In this episode, Ash and Dusty explore the intense overlap between ADHD and early gender transition, focusing on how sudden, widespread change taxes executive function and identity. Ash describes the real-world disruptions—wardrobe overhaul, haircuts, public outings, bathroom access, and safety concerns—that made routine tasks overwhelming. He discusses how ADHD can make introspection and identity work harder, and why finding queer and trans communities provides essential context, normalization, and compassion during that liminal period.
He also addresses medical and emotional factors: the practicalities of hormone therapy (scheduling, dosing forms like gels that require stillness), how hormones can alter attention and emotional experience, and the increased need for logistical planning and accessible care. Both hosts emphasize the importance of supportive networks, adaptive strategies (including coaching and somatic outlets like kickboxing), and small, present-focused steps to move forward while navigating the fog of transition.
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Episode Transcript:
[00:00:00] Ash: Hi, I am Ash. [00:00:03] Dusty: And I’m Dusty. [00:00:04] Ash: This is Translating ADHD.Dusty, this week I wanna talk about last week. I kind of caught listeners up on my own journey to the best of my ability. That is something that I will be trying to put, language too, for the rest of my life, especially if you’re doing the type of work that you and I do.
That’s curiosity led and interested in individual lived experience. It was a difficult experience, but it’s really rich on the other side in terms of how fascinating it really is. But anyway, I’ve caught you all up, to the best of my ability, I’ve put language to the experience. For those of you who do not have that lived experience, to better understand where I’ve been, and this week, I wanna turn my attention towards the interplay between ADHD and transness, particularly in early transition, where it is absolutely the most impactful.
And what’s really funny about this is a couple of years ago at the CHADD Conference, Brendan Mahan asked me to be on his podcast talking about ADHD and transness, and was really enthusiastic about bringing that topic to his podcast.
His podcast, by the way, listeners, is ADHD Essentials. I’m not sure that new episodes are coming out at this moment in time, but there’s a huge back catalog of really interesting stuff. I’ve been on that podcast a couple of times. Dusty has been on that podcast a couple of times. Cam has been on that podcast a few times.
[00:01:36] Dusty: Yeah, I spoke to Brendan, and it will be coming back. [00:01:39] Ash: So something to look forward to there! Anyway, for the purposes of the story today, Brendan earnestly asked me to bring some insight about the intersection of those two topics to his podcast, and I was very interested in working with him again, but I couldn’t make sense of that topic at the time, because I wasn’t far enough in my own journey, despite knowing all I know about ADHD to distinguish what was ADHD and what was not ADHD or other stuff, I just couldn’t make enough meaning of it to bring that topic to life.And so here we are two years later, and I’m ready to bring that topic to life. But, before I start down this road, Dusty, I’m actually curious as somebody who hasn’t had this lived experience, but who knows a lot about it by way of your own queer community, by way of our friendship, what does this topic bring up for you? What questions might you have for me? What do you think some of the ADHD pitfalls might be?
And you don’t have to answer all of those questions. Whatever this brings up for you. And listeners, I did not prepare Dusty for this, even though I knew I wanted to open this episode this way, so we are all gonna hear whatever Dusty has to say together for the first time.
[00:03:00] Dusty: Yeah. Well, I think people should refer back to the episode that we did on ADHD and queer frameworks. I’m curious about all the changes that happen when you’re transitioning and all the changes that happen when you’re accepting that you have to do things differently with ADHD. What’s it like to handle so much change all at once? If your identity is in flux, how does that impact figuring out what ADHD structures are gonna work for you?But then also something that a number of my clients have brought up that I really never thought about was the impact of hormones and hormone therapy on ADHD, executive function, mood and emotion.
So that’s something that I’m learning about now, watching a lot of my clients go through it, and it’s just, I never thought about it.
