Is There an LGBTQ - ADHD Connection?

Several studies have found an association between individuals with ADHD and those identifying as LGBTQ. Individuals with ADHD report higher rates of same-sex sexual behavior, and higher rates of having a same-sex orientation than the general population. Those who identify as having a non-heterosexual orientation are more likely to have ADHD than their exclusively heterosexual peers.
The connections between ADHD with transsexuality appear even more robust, with virtually all studies to date finding increased rates of ADHD among the trans population.
Some part of this association appears to be due to “minority stress” - the high levels of stress faced by stigmatized minorities individuals. But genetic and other biologic factors also appear to have a role. Neurodiverse individuals (ADHD, autism spectrum, LGBTQ, left-handed) are more likely than the general population to have more than one of these identities, and are also more likely to have auto-immune conditions.
Why does the ADHD-LGBTQ connection matter? For one, it may introduce confounding variables into neuroanatomical studies of those with ADHD, if they do not control for sexual orientation (which itself is associated with structural brain differences). Stigma also reduces the likelihood of individuals seeking appropriate medical care for any of the conditions that they are dealing with. Having ADHD may create particular challenges for trans individuals trying to navigate convoluted government bureaucracies when trying to access services.
References:
The transgender and gender diverse and attention deficit hyperactivity disorder nexus: A systematic review (2024)
www.tandfonline.com/doi/abs/1...
Cortical brain structure and sexual orientation in adult females with bipolar disorder or attention deficit hyperactivity disorder (2018)
onlinelibrary.wiley.com/doi/1...
Sexuality in Adults With ADHD: Results of an Online Survey (2022, Germany)
www.frontiersin.org/journals/...
Psychiatric morbidity associated with same-sex sexual behaviour: influence of minority stress and familial factors (2010)
pubmed.ncbi.nlm.nih.gov/19460...
A Systematic Review of the Relationship Between Neurodiversity and Psychosexual Functioning in Individuals with Autism Spectrum Disorder (ASD) or Attention-Deficit/Hyperactivity Disorder (ADHD) (2023)
www.ncbi.nlm.nih.gov/pmc/arti...
General:
Psychiatrist, neuroscientist, and author John Kruse, MD, PhD presents practical, actionable, well-researched information about treatment options that scientists and clinicians recommend for adult ADHD and other mental health conditions. Subscribe if you're curious about how neuro-atypical brains can optimize their functioning in our shared, and somewhat strange, world.
Dr. Kruse has posted talks in both the "live" and the "video" sections of this channel. Thumbnails on ADHD topics have a pink background, and those on more general mental health topics have a purple background. A small collection of ADHD-Trump videos have an orange background.
You're welcome to email him with topics you want discussed, people you think he should interview, or if you would prefer a time for the weekly KZbin Live option other than Tuesdays at 6:00 pm (Pacific Standard Time).

[@foxybyproxy]

i have each one! woot! i have definitely been bi curious since childhood and had no problem finding the other kids to experiment..it was like sharing a language and so natural. still in the closet, tho. then again, i can barely manage my life in general..this is a surprise to me, dr.! thanks for the topic...

[@dylannicks1146]

Interesting connection, I myself am gay and notice the likes of ocd and anxiety has been a prevalent thing in my life

[@afser1533]

Hey doc, I really appreciate your informative videos. I had some off-topic questions. If you could find some time to answer these and help me understand exactly what's going on I'd really appreciate it. How should ADHD meds exactly feel like if it's working? I am trying 15mg to 20 mg methylphenidate IR (single dose). I have no idea if it's working or not. But it doesn't seem worth it. I was expecting a complete cessation of my ADHD and feeling focused but still calm, a zen like focus and motivation. Whereas I am feeling the following: 1) the racing thoughts are gone but that's replaced with a head pressure. 2) The feeling of not wanting to study is gone. 3) My senses are heightened but like in an uneasy way. I've a 4 year old who is very talkative and hyperactive, which didn't used to bother me while unmedicated but when I am on it, her behavior feels intolerable to me. I don't feel anger or annoyed towards her, it just feels unbearable. 4) I feel stimulated on it whereas I thought stimulants calm down people with ADHD. I feel slightly more energetic and motivated but it's not very focused at a single thing rather scattered. 5) I am not sure my hyperactivity is increased or not. My racing thoughts are not there but I feel very uneasy. 6) If I get on my phone after taking medication, I get sucked into it and find it very hard to get of it even though I know I have other things to do. 7) My cognitive sharpness also seems to be not so improved on it. I don't find myself very sharp while studying. 8) The crash is also horrible. I was initially taking it with food but felt absolutely nothing from it, neither positive or negative. I've recently started taking it on empty stomach, having some food after 30mins of taking it and started feeling these effects for the first time. Was my expectations not in line how it's actually supposed to work? Are these effects signs of overdose or should these pass after a while? Lower doses seems to do nothing for me. Can you share some tips on what things to do to feel the full benefits of medication? If you can do a video about this topic, that'd be awesome. Will combining Clonidine with methylphenidate help mitigate these effects and help with the crash? Do you have any experience on this? I don't have many other options other than methylphenidate, so don't want to give up on it yet. Is there any problem with exercising before taking medication in the morning?

