#491 The Libido (and Sanity) Landmine with Mandi Dixon

Summary

Shameless Sex Podcast #491

The Libido (and Sanity) Landmine with Mandi Dixon

Release Date: June 23, 2026
Hosts: Amy Baldwin & April Lampert
Guest: Mandy Dixon, LPC – Counselor, EMDR Therapist & ADHD Executive Function Coach

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Episode Overview

This episode delves into the complex intersection of perimenopause and ADHD in women, with a special focus on how hormone fluctuations can impact mental health, libido, relationships, and daily life. Hostesses Amy and April—both of whom experience these challenges—are joined by expert therapist and coach Mandy Dixon to unpack why this topic is so rarely discussed despite its deep impact on millions. Listeners gain practical tools, validation, and honest conversation about thriving through perimenopause and ADHD.

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Key Discussion Points & Insights

1. Personal Experiences Spark the Conversation

• Amy and April express that the topic deeply resonates with them as they experience perimenopause and ADHD symptoms firsthand ([00:55]-[03:39]).
• Mandy Dixon shares her journey as a mom, woman, and therapist discovering her own ADHD diagnosis and subsequent outrage at the lack of awareness around perimenopause and its mental health impact.

  "I went on a deep dive and learned all things... And then I was outraged that nobody had told me, as a mental health clinician, about this, which greatly impacts mental health."
  — Mandy Dixon ([11:24])

2. Definitions and Distinctions

• Perimenopause: The multi-year transition when ovarian hormones fluctuate wildly, leading up to menopause (technical menopause is just one day after a year without a period).

  "I feel like it should be more like retirement, not failure. It should be, yeah, glamorous retirement." — Amy ([16:05])

• ADHD: Often underdiagnosed in women; historical research focused on hyperactive boys. Discussion of inattentive vs. hyperactive subtypes and gender bias in diagnosis ([18:01]-[19:32]).

3. The Perimenopause-ADHD Compound Effect

• Mandy explains why ADHD symptoms feel more severe during perimenopause:

  • Estrogen directly impacts dopamine regulation—a key issue in ADHD.
  • Wild hormone fluctuations destabilize women’s hard-won coping mechanisms.

  "It can just be a roller coaster of symptoms. It's hard because some days you feel fine and other days you feel terrible and you can never really pinpoint what it is." — Mandy Dixon ([20:12]; repeated from intro at [00:00])

• Women "fall apart" exactly when they're expected to hold it all together; those most put-together are often hit hardest, creating identity friction.

  "It's the high functioning, the women that hold everything together, they look really great on the outside... they have built these little elaborate coping mechanisms..." — Mandy Dixon ([25:53])

4. Sex Drive, Emotional Regulation, and Presence

• Discussion about how ADHD impacts sex and libido, especially during perimenopause.

  • Testosterone can help some, but everyone is different.
  • Emotional dysregulation in ADHD can make it hard to connect sexually.

  "If one of your biological design already struggles with presence, then that is going to affect sex..." — Amy ([24:48])

• Amy and April both note testosterone treatment improved their mood and libido but acknowledge that body-mind disconnection and mood swings still challenge desire and sex.

5. Practical Tools & Everyday Coping Strategies

• Body Doubling: Working alongside another person (virtually or in person) increases focus and accountability when tackling boring or daunting tasks.

  "Just having somebody there physically ...not only like accountability, but it keeps you focused on what you're doing, even if it's boring." — Mandy Dixon ([30:35])

• Hosts share personal tools:

  • Amy uses music to anchor focus.
  • April finds bilateral/binaural beats helpful for focus and sleep.

• Mandy describes her toolkit for mental steadying:

  • ADHD medication
  • Hormone therapy (including antidepressants, especially as a “buffer”)
  • Prioritizing sleep, regular meals, daily movement, and therapy
  • Embracing new supports (“letting go of the shame that I need extra tools now... that all helps.”) ([36:30])

6. Navigating Diagnosis and Healthcare

• How to seek ADHD diagnosis: Start with your nearest doctor, ask for an assessment, and be aware of varying protocols by region ([38:48]).
• Mandy offers "provider prep talk" coaching to help women advocate for themselves at the doctor: preps scripts and strategies for getting heard ([44:01]).