[00:03:53] Ash: Dusty, I love that because you touched on a number of things that I want to cover today. I’m actually gonna start with something I said in my coming out episode, which was, “what was simple and easy and routine suddenly isn’t anymore”. So at the very start of a transition journey, and that looks different for everyone, by the way, some people sit with the knowledge of transness for a long time before acting on it. My story was almost the opposite of that, where I found that answer for myself and it felt correct, and it was two months from the time that I had that realization for myself to the time that I came out publicly on the podcast and everywhere else, and made the decisions along the way to do it in that way.But anyway, at the very start of transition itself, you’re starting to live your life differently. You’re coming out to people. You’re in this new place. It is really intense how hard everything gets and all of the things that you have to think about that you didn’t have to think about before. And in my case, this is particularly true because I was 38 years old, right? So something as simple as getting dressed in the morning – I went from having a wardrobe that suited every facet of my life at the time, to having one pair of men’s jeans and a couple of hoodies and t-shirts from my old wardrobe that worked well enough while knowing nothing about how I want to dress myself in this new time.
I hate to use the language, new identity, but I guess newly discovered identity, right? Knowing nothing about what I actually want to wear other than I do not want to wear women’s clothes. Again, that part of my life is definitively over and by the way, that’s a statement that is true for me.
I do know trans men who mess around with feminine attire and feminine accessories, and that is absolutely valid. But for me, that was something that I pretty definitively knew so much so that it was the question that I would go back to in those early panic moments of, is this real or am I an imposter?
I’d ask myself, do you wanna put the girl clothes back on? And there was a gut level response of nope, absolutely not. So going from having a complete wardrobe for any situation that would arise in my life to having nothing. Completely different context, but not too dissimilar from like having a house fire, right? Like everything that I own to dress myself and go out in the world is useless to me now, and I don’t really know yet what I’m looking for to start to rebuild that in some way.
[00:07:15] Dusty: Yeah. What a mind bender for executive function already, right? It’s hard enough to manage laundry and I know a lot of people with ADHD will struggle with changing body size. Like we change meds and we struggle with binge eating and then we struggle with no appetite for our meds. And so on top of managing what clothes fit, what clothes are clean, where do I find my clean clothes, etc. now it’s like, okay, which clothes can I actually wear from a functional aspect. And then so many people with ADHD can have budgeting and finance issues sometimes too, right?So if you’re in a comfortable life situation where you’re older, you’re more subtle, that’s one thing. But if you’re very low income and maybe you can’t afford replacing these items or you can’t afford some of the “smaller things”, like haircuts, right? Like, I mean, you should get haircuts pretty frequently, even if you have long hair anyways. But if you’re like a man or you have a short haircut then you have to get haircuts all the time. And so even that one thing, I feel quite badly for trans women because there’s so much more – like if you’re gonna do makeup and jewelry and nails and all that a couture mon that goes along with femininity.
I think, understandably, a lot of trends women are really excited about and looking forward to because it might feel like “I get to do this” more than “I have to do this”. But, at the same time, there is also I have to do this for, you know, stealth or for safety. And then there’s so much cost associated with that and there’s so much more to manage, like makeup has expiration dates and if you don’t keep an eye on the expiration of your makeup, you could end up with like a sty on your eye or there’s so much more to manage there just in appearance.
[00:08:55] Ash: Yeah. And dysphoria in the mix too, particularly in early transition. You talked about haircuts, my first haircut, and I still see the same barber, she’s wonderful. She’s queer herself. I went in and I was in tears. This was before I had come out publicly and I told her I wasn’t really sure what would look good with my hair.My hair was pretty difficult in terms of, there’s a lot of texture and it grows in different directions. So I wasn’t sure how to look at men’s haircuts and look at myself in the mirror at the time and know what would look good on me. And I’m saying all of this to her and I’m in tears and she held space for me, which is something so beautiful in queer communities, by the way. It’s like she knew where I was. She made it okay for me to not be okay. And then at the end of that haircut, that I was feeling very good about by the time we finished, she turned me around and I was disappointed because I saw a tired, old woman in the mirror with a man’s haircut, right? And the same thing translates to fashion when you put on clothes and you don’t feel good about your face or what you’re seeing in the mirror.
Otherwise, I think there can be an expectation that the clothes will do something for you there that they’re not doing right. So it can very much become about what you’re projecting out. And I will say that early on, a lot of how I dressed was more about trying to be seen the way I wanted to be seen.
And there’s a full circle moment here where now I dress how I like to dress and, and I’m still learning there, but now I know how to put a fit together and look in the mirror and be like, yeah, that’s me. Yeah, I feel good in this or that.
