Hormones and autism

Related to my last post looking at hormones and chronic pain, does hormone imbalance make me present as more autistic (which is to say, throwing up more of the challenges of it than its many gifts)? In a sense, yes, for instance impacting executive function for two different reasons, depending which way my hormones are swinging. The core issue of autism is there anyway (including weak executive function amongst other foibles) but either extreme can trigger that off to make it much worse.

In other words, autism is my core trait and, really, my home and happy place since there is no other version of “me” that I know, but when I’m out of balance I experience the pitfalls of autism more.

For instance, during hormonally balanced times, I can cobble together my own unique style of executive function, which is always going to be a tadge more make-it-up-as-you-go-along seeming than the next person’s (even if I happen to know what I’m doing and why), in fact there’s even a sort of creative genius in all that when I’m on par. It’s the kind of approach that makes me more cut-out for small creative businesses than for corporate because I don’t fulfil other people’s performance expectations, following protocol, even if the results are generally good. It can even lead into enhanced creativity, the kind of chaotic multitasking that looks a lot like talent on a good day. So whilst I may not have all my different balls audited and accounted for, like the steps of a protocol that can be accounted for or replicated, I can somehow keep them all spinning in the air for a while, perhaps even juggle them and do party tricks, when I have balance at my core.

The very opposite when I don’t. As per my last post, when I am progesterone dominant I seem to lose executive function to too much abstraction, navel-gazing and anxiety and, when I am oestrogen dominant, I can manage it to a point but it goes right out the window when I become highly overstimulated.

More important than work prowess is that I don’t even take care of myself well when my executive function is “down”. I can think to myself “I need headphones and music to keep myself distracted from triggers” so I get my headphones, diligently put them in my ears and continue what I was doing…only to realise, many hours later (and, by the way, this indicates I also forgot to get up and move the body, refresh my drink or to the bathoom…) to discover I forgot to put on any music. It’s as though the intention stalls half way through the very process of actioning it.

The other thing is, if hormone imbalance leads to overstimulation because I become more sensitive to stimuli (as per with oestrogen dominance) then that, of course, makes me seem a whole lot more autistic, to myself and others. Having to withdraw and avoid a lot of things (places, foods, crowds) does not easily pass as “normal” and makes me want to withdraw into my inner sanctum. This is less of a case of feeling emotional (in the same way of that other account) than feeling irritated and I just want to be left alone at such times. I guess you could say, its burn out more than melt down.

Equally, too much progesterone and I can be away with the fairies, by choice, for long periods of time, and that also passes as autism. At that progesterone end of the swing, I tend towards emotional meltdown and can even feel borderline depressed. In other words, I can become more emotional and ruminatory than usual during progesterone highs, as per the known effect of PMT, which is a different effect to the high irritablility of oestrogen because I’m far more likely to take things personally or ruminate over my own failings, becoming anxious, under the high-progesterone effect. You could call this subjective or emotional sensitivity compared to the objectified, external-source sensitivity of the oestrogen effect.

Scientists propose that the reason progesterone affects mood like this is because of its effect on GABA receptors in the brain. I already talked, in previous posts, about the significance of GABA in autism and how supplementing it is thought to mitigate some of the most challenging autistic behacviours (I find this helpful too). Andrea Rapkin of the University of California suggests that in premenstrual dysphoric disorder (PMDD), progesterone alters the shape of GABA receptors in the cerebellum, making it harder for GABA to bind to them and damp down anxiety (Why women get anxious at that ‘time of the month’ | New Scientist). If GABA is so important in autism, making it harder for it to complete its task is not going to help. However, to confuse matters, another study confidently states “Progesterone, especially allopregnanolone, potentiates GABAergic synapses through GABA A receptor activation, increasing the openings of GABA-gated chloride channels (95) and thus inhibiting synaptic transmission (9394). For this reason allopregnanolone has been attributed as having anti-anxiety effects similar to those of benzodiazepines and other positive modulators of GABA-A receptors (9697)” (Steroid Hormones and Their Action in Women’s Brains: The Importance of Hormonal Balance). Certainly, the natural progesterone cream I use claims on their website “One of the little known effects of progesterone is that it has a calming effect by activating the GABA receptor sites. GABA is our most calming, inhibitory neurotransmitter and effective against some forms of epilepsy”. Confused by the apparent contradiction in this information? This is extremely confusing territory and science still has a way to go.