7. Menopause & ADHD—What Comes Next?

• Research suggests stabilization post-menopause might improve symptoms, but Mandy and hosts note that many women don't feel significant relief.

  "Theoretically ...your ADHD symptoms improve. ...Every woman that I've talked to in menopause says that is not true, that it gets worse, or some of them have said you just get used to it."
  — Mandy Dixon ([40:38])

8. Libido Q&A: The Ball Dilemma ([04:05]-[09:41])

• A lighthearted, honest response to a listener’s anxiety about pleasuring her partner’s testicles.
  • No obligation to fit both in your mouth; one is fine or just use hands.
  • Communication is key—ask what feels good!
  • Use lube (Uberlube recommended) for manual play.

  "When I put my mouth on balls, I'm doing maybe like, a light suction on one side... but I'm not, like, trying to, like, swallow them necessarily." — Amy ([05:04])

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Notable Quotes & Memorable Moments

• On being seen:

  “I felt normal and almost broke down crying a couple of times because the things she was saying I could relate to so much.” — April ([01:42])

• On shame and coping mechanisms:

  "You never really get anything done. You're fucking all over the place. So it's spiraling." — April ([27:36])

• On asking for help:

  "Letting go of the shame that I need extra tools now which I didn't used to, and using them, learning them, using them—that all helps." — Mandy ([36:30])

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Resource Timestamps

• Intro to episode context ([00:55]-[03:39])
• Listener Q&A: Ball Handling Tips ([04:05]-[09:41])
• Mandy Dixon’s personal/professional journey ([11:24]-[13:33])
• Definitions: Perimenopause vs. Menopause, ADHD Details ([15:41]-[19:32])
• How perimenopause and ADHD combine ([20:12]-[22:42])
• High-functioning women under pressure ([25:53]-[27:28])
• Behavioral tools and management ([29:18]-[31:14])
• Sensory coping: Music, binaural beats ([35:32]-[36:08])
• Symptom navigation & personal strategies ([36:30])
• Diagnosis & advocacy advice ([38:48]-[44:01])
• Menopause and ADHD research ([40:38]-[41:27])

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Connect with Mandy Dixon and Additional Resources

• Website: mandydixonlpc.com (therapy, Texas only); mandydixon.co (coaching)
• Instagram: @mandydixoncounseling
• Coaching, EMDR, ADHD consultation, “Provider Prep Talk” sessions
• Mandy’s book (in process): Ugly Perimenopause

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Episode Tone

Warm, validating, intimate, and often humorous. Hosts and guest alike blend scientific knowledge with personal vulnerability and real-life hacks—making complex subjects approachable and relatable.

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Bottom Line

Women with ADHD can be blindsided by perimenopause due to hormone-dopamine interplay, societal silence, and ingrained perfectionism. Community, knowledge, personalized tools, and supportive professionals like Mandy Dixon can restore sanity, pleasure, and self-compassion through the midlife whirlwind.

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"We're doing it now. Here we go, walking research projects over here." — Amy ([22:43])

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For full resources and episode links, visit www.shamelesssex.com.

Transcript

[A]

It can just be a roller coaster of symptoms. It's hard because some days you feel fine and other days you feel terrible and you can never really pinpoint what it is.

[B]

Why isn't anyone talking about this?

[C]

I'm Amy.

[B]

I'm April.

[C]

Certified sex educators, sexperts of the year and best selling authors.

[B]

And we're on a mission to help you have more spicy, connected and amazing shameless sex. Welcome to the Shameless Sex revolution.

[A]

We're so close, it's like we have

[B]

our own language, making sex and relationships shameless.

[C]

To learn more, go to shamelesssex.com and

[B]

for 15 off some of our favorite sex toys, use code shameless sex. @PurePleasureshop.com you are listening to a pleasure podcast.

[A]

For more from our sex podcast collective,

[C]

visit pleasurepodcasts.com well, hello everyone.

[B]

Hey everybody.

[C]

Welcome back to Shameless Sex. This episode is with Mandy Dixon. And selfishly, we chose this because it speaks to us is perimenopause and adhd.

[B]

I think it speaks to a lot of people.