So, when you’re talking about executive function stuff, here’s another big whammy in early transition – logistics.
I went from pretty much being able to go anywhere, at any time, for any reason as a cisgender, heterosexual white woman to being acutely aware of what’s the crowd like here? Because, in early transition, people were not reading me as man, but they were certainly reading me as queer, right? That was something that I couldn’t hide. The only way to hide it would’ve been to put on the girl clothes at that moment, right? But, with my physical being and the way that I looked at that time, the way that my voice sounded, people were honestly reading me mostly as lesbian, but certainly like queerness was suddenly very visible, right?
So, going from sort of, I can go wherever, whenever, for whatever reason to, what’s the crowd like, what’s the safety situation? Where is this? What’s the bathroom situation? My best friend from high school invited me to his 40th birthday party and the location of the bar was such that I was concerned about those very things. I sent him a text saying I would like to be there, is this a safe setting for me? And well, we will talk about this more in the allyship episode next week, but it was such a great show of allyship that he had already thought of that. He’s like, I thought of that. I checked out multiple places and ruled out a few others, but I went to this place and I talked to the owners. I checked out the bathroom situation, both single stalls, both for both genders. So you are all set there.
But you see the number of things I had to think through to show up for my best friend from high school, my brother from another mother who of course I’m gonna be there for you. And of course I’m stoked to see your family and catch up with them. But all of a sudden there are all these barriers and stressful considerations.
[00:13:03] Dusty: It reminds me of a story that another friend of mine told me who is neurodivergent and she also has Ehlers-Danlos (EDS) – so some physical concerns and she was invited to a bar where there was nowhere to sit down and nobody considered it because nobody thought about disability. But she can’t go somewhere for long periods of time where she has to just stand.That happens to a lot of people with a DT (Disautonomia) too, whether it’s hypermobility or chronic fatigue or POTS, there is this creeping added layer of is this space accessible for me? So it kind of reminded me of that.
But yeah, absolutely, that’s for sure a huge thing and in terms of logistics, I can’t imagine. It’s hard enough for me to remember to just take my ADHD meds. Luckily, I don’t have any other meds I need to take but then you can also get to a point where you have to get your hormone stuff. And I know some clients who are transitioning and they have a testosterone gel that when they put it on they have to sit still for like 20 minutes and they can’t do anything. And I feel like I would probably lose it in my house somewhere, like not be able to find it.
I had a friend who was here in British Columbia, and one thing I’ll say – bless the Canadian medical system – but we do always have a shortage of doctors. So it’s hard to find a doctor and it’s hard to get a good doctor and so you kind of have to take whatever doctor you can get if they have a space so then on top of that finding a trans-friendly doctor or care provider…
[00:14:31] Ash: Dusty, I think, “is this space accessible to me” is actually really beautiful language to describe what I was going through because it was very, very true and, and still is when I am driving. When I’m road tripping (I live in the Midwest in the US), so if I am driving from St. Louis to any other major city by car, I am gonna be on the road for at least four hours. There will need to be at least a bathroom break, and I am still very uncomfortable in unknown men’s bathroom situations, particularly in rural America, right? And that’s kind of another like mind bending thing of transition is when people start to see you differently, then the game changes. I can use a men’s room and I can’t use a women’s room, right? If the option is A) a men’s room or B) a women’s room that are both crowded – I do not belong in a women’s room and I would make women uncomfortable in a women’s room at this point in time, and men do not tend to notice me if I go into a men’s room.But there’s still that nagging, and this is where the political climate does have an impact, there’s still that nagging fear that somebody who is psychotically transphobic would clock me or spot me because I am still “clocky” if you know what you’re looking for.
[00:16:13] Dusty: I was actually here as well, and as you said earlier, I’m still uncomfortable going into men’s bathrooms. And based on your country, like as you should be and it’s only gonna get worse. But I was here in Vancouver and we have a two week fair that happens at the end of summer called the Pacific National Exhibition, or the PNE.I was with my kids at the PNE and something I saw that I thought was so nice is when we were in the line for the bathroom, there’s a sign that says like women’s bathroom, and then underneath it it said “Trans people welcome here”. And all the bathroom signs in all of the fairgrounds have that. It says it clearly, it’s explicit – trans people are welcome in this bathroom. So I thought that’s really good because it also sends a signal to the people who are transphobic that “hey, the rules of this bathroom are that trans people can go in it so mind your own business.”