By the way, how is PMDD different to standard PMT? Apparently (UpToDate) its much more severe: “Common symptoms include anger, irritability, depression, and internal tension that are severe enough to interfere with daily activities.” Hmmm…I feel lot like this when I’m having a progesterone-style health crash of the kind that has me way too soft and painful in my joints to get off the sofa, thus I become overly fixated on some highly-cerebral or repetitious task that has me locked down in deep tension and borderline aggressiveness if anything, or one, should interrupt me. I can also dance with the edges of existential crisis at these times and, if I didn’t have my interests and my family, my faith in a bigger picture and strong sense of the sacred to keep me buoyed, I suspect I could very easily tip over the edge when progesterones are coming on too strong (yes, even now I’m menopausal because of the fact I used natural progesterone to mitigate pain, as per my last post). In other words, getting it just right is essential to my ability to function well as a human being. I seem to take “ordinary” side effects of hormone imbalance to a new extreme, resulting in meltdown and physical disability, which is why I know hormones are a crux-matter to me. Yes, I suspect this is an autism thing!

Why, by the way, would autistic people take ordinary side-effects as experienced by most people in response to hormone fluctuations and exagerate them to a whole other, almost pathological, level (such that my responses feel like they directly feed into my autistic traits, my fibromyalgia pain and Ehlers Danlos Syndrome and even my allergies and intolerances, thus, IBS, PoTs and a whole lot of other things besides)?

Well, if an (ever rife in our modern world) state of oestrogen dominance 1) potentially affects autistic people more often because of our increased sensitivity to even subtle environmental and food exposures and then 2) flips us more vehemently into “male type brain” behaviours (which is what I notice) then there is a compelling argument that austism can lead to a stronger hormonal effect. Add to this our particular struggle with variables and transitions and, suddenly, the menstrual cycle becomes a living nightmare, only to be swiftly followed by all the confusing vagaries of menopause.

Did our autism, potentially, start with hormone (over)exposure at a very early stage of development?

Studies are showing that, indeed, “prenatal oestrogens contribute to autism likelihood, extending the finding of elevated prenatal steroidogenic activity in autism” (Foetal oestrogens and autism | Molecular Psychiatry).

Yes, its a strongly heritable genetic trait but prenatal hormone exposure is certainly being touted as an epigenetic factor. How or why my mother may have been more oestrogen dominant when I was in the womb, compared to 8 plus years earlier in the case of my siblings, is left to my own speculation but she was a 40 year-old overweight female (excess weight is known to cause oestrogen dominance) exposed to a range of oestrogenic environmental factors I could list, and that probably played a part.

If I had to summarise what the hormone pendulum feels like to me, since I live on it, its as though I vacillate between extreme female brain and extreme male brain traits which, interestingly, is the finding found in studies looking at male autistic brains…both of these traits light up in different parts of the same brain of those males studied. To me, it feels like the part of the brain that lights up and takes over in me, sometimes a little too strongly, is dictated by hormone exposure, the variation of which can cause disorientation from the feeling of extreme inconsistency in my motivations and abilities, even before my various chronic health issues start to join in with this highly overwhelming state of affairs. In other words, I struggle to predict how I will perform from one day to the next and my abilities, moods and desires feel like they are in a constant flux. This made my monthly cycles into a nightmare for a lot of years since it would feel as though my very fixations, priorities and personality type would switch, on top of all my other symptom vagaries on the hormone shelter-skelter ride. I was, frankly, glad when my periods stopped once and for all and have felt, somewhat, more settled ever since…though with the trade off of significantly worsened health.

Its telling that studies conducted by Belinda Pelizer flagged up how the feminising effects of certain birth control pills affected the facial recognition skills of people taking them, increasing this ability (difficulties with facial recognition is a known autistic trait and one that I share). However, most birth control pills have a masculising effect, remodelling women’s brains to enhance male traits such as spatial awareness whilst making them less empathic and articulate. When you are autistic, this kind of gender emphasis is the very last effect you need more of!

My own experiences on the birth control pill, of which I tried several types as they all caused unpleasant side-effects, were problematic and, in hindsight, I felt they had severely “messed with my head”, my emotions and my personality for years, though its so hard to evaluate that when you are under their effect. It was mostly stark to me how much better I felt when I came off them after about 9 years. It was like coming home to regain a part of me that had been absent as the effects wore off and I thrived for the next few years, becoming stronger and more centred in my own skillset and personality traits, enjoying the best of them more than I had managed for most of my adult life. I never returned to using the contraceptive pill after that, refusing to go back to those horrible, wholly undesirable effects, even though (at the time) I could never quite pinpoint what it was they did to me except that I felt “off” and couldn’t find my comfortable place. Could it be that being on the pill accentuated the worst of my autistic traits, emphasising my struggle areas whilst compromising my unique strengths? I think so. The type of progesterone used in the pill is a synthetic form called progestin which has a link to autism. New studies indicate that pre-natal exposure to this is associate with ASD (Prenatal Progestin Exposure Is Associated With Autism Spectrum Disorders). There are too many coincidences here to ignore; not saying that we were all exposed to progestin but that there is a clue in that, pointing towards a heightened sensitivity to hormone balace that is embedded somehow in the autistic brain.