[C]

It does. Well. And even if you're not adhd, the perimenopause part will. If you are inevitable, a pussy owner who is going to live past age 35.

[B]

Yeah.

[C]

And if you're a fan of pussy owners who are going to live past age 35, you should listen to or ADHD people you're in a relationship with. Someone you have ADHD, just listen.

[B]

I think it might apply to most folks out there somehow. Maybe it's not your partner, maybe it's someone that you know. So.

[C]

Yep.

[B]

What did you enjoy?

[C]

You. Because since you and I both resonate with so much of this, what tools are you using from this podcast, Jibo?

[B]

Well, first of all, when I saw the topic, I was really excited and nervous because I didn't know if I would get enough information or feel seen. And I was pleasantly surprised and also felt normal and almost broke down crying a couple of times because the things that she was saying I could relate to so much. And so I've been utilizing some of the tools and I don't want to spoil it for everyone, but there was something that I believe because we're recording this and the episode hasn't aired yet, so I haven't listened to it again since we recorded it. But it was called either mirroring or shadowing. Having a person while you're working next to you with you. Either someone that you know that you can work with, not maybe even doing the same thing. But I've used that with some Friends doing work. Because I'm in my office all the time doing co working. Yeah, it's like co working, but it kind of helps you be more accountable and so you don't get distracted.

[C]

No less than squirrels.

[B]

Yes. And it's. You'd think that your dog could help you. It's not true. My dog is more of a distraction.

[C]

Yes, I've seen that.

[B]

That's an applicable tool. And this is about sex as well. You'll. You'll see or you'll hear some of the things that Mandy talks about that are helpful to apply to your sex life and to have more sex and even like more embodied sex and pleasure. So that was great. But I think that as a person that is ADHD from a young age, and then having it spiral into something that's even more. You can tell how ADHD I am the older I get unmedicated. It's sort of. It's empowering to have her and her research and expertise in applying it into my day to day life. Now people out there listening. Maybe you're not experiencing ADHD symptoms as a human yet, or maybe you don't realize that you are. She runs through what some of the symptoms that can present in your life that you will know. You might want to seek professional help or tap into some of the other tools that she provides. So what about you? How did you take anything away that you want to share?

[C]

I learned that it doesn't get easier in menopause. That was one of my questions. I was like, if it's so hard during perimenopause, wait, is there hope? And during menopause she's like, the answer is not looking so good. So, yeah, stay tuned. It wasn't guaranteed that it was worse. Like, for some people it might be. But yeah, I found it very fascinating. So stay tuned, everyone, and listen and learn. You ready for a sex question?

[B]

I think so. It looks like it's a quick one. Short and sweet one. Okay.

[C]

It's about balls.

[B]

Oh, I love. I love balls. Just like my dog loved balls. Balls too.

[C]

I have a dog that needs to lose his balls. Oh, shoot. Get neutered soon. Okay, here we go. My boyfriend says I don't touch his balls enough. I'm not very experienced with the balls, let alone blow jobs, and his are pretty big. Am I supposed to get them in my mouth? Any tips to make me more confident? I love.

[B]

Am I supposed to get them in both of them? You can't force anything in there. And it's, oh, my God, my mouth

[C]

could never fit my partner. Both of his.

[B]

Yeah, your partner has.

[C]

His are huge. Yeah, they're gigantic. Oh, my God. I would. If I. My mouth would need to be, like, three times the size.

[B]

I've never fit two balls into my mouth. Just. Just saying one ball, maybe.

[C]

Yeah.

[B]

But two at the same time. I have a small mouth, so I'm wondering if this person's balls are that big.

[C]

Well, and then, like, there's no. But there also is no. Like, no one says you're supposed to put both balls in your mouth. No. So we just answered that question.