[00:17:03] Ash: Absolutely. I love that, and that would make me feel a sense of comfort and security because that’s signaling safety. So that tells me something about the community that I am in right now. So more so than giving me permission, there’s a safety signal there that would be relieving, particularly at that moment in time.I’m talking about when bathrooms were terrifying. It was a terrifying issue for me. I do mourn the loss of the women’s room. I just wanna throw that as a funny aside, because there’s so much cool women and femme people being cool to each other that happens in a women’s room that’s lovely and beautiful.
And men…because of, well, they’re gross, but they’re also terrified to interact with each other in the bathroom because of patriarchy and internalized homophobia. So the thing that actually makes it a little bit easier for trans men than trans women is if you pass well enough, which I do, the trick to the men’s room from there is just to act like a man, right? Like, go in, don’t look around, be a little embarrassed that you’re there and that’s the whole MO.
But it was a weird thing to get used to coming from a bathroom situation my whole life that is relatively social, right? Like, if you’re both washing your hands, you might chit chat or if you need something, you can ask for it.
[00:18:35] Dusty: All I wanna say is, it’s so funny about the direction you went, ’cause that is not the direction I thought you were gonna go. I was gonna say “do you miss the women’s bathroom because it doesn’t smell constantly like poop” – because we don’t like poop and especially from each other for some weird reason.And then men’s rooms are always so gross, but you went a different route.
[00:18:50] Ash: Yeah, I did. Yeah. No, the grossness factor I can deal with, and that’s the phish tour in me, right? Like the men’s room and the women’s room on phish tour are equally vile. They just are because it’s that type of environment. So I can cope with the vileness aspects, the smells, etc. The social elements were certainly a huge adjustment, honestly, because again, I lived 38 years having one experience, and now I am having this new experience and carrying fear for my safety while also trying to kind of get over that hump/bridge, that gap for myself, where if I need to, I can walk into a men’s room and use the bathroom, which I can do these days, by the way, in almost any circumstance.But in certain circumstances, it’s still uncomfortable for me. I don’t know if that’ll ever go away or not. TBD.
The next thing I wanna talk about, and I think it’s so interesting that you brought this up when I asked you what would have your attention is sense of self and identity.
This is already hard with ADHD for years. One of the cornerstones of my coaching practice has been coaching people around identity. And why is this true? Because we live this experience of otherness that the people around us don’t understand and that we don’t understand. So we start becoming these very reactive beings where we’re trying to avoid conflict. We’re trying to avoid those moments where the other shoe dropped. We’re trying to put on a certain persona. And ADHD itself, because we have these searchable but not indexable brains, makes introspection, I don’t wanna say harder, but certainly makes it something that doesn’t come to us naturally, the way that it might come to other people, because we can know things about ourselves but don’t have that awareness in a way that’s useful to us, right?
So when I’m doing identity work with clients, we’re not finding brand new, crazy things but we are finding little nuggets that they were previously unaware of that we’re building on so that they understand something more about themselves, who they are in this world, which helps inform where are we going on this journey and what is a life that fits for you?
And so ADHD makes identity stuff hard, and then you throw in transness and puberty, and everyone listening to this podcast has been through puberty, so you can understand something about that liminal identity space. Middle schoolers and early high schoolers tend to be kind of “cringe” as the kids say, because you’re trying on different things and you’re seeing what fits. You’re figuring out who you are and who you aren’t, and ADHD can make that really hard to attend to. It can make it all feel really messy.
Some language that I sat with for quite a while in my transition because there was an extra element for me, and I talked about this last week where I was trying to make more meaning of the powerful work I was doing in my coaching practice, but so unable to separate the noise in my head in terms of what’s ADHD, what’s transness, what is this for me? How can I turn this inward to help me understand this differently? I was just not able to get there in a meaningful way until I was. I tell new trans people the only way out is through.