[@dr.johnkruse6708]

All good questions, and I hope that you are also bringing them up with your prescriber. I may not address all of the points you have brought up, but my response to the overarching question is that ADHD is as much a wiring issue as it is a neurochemical one, which means that, at least with current medications, even optimal dosing never obliterates all symptoms of ADHD. But many people are more functional in school, work, or family/social interactions. Many people with ADHD do feel calmer, and have more control over their thoughts, if the feeling of being stimulated is mild, it is likely to decrease with the next days or weeks, but if it is not abating, or is increasing, that is a clear sign that the dose is too high. I often encourage people to solicit feedback from friends or family members about any changes they might see in you, because we know that ADHD affects the ability to attend to one's own symptoms. So while most people have a pretty clear idea of whether meds are working for their ADHD, sometimes they are either missing big benefits or side effects. Usually slow release forms, particularly Concerta, reduce crashing in energy/focus/mood dimensions. Exercise usually helps with ADHD symptoms, and shouldn't interfere with absorption or distribution of the medication.

[@afser1533]

​@@dr.johnkruse6708 I guess to oversimplify it, stimulants increase the baseline energy and dopamine of the body and make it easier to initiate difficult tasks. Is there any type of adhd medication that gives a "calm self-control" effect? Is Bupropion known for this? I am also taking Clonidine with the methylphenidate now. The sedating effect is immediate. But haven't noticed anything significant about my ADHD. Does it need to build up in my system for improving ADHD? Why does it need to build up in case of ADHD while all of its effects for other uses (insomnia, anxiety) is immediate?

[@KrassimiraJeliazkova]

Apologies to ask a question a bit "on the tangent": I am more interested on ADHD and learning, can you recommend a reliable study or podcast?

[@dr.johnkruse6708]

I don't watch too many podcasts, so I'm not sure what to recommend, other than that ADDitude magazine is a good online resource with lots of information that usually has been well vetted.

[@KrassimiraJeliazkova]

Thanks, will definitely check ADDitude magazine out! @@dr.johnkruse6708

[@KrassimiraJeliazkova]

This triggered a question in my head: I keep hearing about the impact of the Internet (number of hours spent online etc) on attention span, especially for young people, and its innumerable implications. Is there any serious research on this that you would recommend? Also, the concept of "different", in order to understand difference one has to have a notion of similarity. As far as I can see there are no two human brains on this planet that are the same, so the concept of difference has always baffled me...

[@dr.johnkruse6708]

I have two videos on this channel where I tried to address some of the research on the internet and ADHD community: kzbin.info/www/bejne/iKrSo4NufpWVeJI and kzbin.info/www/bejne/fpatZ6Ksa96mfM0 There are links to some of the research in the info connected to the videos.

[@KrassimiraJeliazkova]

Thanks for these! I really like your calm yet clear definitive way of expression. Might come back with other questions, not necessarily directly related to whatever the subject of your video was, please take it as an sign of appreciation! 🙂😊😉@@dr.johnkruse6708

[@Alex-js5lg]

I haven't watched this talk yet, but the title gave me a thought: people with ADHD tend to be less mindful/introspective, and I'd imagine that could lead to a lack of self-understanding and firm identity. Gender/orientation tie in with those concepts quite extensively, so it seems to me that a correlation would make some sense. Edit: actually, aren't kids with ADHD are also quite disproportionately victimized and rejected by peers? Being on the receiving end of that sort of behaviour could logically cause someone to be less comfortable in exploring their identity throughout their development for fear of being bullied about that too.

[@phoenix1629]

There is no relationship

[@Alex-js5lg]

Bullshit. People who are gay, trans, questioning, etc are very disproportionately victimized by others (both in terms of bullying *and* actual violent crime). We know trauma and stress tend to exacerbate ADHD symptoms, and we know that subjection to violence and harassment tends to be traumatic and stressful. There's one link for you. If you disagree, feel free to articulate why.

[@Titsnitch]

yes... i have adhd and heavily dislike them

[@Alex-js5lg]

... sorry, are you saying you heavily dislike people who fall under the LGBTQ+ umbrella? If so, that's not an ADHD issue, that's an issue of intolerance and your own internal discomfort.

[@dr.johnkruse6708]

@@Alex-js5lg thanks for speaking up. I'd agree with you. I only worry that often people with ADHD often jot down disjointed comments, so the writer may have meant something completely different from how you or I interpreted their comment.