[B]

1. If one can't fit either, it's okay. You could use some cupping and some lube on your hands.

[C]

When I put my mouth on balls, I'm doing more of a. Like, I'm not, like, suctioning in a. Because balls are super sensitive for the. We're going to talk to this person as if they're new, because they're very new to balls. So balls are really sensitive as, you know, like, if penis owners get like, any little nudge in the balls, like, oh, my God. Right. Not all of them, but I have definitely seen that response. And. And they have a lot of nerve endings. And so this is an area that apparently your partner wants them touched. But there. There's like, a caution around it because they are extra sensitive. So when I put my mouth on balls, I'm not like. I'm doing maybe like, a light suction on one side of. Of a ball. That sounds funny. I have the testicles, and then sometimes I'm, like, using my tongue to massage or something like that. But I'm not, like, trying to, like, swallow them necessarily. It's like I'm trying to stimulate them from just, like, one side, sometimes the undercarriage of the ball, sometimes the other side. But I don't. I don't have. You don't have to, like, put your mouth all over the entire ball sack.

[B]

You could probably use your tongue and just lick the balls a bunch. Yeah, might be.

[C]

You know what's nice undercarriage, because it connects to the perineum.

[B]

There you go.

[C]

Yeah, that. That area there, too.

[B]

Your hands are also a hell of an apparatus to utilize.

[C]

Hell of an apparatus.

[B]

Hell of an apparatus. You can mimic a lot of what you do with your mouth with your hands. And I would say use lube when you're doing that, because skin on skin, without any lubrication, without any lubrication could be challenging.

[C]

Yeah. Uber lube's great for all kinds of sex. Also, though, oral, because if you're using it and you get your mouth there, it has no flavor and no scent. So definitely because there are lubricants. When you get your mouth in the area, all of a sudden tastes like chemicals. That's a lot of lubricants, actually. So uber lube. Great for all kinds of sex. When I use my hands on balls, usually it's just one hand. I will hold them and kind of move them around, like in a circular motion. Like those stress balls that you can buy like in Chinatown. Just moving, not squeezing. Like. Like jumbling. Like jumblies.

[B]

Like finger. Like each individual finger kind of is there.

[C]

Yeah, they're kind of like tapping around to just kind of like create some movement around it. Like a massaging motion. Some people do like their balls held or almost tugged. But if you're doing that, you're taking. So maybe it's your thumb meets your pointer finger. You're wrapping that between where the body and the testicles are. So there's like. It feels like there's open tissue there. And so you can kind of squeeze there and then put your ear. So your hands are around the testicles and you can lightly pull down. But this just depends if the person's into it. But some people really like that pressure. And fun fact, when you do that, it can postpone or delay. Sorry, same thing. Ejaculation. So if that person's like, I'm going to come soon, but I don't want to, or you don't want them to, with consent, you can do that and it will temporarily postpone ejaculation.

[B]

I wonder if there's some. There's gotta be great toys out there like a cock ring or something that you could put even big balls in when they're. When there's no erection. And if. If the vibration. I don't know this the answer to this, because it depends on the human. But if the vibration would help him feel stimulated enough while during maybe a blow job or they're. They don't really. They're not saying if they're doing blow jobs, but maybe that vibration would be a stimulation that you wouldn't need the mouth. Yeah, that would feel nice. You could try.

[C]

Well, fun fact, we are recording another intro after this. And. And so you haven't seen this yet, but the intro has a testicle monial from someone who's using the magic wand. Wand on their balls.

[B]

Well, there you.

[C]

So there you go. Right? So the magic. Yeah, there you go. The magic wand. We love it. It's April's favorite toy for her own clitoris for a long time. We also use it for massage, but penis owners can use it also around or under the balls, especially on the taint can feel really nice. So it's a great tool for that.

[B]

Is it on neck? My neck. Because my neck gets so tense.

[C]

So I have one in my bag right now if you want to use it.

[B]

We have many ones and there's lots of different sizes if you don't want the.

[C]

But oh, waterproof though, because that way, like why not? It's ten times more powerful. You use it in the shower or the bathtub and you know it's, it's worth it.

[B]

It actually has a quieter vibration as well. Because a lot of my old school ones I love, but they're. You can hear them in the other room like I'm using a vacuum. And the waterproof has this deeper rumble that is more quiet.

[C]

It's fantastical. Uh huh. I did that for the testicles anyways. I mean the balls. So in summary, the balls, the balls, they're not that complicated. They're super sensitive and also communication. If you're new to putting your hands or mouths on testicles, on a testicle owner, as you start to do, ask them, how's this? More pressure, less pressure or show me what you like. Maybe they can show you on their own balls. That will definitely help you. And if you would like to try this here magic wand, maybe some uber loop, I don't know, you can go to PurePleasureshop.com use coupon code Shameless Sex. You get 15 off those and any toys on that website.

