first paper by Martel et al. (2017) they are describing how the hormone estrogen may (they can’t observe this directly remember) boost dopamine production in the body and help the neuron to use it through increased receptor sensitivity, they say that progesterone may blunt these same effects. They say that this is part of why ADHD symptoms in some people worsen in the luteal phase, the days after ovulation when progesterone rises and estrogen drops.
I hope this explanation is helpful, yes it’s biology and detailed but as writers you can find ways to illustrate this that move away from the defecit model.
What else might be going on?
Let’s move to the second paper, Osianlis et al. (2025) reference the same hormonal mechanisms but move beyond them. They argue that hormone-related changes in dopamine are just one part of a much more complex picture. The real insight comes when we ask: what else modulates dopamine?
So what else?
Yes, estrogen modulates (infuences) dopamine, but so does sleep, stress, nutrition, medications, and even social context. Chronic sleep deprivation impairs dopamine, affecting decision-making and focus (Volkow et al., 2012). Stress alters dopaminergic activity in complex, sometimes contradictory ways, short bursts may increase dopamine, but long-term stress impairs it (Pruessner et al., 2004). Even emotional labour, like masking ADHD symptoms to appear “normal”, can drain the very circuits that dopamine is meant to support.
That’s why hormonal changes don’t act in a vacuum and postpartum dip in estrogen might coincide with broken sleep, identity upheaval, and a healthcare system that isn’t built to catch people early. It’s not just the hormone that tips you into burnout.
What changed between 2017 and 2025
Martel et al. (2017) focused on mapping hormonal shifts to ADHD symptoms in a narrowly defined population of “women.” The underlying tone was one of risk: hormones as biological disruptors, symptoms as outcomes of internal dysregulation.
By 2025, Osianlis and colleagues take a wider-angle lens. Their systematic review pulls in not just menstruation, but puberty, pregnancy, and postpartum. They flag menopause as a critical knowledge gap in the literature though.
The review method is different to the 2017 paper, for a systematic review scientists decide in advance what they’re looking for, where they’re going to search, and how they’ll decide what stays and what goes (a protocol). This review took over 4000 studies and whittled them down to 11.
A review protocol is a bit like a recipe, it lays out the ingredients (which databases to search, which studies count, which outcomes matter) and the method (how you’ll sift, sort, and make sense of what you find). Researchers often pre-register this plan to keep themselves honest. It means they can’t just cherry-pick studies that support their theory or ignore awkward ones that don’t fit. This is great for writers as you will find nuance and different perspectives in the review.
There’s a ton of bias built into academia in general, what gets studied, how it’s published, and who pays attention. A well-conducted systematic review tries to minimise that mess by following a transparent, reproducible process. It gives us a more trustworthy picture of what the evidence actually says.
Here’s what those 11 studies that made it into the systematic review tell us.
The review doesn’t just say “hormones affect ADHD” it asks what else is going on when hormones shift? Stress. Sleep deprivation. Role change. Power dynamics, and notes that the biologically intense post partum period, is psychologically and socially disorienting. The data in those 11 studies shows this is not just about estrogen levels, and the review shows nuance such as why a symptom spike might be survivable for one person and crushing for another. These are the same questions we ask about trauma, and individual responses to trauma.
Curiously, for me as a social psychologist, neither paper uses the phrase social identity. And yet everything they describe, diagnosis delay, symptom masking, shame, self-blame, misrecognition, is soaked in it. In how your difference is read, and by whom. That’s also where the social model of disability (Oliver, 1990) offers a crucial lens around the gap between how we move and how the world sometimes refuses to shift. Rather than framing ADHD (or any neurodevelopmental condition) solely as an internal deficit, it asks: What if the disabling part is the environment?
If you forget appointments, you’re flaky. If you interrupt, you’re rude. If you struggle with organisation, you’re failing at being a functional adult. ADHD gets moralised.
In one paper Stenner et al. (2019) paper, people describe diagnosis, when it comes, as a "pattern shift." They remember their lives differently. Suddenly, “disorganised” becomes “overwhelmed,” “difficult” becomes “unsupported.” ADHD lets them revise their own biography. That’s social identity work, not symptom tracking.
Singh et al. (2020) go further. They show how access to that identity work isn’t evenly distributed. Race, class, and age determine whether ADHD is received as a helpful label or a disciplinary one. In middle-class white families, it might come wrapped in psychoeducation. In working-class or racialised communities, it’s more likely to arrive via detention slips or suspicion.
But that’s only part of the story. Black children are less likely to be diagnosed and more likely to be disciplined, for example, in the U.S., Black students had about a 40% lower chance of diagnosis compared to white peers, despite controlling for behaviour and academic performance In the UK, too, Black children face extra delays and stigma in getting ADHD or SEND support, often dropping through the cracks of an overstretched system .
For many Black women, the menopause transition brings long-overdue diagnosis, but with it arrives extra layers of shame and disbelief. As
noted when she read this article, it’s not sufficient to just mention race, we need to name how racism actively shapes who gets recognised, supported, or even believed. ADHD doesn't happen in a vacuum. It unfolds in classrooms, clinics, and consulting rooms already structured by race, class, gender, and age.Neither the Martel et al. (2017) narrative review nor the Osianlis et al. (2025) systematic review meaningfully engage with race or racialised identity. While both offer important biological and developmental insights into how ADHD presents across the female lifespan, particularly in relation to hormonal shifts they largely treat the population as biologically homogeneous or universally applicable, the studies they have drawn on do not examine how race, culture, or structural inequality might shape those hormonal or behavioural expressions.
These papers a decade apart tell us that ADHD isn’t just a hormone story.
Psychology is catching up slowly, the move from Martel to Osianlis reflects that shift, from pathologising hormones to recognising hormonal life stages as contexts, not just confounds. But we’re still a long way from a model of ADHD that treats gendered and embodied experience as data.
“If something sounds like an easy and guaranteed ‘fix’ that works regardless of the context, the chances are it exists to sell rather than necessarily help.” — Alicja
It’s a useful reminder that while hormones do play a role, the narratives we build around them often flatten what is in reality deeply contextual, complex, and tied to our environments, identities, and support systems.
Emma from
said:“It’s so important to consider the busy, tiring, and stressful lives women lead—especially during menopause. Many of us are being diagnosed with ADHD at this stage, but there’s little support unless you can pay for it. It’s not just dopamine or estrogen—it’s the expectations and the lack of support. The shame can be crippling. I wonder if more women with ADHD are ‘going into hiding’ to avoid the scrutiny and criticism.”
There’s one more paper you might like! plus Field Notes for my subsribers
Just as I was getting ready to post this last week, a new article alert popped up in my dashboard. The study, titled “I felt like a broken person,” explores the lived experience of women in the UK ..