So, for trans folks with ADHD, I think the road can be a lot more complicated. I also think we uniquely need community for that reason. I think all queer people need queer community. We all need mutual understanding. We all need places where we feel like we can fully be ourselves. ADHD people in particular, there’s a coaching skill called normalizing, and we really need that.
We need to hear our lived experiences coming out of other people’s mouths. We need to relate, we need the context, right? Our brains are wired for context. So when you have other trans people in your circles. They can help you better understand yourself just by way of talking about their own lives. And so it was one of the biggest supports for me in getting through the liminal space of identity.
I was in the moment of nothing will make it all makes sense, but none of it makes sense for so long. Some language that I wanted to use and the useless frustration I was sitting in, in that place, knowing there was meaning to be made and I couldn’t make it was the support of other trans folks, and not even necessarily in a way where, that’s why I was accessing that all the time at the time, but just having time and space to be with other trans people to be able to comfortably talk about our trans experience in a shorthand way.
Listeners, you can relate to this. It’s really, really easy to talk to other ADHD folks about ADHD because they understand your lived experience. And even if it’s not the same, they can relate to it. They can pull something from their own experience of ADHD and shortcut those connections to know something about your lived experience.
So the same idea is true here. I love the cisgender, heterosexual folks in my life. The cisgender heterosexual folks that are left in my life are absolutely the realist of the real ones, but those people who had previously been my support network couldn’t be at this moment in my journey, and in fact, those relationships got backburnered for a little while. Not because they were doing anything wrong in how they were showing up for me, but because this is what I needed and I needed to be far enough along in my own identity journey to feel comfortable being the one queer friend at the barbecue when my high school best friend invites me to the barbecue, and that took knowing something about who I am that I didn’t know until I knew.
So again, kind of a full circle moment where my world got really small for a while. It got small because I prefer to go to places where there are queer people and safe bathrooms. And also because it was helpful for me to be able to talk about my life and what I was going through in that moment with people who could relate and understand in a way that straight people cannot.
But now full circle, like we’re bringing those relationships back into the fold, and I’m recognizing that yes, those relationships are always going to be different than they were before because we relate differently now. But now that I am there, like they’re still lovely and wonderful and valuable.
Does that make sense, Dusty?
[00:26:08] Dusty: Absolutely. I mean, I think like this is kind of like moving us towards that allyship episode and some of the things we talked about last time, and I wanna be conscious of time before we run out of time. Can you speak a little bit to the hormonal aspects and the connection between hormones and ADHD because that’s what was really interesting to me too?And I think maybe something you don’t always like when you’re about to transition, maybe it might not be something that you might consider, especially if you don’t know the connection between things like ADHD and hormones.
[00:26:37] Ash: Sure. So this was something that I did absolutely consider and was aware of because of my context, because I was already a working ADHD coach who had had conversations with clients about hormones. Interestingly, not any trans folks, but clients in perimenopause or menopause or even clients who menstruate, and that monthly hormone fluctuation that comes along with a menstruation cycle like breaking down PMS. I had a lot of context for the fact that hormones absolutely do impact ADHD symptoms and I went searching for the impacts of testosterone in particular, and there wasn’t a lot of information out there about trans men, but there is a lot of information saying that for men in general, everything else being equal, ADHD symptoms do tend to be worse.I do think that that is true. And so coupling that with all of this new executive function tax that we’ve been talking about, this time period we talked about the entire episode was really frustrating. I do feel like I had to relearn my own ADHD in a way, if that makes sense. That previously being something, the only thing that I really fully and completely understood about myself.
Another interesting thing, and this is true for trans men or trans women, although the way in which it happens is different but hormones change how emotions feel in your body. I took up kickboxing because I stopped being able to cry and it physically felt like I had pent up emotion. Aggression isn’t quite the right word, but it felt like it could turn in that direction if I didn’t find an outlet for it, if that makes sense. And that was coupled with my already concern about weight gain on HRT because puberty doesn’t know that I’m already a grown adult and the growing part is done.
Those are the two reasons that I took up kickboxing as a way to better deal with my emotions. And Dusty, I too am noticing our time, but I have a little story to maybe take us out that I think kind of puts a bow on the story I’m trying to tell today.