[B]

Yeah, that's a good savings. Everybody needs to save some money right now. Balls, balls, balls, balls and balls. Okay, so are you ready for the bio balls? All right. Mandy Dixon is a licensed professional counselor, EMDR therapist and ADHD executive function coach based in Allen, Texas. She specializes in the intersection of ADHD and perimenopause, a combination that is dismantling the lives of women who spent decades of being called fine. She's been featured in USA Today and Good Morning America and she's currently writing her first book centered on ugly perimenopause. To learn more, go to Mandy Dixon, LPC.com Balls.

[C]

All right, everyone is interview time. And we are here with Mandy Dixon and we are talking about two things that are double whammy that April and I both deal with. One being perimenopause. And we have done an episode that was just all about perimenopause. And I know it's a hot topic out there right now. Perimenopause, perimenopause. So if you're perimenopause and you don't have adhd, still listen or you're going to be a perimenopause or you have friends that are perimenopause or a partner so you can better understand them. And this one, we are linking this to adhd. So we're talking about perimenopause and ADHD and what nobody warned you about. So before we dive deeper into this topic, you already heard a little bit about Mandy in the intro in the bio. But Mandy, welcome to the show. And can you please tell us and our listeners a little bit more about how you got into the field of therapy, sexuality, all the things.

[A]

Well, thank you for having me. I would say that I was just a regular therapist, you know, just kind of when you start out, a lot of times you just kind of look for, you know, what interests you. And some people specialize in things and some people just kind of stay more general. But my son was diagnosed with ADHD right early on in my career. And I wanted to just learn more about that, just to be a better mom and be able to support him better and felt like I just wasn't trained enough on it. I went on a deep dive and learned all things. Then later on I got diagnosed and I was just outraged at, you know, how this looks in women, you know, why this wasn't being talked about more. I didn't believe it at first, I'll tell you that. It took a little bit of convincing. And then, you know, I was working with ADHD kids mostly in my, in my practice, and I started feeling off myself. I couldn't figure out what it was. I was going to doctor to doctor to doctor, just like you hear every woman in perimenopause, the same story. Couldn't figure it out. And finally I realized it was hormones. I understood perimenopause. And then I was outraged that nobody had told me as a mental health clinician about this, which greatly impacts mental health. So I decided to learn about perimenopause and menopause. And again, when I focus, deep dive and learn all the things, never thinking that the ADHD would like really come together with this. But I found that a lot of women who are late diagnosed, and those are early diagnosed struggle too. But there's a different kind of struggle that the late diagnosed have where they just never really learned what ADHD was or learned any of the coping strategies and so they had that shock. And then the women that had been diagnosed with ADHD had perimenopause. And it's. The symptoms seem to be very, very strong for, for women with adhd. So I just started talking about my own experience online as a professional woman and just kind of started working more and more and more with these women.

[B]

I'm so excited to talk to you about this because it is very much so a part of my life. Adhd, add, and some folks take out the H for hyper. I think it's hyperactive, and I'm definitely hyperactive. And since I, I think I, I was diagnosed when I was. I think it's six or seven really young. But my mom never wanted to medicate me, which. Right. Because my brother is also ADHD and so is my dad. My mom is not. But it wasn't very common, I think, back in the 80s for a lot of girls to be considered ADHD. And so there were, I don't, I don't think there was enough research, but I never took medication until I was, was, I think in my 30s. But I felt like it made me a robot and it sort of took the soul out of me. So I now I'm on medicated. And so the symptoms, they are so present because of perimenopause. And the medication helped a lot, but it still, you know, again, was soul sucking. I wasn't like myself. So, yeah, I will say that I'm not saying anything bad about medication. I believe that it can help people. But ADHD living, it can be really burdensome and it can be my company, they get. I like Pipe Dream. Amy, you know, has known me forever, so she is very compassionate to my ways and also has struggles with some ADHD tendencies. But my company at Pipe Dream, they have, they're like, they go like, click, click, click, click, click. Because I go, I go on a lot of tangents like. And the squirrel brain takes over and

[C]

is that how they reel you? But you back in?