Please also hold in mind that it is exposure to progestin (a synthetic creation) that is being associate with autism here, not natural bioidentical progesterone cream as used by me. Exposure to testosterone in the womb is also being linked to ASD, and (as I said in my previous post) progestin is more of a close cousin of testosterone, being derived from it, than being progesterone per se. The same study referred to above continues: “autistic women have elevated androstenedione levels, the precursor to testosterone” (Foetal oestrogens and autism | Molecular Psychiatry), so this could be another weak spot. As before, progestin is a derivative of testosterone. Yet it is exposure to oestrogen that seems to be the bog contender, potentially leading to male-type brain development, as per the study refered to in this article:

“High levels of prenatal oestrogens were even more predictive of likelihood of autism than were high levels of prenatal androgens (such as testosterone). Contrary to popular belief that associates oestrogens with feminisation, prenatal oestrogens have effects on brain growth and also masculinise the brain in many mammals”. High levels of estrogen in the womb linked to autism — ScienceDaily

So, if genes plus prenatal epigenetic exposures to hormones is a potential route for getting there, what (if anything) can rebalance hormone exposures during the course of an autistic life? Surely its supplementing with a natural, bioidentical, version of whatever is out of whack…but cautiously, not in a ham-fisted one-size-fits-all manor, keeping a close eye on the effects (we do tend to be hypersensitive, after all).

Is the natural progesterone cream approach (which still exists mostly on the fringes due to the dominance of patented synthetic hormones) being trialled, at all, for autism? I found this protocol, using 5% progesterone cream, devised by Dr Michael E Platt, as explained in his own words:

“the brain uses more sugar than any other part of the body. However, the creative brain requires much more sugar than a “normal” brain because it is more active. Accepting the fact that the autistic brain represents an exceptional amount of creativity, then one would also have to accept that the autistic brain requires an exceptional amount of sugar to fuel it. Because of this need for high levels of sugar, the body continuously pours out adrenaline to raise sugar levels for the brain via a process called gluconeogenesis.

My approach to treating these children is simply to lower adrenaline levels in the brain. To accomplish this I recommend using a 5% transdermal progesterone cream to help control insulin and adrenaline, and a diet that includes large amounts of low-glycemic carbohydrates, especially green vegetables, in order to provide a steady supply of fuel for the brain. Once adrenaline is lowered, the mind will stop racing. The lowering of adrenaline also prevents over-stimulation from sensory input, allowing the children to communicate more effectively. In addition, I would recommend certain supplements, including digestive enzymes to help with digesting the vegetables, coconut oil and vitamin D3 for the brain, and a B vitamin supplement. Several of my patients who were mothers of autistic children followed this protocol for their children and saw dramatic improvement”.

Autism: A Revolutionary Approach to Treatment – PUT OLD ON HOLD Journal

As ever, it’s a balancing act. Too much progesterone and I’m back into those alreaded noted extreme “softening” effects (which include worsened EDS symptoms) as per the experiment in my last post. Also, progesterone is a precursor to testosterone which might (I suspect) be an autistic trigger (as it is in the womb), especially if it really is already higher in autistic women, as well as having other adverse effects. For instance, it can cause frontal balding in women, an issue I’ve had for a few years now where a terribly fragile and sparse patch of my hair is only hidden by the sweep of my parting (and all attempts to thicken this with supplements, tonics and diet have gone absolutely nowhere). Also acne, which I have had an increase of over the recent phase of experimenting with increased progesterone dose. The fact is, I know I have to be very careful indeed not to overdo it in either direction but I do have to continue to play this game because, without the right hormone balance for me, I find myself in such pain and limitation its not sustainable or acceptable to me; not when I know I do far, far better in my health and quality of life when I get it just right.


Disclaimer: This blog, it’s content and any material linked to it are presented for autobiographical, anecdotal purposes only. They are not meant as advice. They are not a substitute for medical advice, diagnosis, treatment, or prescribing. The material and opinions shared are anecdotal and should not be considered to be medical advice or diagnosis. This article does not constitute a recommendation for the treatment or choices described and the effects related are my own anecdotes, not a prediction of how anyone else might respond. I do not advocate taking any of the supplements referred to or following any of the choices or steps outlined and suggest that you conduct your own enquiries with medical advisors. Please consult with a licensed healthcare professional if you have or suspect you might have a health condition that requires medical attention or before embarking on a new treatment plan.

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