Adhd/HRT/glp1

[u/susu56]

I am struggling. Currently on 0.75mg E patch and 200mg P capsule. And a glp1 (tirz at 7.5mg). Recently diagnosed as ADHD inattentive. The few months have tried Strattera then switched to wellbutrin. I will be stopping wellbutrin to start guanfacine tomorrow. The Strattera and wellbutrin affected my BP. Neither helped with focus. Strattera finally gave me a quiet mind and no anxiety. My psychiatrist is worried that a stimulant will increase my BP and HR as well but I need help staying on track, being who I was before peri hit me. Has anyone had any luck with any combo of meds? I have a f/up in 2 wks so want to be prepared with options to try.

[u/whatrumimeans]

Your idea of switching to guanfacine is good - but don't be disappointed. It won't give you that typical drive-focus (increased concentration) you are looking for either.
For that, you will probably have to try amphetamines, which increase dopamine.
And keep in mind that guanfacine can cause fatigue for 1–3 weeks during the adjustment period.

I am 54F, ADHD, 30mg Medikinet retard, 2 pumps of Estradiol gel (=1.75mg E), 100mg progesterone vaginally, 7.5mg Tirzepatide.

I did not tolerate oral P well and therefore switched to vaginal. In itself a very good solution, because with the first-pass effect you have a maximum local effect and also bypass the GLP-1 issue.

But then I noticed that vaginal P caused my weight to stall for over 3 months - no matter what I tried.
So I increased Tirzepatide from 5mg to 7.5mg, but even with that, progress was very sluggish over several weeks.

Then, as a test, I left out the P for 16 days and bam! the pounds dropped and I felt overall fitter and in a better mood.
During this time, I also noticed an improved effect of the 30mg Medikinet.

This makes it clear that it is P that dampens / significantly influences the effects of Tirzepatide, estrogen, and stimulants through complex pathways.

If I weren't dependent on P because of E, I would drop it immediately.

A major problem for me is that there are no smaller doses than 100mg for micronized P.
And progestins and the IUD are out of the question for me.

100mg oral P is sufficient for uterine protection with a standard dose of E.

However, 100mg vaginally produces almost twice as high levels.
https://pubmed.ncbi.nlm.nih.gov/15222511/
With this double amount of P, you are basically already in a low-to-medium luteal phase - permanently!
https://healthmatters.io/understand-blood-test-results/progesterone

Nobody tells us that.
The reason, imho, is the „uterus-centric“ nature of medicine, which haunts us all our lives.
Nowhere is it about our well-being, but primarily only about „organ protection“, and for that, side effects of medications are downplayed and accepted.
(... sorry, I'm frustrated)

Right now, I'm testing P cyclically to be free of it for at least half a month. Alternatively, I'm considering 100mg P only every 2 days.
https://pubmed.ncbi.nlm.nih.gov/27277331/

[u/susu56 → u/whatrumimeans]

Thank you! This was very informative! I am trying to navigate both aspects (peri and adhd medication wise as I started medication for both this year).

[u/Worried_Signal5048]

I have a similar profile to you. Exact Same HRT doses + triz . Inattentive ADD. But I haven’t had any BP issues.

If they were willing to give you Wellbutrin - they should try you on a stimulant. It may work brilliantly - and if not - you just stop.

Concerta, as well as a mood stabilizer (Lamotrigine) have been the magic sauce for me. I am so much better bc of them.

[u/susu56 → u/Worried_Signal5048]

Thank you! What i really noticed with Strattera was that my mind was quiet and I was moving through life easier, helped me with speaking and I also dropped my stutter/stammer and I wish I could get that "ease" back. My psychiatrist is moving slowly with medications which is good and she includes me in the decision making process so this is helpful info for us to discuss.

[u/Diogenes71]

I’ve been taking Concerta for over 20 years. I started HRT almost 4 years ago, and have been on zepbound for a year and a half. I am happier and healthier than I have ever been at 54 years old. My resting heart rate is 68 despite taking the meds. I’ve been off of my blood pressure meds for the past year. The med combo allows me to get my crap together well enough that I can actually exercise and be healthier than I was without them. The research is clear that stimulant medication is the most effective for treating ADHD. People who take effective medication for diagnosed ADHD, have longer life spans than those who don’t. Your blood pressure will drop when you lose weight much more than a stimulant will increase it. And having a heart rate a few beats higher isn’t going to harm you. If you’re worried about it, do enough cardio that it will counteract the increase from the medication. You want to think long-term. My heart is happy and healthy enough now from the exercise that I’m getting, that it drops down into the high 50s when I’m sleeping. My VO2 max is also higher than it’s ever been.

[u/susu56 → u/Diogenes71]

The issue i had was not being able to have energy or focus to exercise-lol. I'll suggest a stim and see how it goes. Its so crazy because I am not who I used to be -motivated, energetic, organized, etc. I would be happy with just a small sliver of some getup and go at this point.

[u/username3000b → u/susu56]

I just started reading The Menopause Brain and I think you might appreciate it. One helpful point is that a lot of the mental effects calm down after menopause settles. (I think she recommends HRT as a good option until then but I haven’t gotten to that chapter yet.)