[B]

They say, I have a couple of people on different teams, like the E commerce teams, like, click, click, click. I was like, okay, all right.

[C]

Oh, sorry.

[B]

It helps. But I will say that sometimes I know there's different types and I know we're going to talk about this and this is the first question. And sometimes I wonder how far in on the ADHD spectrum, if you will, I am considered. But I want to talk to you more about perimenopause and adhd. So can we first start with getting clear, I guess, on the definitions? Right. What is perimenopause. And then what is adhd?

[A]

So perimenopause is a natural thing that happens to women or people born with ovaries. It's the natural transition from being in the reproductive stage of your life to ceasing to ovulate. So they call it complete ovarian failure, which is kind of a sad thing, but it's.

[C]

That's what menopause is.

[A]

It's when your ovaries are not making eggs anymore and you don't have a period and you. You don't reproduce.

[C]

I feel like it should be more like retirement, not failure. It should be, yeah, glamorous retirement.

[A]

It should. So technically, menopause is one day, that's one year without a period. So that's menopause. Everything after that is post menopause. So that's hard to measure because some women have iud, some women have had hysterectomies. They just don't get regular periods. And so. But technically that's the definition. So menopause is one day. Everything before that or leading up to that is perimenopause. And so it can last seven to 10 years. But we have a little bit of new research on ADHD women that shows they can experience symptoms even before that. So I didn't do the math, but age 35 to 39 is typically the most severe time, according to that new research, that ADHD women report symptoms. So average age in menopause is 51. So what is that, 11 years?

[B]

15.

[A]

11 to 15? Yeah, yeah.

[C]

Something like that, yeah. Longer.

[A]

Like that. It's longer, yeah. Longer, yeah. So, I mean, it's, you know, 15ish years. It can be where you start experiencing symptoms. It typically starts gradually, and every woman will experience it differently. But it's your body. What happens in perimenopause is your estrogen starts to act crazy, it starts to wildly fluctuate, and your progesterone starts to just naturally decline along with your testosterone. But that's more of a slow, gradual. The estrogen will be up really high some months, down low some months. And it's just like a roller coaster. So if you're somebody that is deeply affected by hormonal fluctuations such as ADHD women, that wild fluctuatingness in perimenopause can just be brutal. It really can be.

[B]

And then define, oh, yeah. And then adhd. Remember Squirrel?

[A]

Yeah, yeah, yeah. So adhd, just to touch on what you said earlier about you being diagnosed as hyperactive when you were 6, and that was Rare for girls. The diagnostic criteria that we have today on how to diagnose ADHD was written on research from hyperactive boys, because that's what they studied, because they assumed it was a boy disorder, because the boys were the ones that were causing the ch. And a couple of the hyperactive girls, they were the ones that got noticed. Right. So that's what the research was developed on. But we now know that just as many girls have it as boys have it. But a lot of girls present with the inattentive type. I know you said you're the hyperactive, but there is another type, and some boys present with the inattentive type, too. So they look like daydreaming. I'm thinking this is how it looks in kids. Daydreaming. A lot of forgetting things or kind of disorganized chaos. So it can just look very different in that subtype. And then the hyperactive. What you think of. There's what you think of when you think of a typical ADHD boy. The hyperactive, bouncing off the walls, fidgeting, blurting things out, things like that. So that's the way it looks in kids, but it can look very different in adults.

[C]

So, and then just real quick, why is everyone saying ADHD and not ADD anymore? ADD kind of went out the window.

[A]

So before there was 80. 80, which was attention Deficit disorder, and then there was Attention Deficit Hyperactivity disorder.

[C]

Yeah.

[A]

So they combined it into one disorder, adhd. And then there's different subtypes. There's hyperactive, inattentive, and combined.

[C]

Got it. Okay.

[A]

It's the same thing. It's just the way that you used to refer to it was ad. Now it's all adhd.

[C]

Okay. Yeah. So it's kind of more like broad, like the umbrella term. There's different variations in it. Okay, cool.

[A]

Yeah.

