Testosterone and ADHD in Men: Is There a Link?

The principal male sex hormone, testosterone is synonymous with strength, virility, and aggression. But the scientific truth about testosterone’s profile and role over the lifespan for males (and females, who also have testosterone) is more nuanced and complicated. Research exploring testosterone’s impacts on mood, cognition, and behavior has resulted in contradictory, often inconclusive, findings; research investigating testosterone’s impact on ADHD is extremely scant.

Amid this dearth of research, men* are becoming increasingly interested in testosterone’s suspected benefits on strength, energy, and mood. Testosterone replacement therapy, approved to treat hypogonadism (testosterone deficiency), has become more common among men with typical hormone levels. In the last five years, testosterone replacement prescriptions have risen dramatically, from 7.3 million to more than 11 million, and a third of these recipients have not been diagnosed with testosterone deficiency, according to the American Urological Association.

Besides being potentially ineffective at achieving desired outcomes, testosterone supplementation without a medical indication can be harmful for men, and may lead to side effects such as fertility problems, acne, sleep apnea, breast swelling, benign prostatic hyperplasia, and high red blood cell counts, which could increase the risk of blood clots

As these very real risks emerge from a murky landscape, here is a summary of what’s known — and not yet known — about the impact of testosterone on the bodies and brains of men, both with and without ADHD.

Testosterone and ADHD: Is There a Connection?

Is there an association between an individual’s testosterone level and their likelihood of developing ADHD. Is symptom severity impacted by hormones? The answer is: we don’t know. There’s no conclusive evidence to suggest an association, however research is extremely scarce.

[Read: For Men With ADHD — and Those Who Love Them]

Estrogen’s impact on mood and cognition is well-established. It plays a key role in modulating neurotransmitters, increasing dopamine and serotonin, which leads to elevated mood and focus. Recently, researchers have begun to explore the influence of estrogen on ADHD, which is thought to be significant. Women with ADHD experience premenstrual dysphoric disorder, postpartum depression, and perimenopausal challenges at far higher rates than do women without ADHD. Additionally, ADHD symptoms are often more severe and ADHD medication less effective during the luteal phase of the menstrual cycle, when estrogen is low.

Testosterone’s implications on ADHD are far less clear.

In the past, ADHD was thought to be a disorder affecting mostly boys, leading some to speculate that testosterone played a role in the development of ADHD symptoms. Some studies have explored whether prenatal exposure to high testosterone is associated with an elevated risk of ADHD. The results were mixed, with some studies finding a link between high prenatal exposure to testosterone and development of ADHD, and some finding no association.^1,2

[Read: When ADHD and Puberty Collide]

No research has been conducted investigating whether testosterone levels are related to ADHD symptom severity.

Research has investigated the influence of testosterone on mood and behavior more generally, including several studies that have tested a potential association between testosterone and depression, with conflicting results. Some studies have found an association between low levels of testosterone and depressive symptoms ^3,4 while others have found that both low and high levels of testosterone are linked to risk of depression.^5,6 Because of confounding factors, these studies have failed to show a causal relationship between hormone levels and depression. Studies regarding testosterone’s impact on cognition have been similarly inconclusive. ^7,8

Even research on testosterone’s most famous behavioral trait — aggression — fails to find a direct cause-and-effect relationship. Experts believe testosterone plays a role in the regulation of aggression, however the exact function it serves remains unclear. Testosterone fluctuates in response to cues of challenge in the environment, and it interacts with other fluctuating hormones such as cortisol, making the tangle of factors very difficult to unknot.^9,10

Testosterone research is inconclusive, in part, because testosterone is difficult to measure. Variability in testing and analysis methods, fluctuations in the hormone over the course of the day, and inconsistencies among labs regarding the parameters of “normal” levels all add to the challenge of studying testosterone.¹¹

Testosterone Over the Lifespan

Hormone levels in women rise and fall dramatically on a constant basis for the whole of their reproductive years. This regular menstrual cycle exists in stark contrast to the hormonal experience of men, for whom testosterone levels change significantly during two periods: puberty and in mid-life. While testosterone levels fluctuate slightly throughout the course of the day, their levels remain stable from the end of adolescence until roughly age 40.