Things change so fast. That’s the other crazy thing, right? Transition can feel really slow, but particularly with ADHD, like you quit paying attention to something for a while and you’re like, oh gosh, where did all that new body hair come from? Like, there was nothing there the last time I was paying attention to my stomach and now there’s a whole bunch of body hair there.
But, things don’t just change internally, they change in terms of how you look. It’s crazy to look at pictures of myself from those early transition days. It’s crazy the journey I’ve been on in terms of people in non-queer spaces and how they receive me just on a basic social level. Right? We went from pretty all the time, MAMs, which hurt, but like were fine and whatever to this funny liminal space where I would get people correcting themselves in both directions, which was terrifying at first because I was afraid of outing myself.
But now in a new, more confident place in my trans identity, I find it really hilarious when it happens and I can be pretty entertained by it.
And so it’s continual change in all directions in terms of your context, and that is such a crazy thing to deal with. And the story I wanna tell you about (this is right before I started HRT), I came out publicly and in the very next week, Cam and I are in New York City doing an interview for a documentary that never came to fruition, but that’s okay, that’s not the moral of the story.
Anyways, I have a client who’s a photographer in New York City and is so generous. She rented this studio space and she charged me nothing. She rented this studio space to do new professional photos of me because the one “professional photo” that I have, I took in my driveway. But this way I would have a photo that more accurately reflected my identity for when I came out publicly to my audience.
So, we spent the whole day, multiple outfit changes doing this photography session, and I never used those photos because by the time on the business front I was there to start using them, they genuinely do not look like me so much. So actually later today, I’m having a new headshot taken because they just don’t look like me.
And similar to the haircut, at the time that they were sent to me, there was also that disappointment of, yeah, that’s what I look like right now. But that doesn’t feel like me yet, both in terms of physical transition changes and also in terms of the clothing I had at the time, right?
I hadn’t yet figured out who I am from that point of view. So I worked with what I had at the time, but would choose and have chosen something very different for today. So Jane, if you are listening, please know how much love in my heart I have for you for doing that photography session with me, and it’s been on my mind to reach out to you and tell you why those photos never got used.
But I also wanted to end on that story because the moral of the story is the change. An internal, an external context is a constant until it’s not right, until you do finally get to a place of feeling more settled, right? Feeling less like a fractal being that’s coding to all of these different contexts and more like a whole person who is choosing.
Now I’m a choice about how I code or don’t code myself.
[00:32:21] Dusty: Yeah, I mean it sounds like a lot. I don’t envy having to manage all those challenges, and I wish all the people transitioning out there a good support system because you need it so much. [00:32:32] Ash: 100%! I will actually toss in that my coaching skills were a massive boon to me here. I’ve had a couple of experiences with trans clients that affirm this and I do think that coaching can be a great framework to work through some of this stuff, particularly if you also have ADHD.So the same identity work that I was doing with clients and building on became useful tools and resources for me in my own journey to sit in that discomfort and to the best of my ability, approach things with curiosity, but detachment, right? Because again, that useless frustration that I was sitting in at times – there were times where the best question I could ask myself was, what can I do now? Looking at all the things I can’t do and looking at how far away I feel from understanding myself – let’s back it up to right now – today. What can you do in service of improving your life from this place?
Because my life in other ways had also crumbled around me during this time. So what am I capable of right now? What can I turn my attention towards? Because we’re not there yet with this bigger stuff, the fog is not clearing on this stepping stone in those bigger ways yet. So on this stepping stone in the middle of the foggy pond, where can I take some meaningful action?
So, trans folks, if you’re listening and coaching is something you are interested in exploring as a way to better understand yourself in your own journey with transition, please do reach out and give me a shout because that is something I am interested in exploring with more intention because it’s certainly something that was immensely useful for me to have those skills in my own toolbox along the way.
Time to wrap.
[00:34:29] Dusty: Yeah, let’s wrap it. [00:34:31] Ash: All right, so until next week, I’m Ash. [00:34:35] Dusty: And I’m Dusty. [00:34:36] Ash: And this was the Translating ADHD podcast. Thanks for listening.