[C]

Okay, so then now putting them together. So perimenopause and ad, like April and I over here, but different variations. So you put the combo together, you already have some hard symptoms with perimenopause. How does the combo affect women having both? And what does that kind of look like versus someone who's just dealing with perimenopause? And that's hard on its own. And why isn't this something that is widely talked about?

[A]

So what we know about ADHD is that people that have this disorder, it's the dopamine part of your brain, which is this prefrontal cortex part of your brain that controls your executive functioning. So those are things like emotional regulation, organization, time management. I Always forget all of them. But things, there's things like that. So the dopamine in your brain helps you with those things. So people with adhd, we don't know that they necessarily have less dopamine, but they, they're not able to use it as well. Maybe they have less. There's no way to measure that. But we know that it impacts your ability, the dopamine signaling. So estrogen, which is your hormone in your body, has it, it directly impacts dopamine. So some women that do have ADHD and take a stimulant medication, they often report that their stimulant medication doesn't work as well a couple days before their period. And that is because the estrogen is low and your dopamine needs that estrogen to work more effectively. So if you are a woman and you have no ADHD medication, you're just, you have ADHD and you're coming into perimenopause, your estrogen is fluctuating wildly, which is affecting your dopamine that your ADHD brain desperately relies on and just never quite uses correctly. It can just be a roller coaster of symptoms. It's hard because some days you feel fine and other days you feel terrible and you can never really pinpoint what it is.

[B]

Why isn't anyone talking about this? Well, we are, but. Yeah, we need more information about why I feel so normal and seen right now for finally.

[A]

Yeah. Well, if you look at the research on ADHD women, they're just, they weren't studied a whole lot. Women in general, right. In health just haven't been studied, especially ADHD women. Like I said, they didn't really study girls. Now they are. But if you think about a woman in perimenopause that just wasn't studied, we didn't even hear the word perimenopause a few years ago. It wasn't just until recently. So they just haven't. There's a little bit of research that's coming out now about girls and women in their hormonal fluctuations. So we can. In terms of ADHD and how that impacts it. So you can put that data with what we know happens hormonally in perimenopause and make some inferences or some infersome things, I guess is a better way to say that. But there's no real hard data because it just happens to been studied.

[B]

Interesting.

[C]

We're doing it now. Here we go, walking research projects over here.

[B]

So I guess my next question and kind of jumping around a little bit, but wondering about how much like the go go go negatively affects sex. Does it affect, does it affect sex drive? Because obviously I'm ADHD diagnosed and I don't necessarily have a problem with sex drive. But that's not to say that other folks don't. So I'm wondering if there's a correlation there and then what is underneath the loss of libido for ADHD women in perimenopause, if that is the case? Maybe because I'm on hrt, that's why.

[C]

Yeah, she's getting. Yeah, you get testosterone. You're doing good over there.

[B]

Yeah.

[A]

You know, I don't study a whole lot about the sex drive and ADHD women or people in general. There are some people that do, and I feel like they're so much better versed in, in understanding that. But I know there is a lot of links and information of when it comes to just sex drive in general, when it comes to ADHD people. But we can talk about what particularly happens to ADHD women in perimenopause. It is those fluctuating hormones that can drive your sex drive. Like, the testosterone is, is the big one. And some ADHD women, they swear by testosterone not only just for sex drive, but for energy, for mood, for brain fog, for focus, for all of that. And then others I've talked to, they're just like, yeah, I mean, it's nice, you know, it's, it's icing on the cake. So it's, it's so individualized. But if you are a. Somebody that struggles with adhd, that emotional regulation is such a huge part of it too. It does not get talked about AS has enough as a symptom of adhd. So if you're having hormones that are directly impacting your mood and you're somebody that has a trouble regulating mood just by nature of having adhd, that can be really hard. And it can be really hard when it comes to sex because you don't know what the mood is or, you know, how to feel calm or how to connect or there's just a whole lot going on.