Challenging Conventional Wisdom About “Hormonal” Teens

During puberty, testosterone levels in males increase exponentially. Research has found that the average total testosterone level of a male rises from 3 ng/dl to 355 ng/dl over the course of adolescence ¹² Testosterone levels reach their peak in late adolescence or early adulthood and remain stable until ages 35 to 40, when they begin to decrease very gradually.
The explosion of hormone production in puberty causes:¹³

• development of the male sex organs
• deepening of the voice
• appearance of facial and pubic hair
• muscle size and strength
• sex drive
• sperm production

Puberty is also a time of significant emotional, social, and behavioral changes — changes that are generally attributed to the dramatic hormonal escalation. But drawing a direct line between pubertal hormones and mood, behavior, and cognitive changes is an over-simplification of a complex developmental period, says Ben Balzer, M.D., pediatrician in Sydney, Australia, and Conjoint Lecturer at the University of New South Wales.

Balzer and colleagues conducted a systematic review of 27 studies in order to assess what evidence exists on the effects of testosterone on mood and behavior in teen boys. The review concluded that there was insufficient data to confirm a significant association.¹⁴

“Hormones are an easy culprit to go after,” says Balzer. “But their role may potentially be small because of the overall cognitive changes and neurological maturation that occurs in that period of life.”

Similar results were found in a 2024 systematic review of 55 studies investigating the role of pubertal hormones on mental health conditions. The review concluded that most of the studies that exist on hormones and mental health outcomes were at high risk for bias and involved many confounding factors. They determined that there wasn’t solid evidence that pubertal hormones cause mental health problems.¹⁵

The challenge of conducting this kind of research, Balzer says, is that hormones don’t act in isolation.

“When we study hormones in mice, we can control every aspect of their life,” he explains. “But when you’re looking at adolescents in the community, you’ve got to factor in their genetics, family environment, living environment, school situation, their social media use. It’s a really complicated thing to tease out.”

When Testosterone Tapers Later in Life

Testosterone levels remain more or less steady until midlife, when they begin to decline very gradually, approximately 1% a year. ¹⁶

While this decrease in testosterone is sometimes compared to menopause in women, the decline for men is far more gradual and happens over a much longer period of time. While men on average, lose 30% of the testosterone by age 75,¹⁷ women on average lose 65% of their estrogen by age 51.

No evidence exists to demonstrate that declines in testosterone due to normal aging cause mood or cognitive issues, as declines in estrogen often do for women in menopause.

Normal declines of testosterone due to aging are distinct from hypogonadism, a condition in which problems with the pituitary gland or the testicles result in the body failing to produce normal amounts of testosterone. Men with hypogonadism may suffer from chronic fatigue, low libido, erectile dysfunction, muscle loss, and weight gain, as well as mood symptoms including irritability and depression. Several studies have found a higher incidence of depression in men with hypogonadism, however research has not shown a causal link between the lack of testosterone and depression.

“The association between depression, testosterone levels, and sexual symptoms in males is difficult to assess, due to numerous confounding factors, such as medical conditions, obesity, smoking, alcohol use, diet, and stress,” according to the authors of a recent study in Frontiers in Endocrinology.¹⁸

Testosterone and ADHD in Men: Next Steps

• Read: ADHD Symptoms in Men Manifest Differently
• Watch: “ADHD and Puberty – How Hormones Shape Behavior and Mental Health in Adolescents”
• Read: Men with ADHD Are Asking: “Why Am I So Angry?”

*ADDitude is dedicated to honoring gender diversity and fluidity. For the purposes of this reporting, the terms “men” and “boys” refer to individuals assigned male at birth.

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