Complex ADHD in a Transgender Adolescent: Case Study and Clinical Implications

Abstract

Background

Adolescents have increasingly been reported as identifying as transgender or gender-diverse and seeking gender-affirming care. Nonetheless, the proportion receiving gender-affirming medical treatment remains low; in the United States, fewer than 100 out of every 100,000 17-year-old adolescents assigned male at birth receive gender-affirming medical treatment. Attention-deficit hyperactivity disorder (ADHD), the most common childhood neurodevelopmental disorder, is a major public health concern and shows elevated prevalence among transgender and gender-diverse adolescents.

Case Presentation

This case presents a 15-year-old adolescent with ADHD and co-morbidities, including gender dysphoria, harmful use of substances, and childhood mood disorders. After antipsychotic and antidepressant pharmacotherapy combined with psychological interventions, the patient demonstrated improved emotional regulation and diminished impulsive behaviors.

Conclusion

This case underscores the need for life course-oriented care that addresses transgender-specific stressors and incorporates preventive substance abuse strategies. It also emphasises the urgent need for research into comorbidity-tailored pharmacotherapy to balance ADHD treatment efficacy with gender-affirming hormone safety.

Plain Language Summary

This report describes the case of a 15-year-old teenager who has both attention-deficit/hyperactivity disorder (ADHD) and gender dysphoria. The teen also struggled with mood problems and used several harmful substances. These challenges made daily life, emotions, and self-control difficult. The patient received a combination of medication and psychological support. This included treatment for mood issues, ADHD symptoms, and emotional outbursts. After a period of care, the teen showed better emotional control and fewer impulsive actions. This case highlights the special challenges that transgender youth may face, especially when they also have ADHD. Stress from gender-related issues and the risk of substance use can make treatment more complex. In this case, care needed to be carefully adjusted to support both the patient's mental health and their gender identity. This case shows that treatment should not only focus on ADHD itself. It should also consider gender identity, emotional needs, and the risk of substance use. Support that looks at the whole person can help young people feel safer, more understood, and more stable in both body and mind.