[C]

Yeah, well, you think of like, so adhd, right? Like, especially if it's like easily distracted, you know, hard to focus sex in itself. When we're, when we're teaching people about how to have great sex, part of it really is being present is a huge, huge part of it. So if one of your, your biological design already struggles with presence, then that is going to affect sex with, you know, what you, with your experience with your own body, your own Connection, your connection to other people and you know, in turn, and then, and I would imagine, you know, libido be connected to that. Like when I don't feel connected to my body, I don't really have a high libido or if I don't feel connected to the people I'm being intimate with. So it's all kind of like layered and connected. And I'm one of those people, probably April too. Like we are on testosterone works really well. I feel more clear, I feel more energized, and also I have a higher libido. So. And then this next question. We are, I think we for these people. So why is it that the women who fall apart the hardest are the ones who look the most put together? Are there any common characteristics of the women that we're talking about here?

[A]

Absolutely. It's the, the high functioning, the women that hold everything together, they look really great on the outside. And what I've seen is that it's almost like they have built these little elaborate coping mechanisms as a way to contain their disorganization or their, you know, bad memory or their lack of focus or their emotional regulation. And it's these little carefully built strategies that they built throughout their entire life. And a lot, it looks a lot like becoming a perfectionist, becoming a people pleaser. Because if everything is perfect, you're never going to get rejected, you're never going to be told that that's wrong. And that can be really hard for somebody with adhd. Or you become a people pleaser where everybody relies on you and depends on you and you're the, you're the good time person. And so when that starts to shift in perimenopause, you just literally, you don't have the stamina, the energy to be able to do everything perfectly anymore, or you don't have the energy to say yes to everything. It's just physically impossible. Sometimes when your hormones start to shift, so that can be a complete collapse. So it can affect your identity because, you know, you've always been the good friend, the good wife, the good spouse, whatever, the good mom, and now you can't do those things. And we find that a lot of times those things are so heavily tied to your identity. When you've developed that as a way to cope with not being diagnosed with

[C]

adhd, you just perfectly describe both of us, April, the perfectionist and I'm the people pleaser.

[A]

A lot of women with adhd, they do become perfectionists and people pleasers, diagnosed or not. It's, it's as a lot of times a way to cope.

[B]

I'm a little of both of those things and it's, it is getting more, it's almost more intense the older I get. And I'm nearly 44 and I feel that in the last maybe two to three, three years I can drop into the fact of how ADHD I am, where I come back into the kitchen and every single cabinet is open and I have like a project here, some plants that I was trying to water, like I'm cleaning something, I'm trying to make an art project. Got my computer like shopping with something and then I'm like vacuuming at the same and I'm like, oh my God, it looks like a tornado went in and spun everything around. And then I have to put like the pieces back together again. And, and thankfully my partner is super understanding and supportive of those moments. When he calls it, he's like, hey, squirrel, hey again, the squirrel. And I'm like, okay, I know I can squirrel out. And it sometimes makes me feel small. And I don't know if you ever get that, Amy, where you have projects going or in your partner will call you out and maybe like you're, you know, your ADHD moment and, and sometimes I'm like, oh, yeah, you're right. But I don't really want to feel like shame about it. But it does have some shame because you never really get anything done. You're fucking all over the place. So it's spiraling. So I'm wondering if folks out there listening perhaps are relating to any of this or maybe they're with a partner that they can see these types of symptoms happening if they don't want to get medicated. Are there ways to treat this? Are there? This isn't a question on the list, but maybe this is something at the end. But wondering about day to day things that you can do to improve your attention and if, if hormone balancing is part of that, but if there's ways that, to combat perimenopause leading to adhd. And if you have any suggestions for,

[A]

for those folks, it's good to look at it as two different things that make each other worse. So look at your ADHD as one thing, look at the perimenopause as one thing and they're going to, they're going to make each other worse. So you can treat ADHD like you said, with medication. That's a good option. And that, that can look like stimulants, that can look like non stimulants. There's a lot of different options to treat that. Or you can go the therapy route where you work on things like how it feels when you get triggered with that shame, how to respond, how to set boundaries where, you know, maybe with you and your partner, where your partner's like, okay, we're going to set you, you can set this boundary where I'm only going to have two projects going at once and I need you to help me, you know, keep that in mind. Something like that. So those are more of like, like behavioral interventions that you could do. And then there's something coaching. I don't know if you've ever done any ADHD coaching. That's more, that's more of those executive functioning strategies like the tips and the tricks and the hacks of, you know, how body doubling, that's one great thing. How to do something that you find really boring and you just. Yeah, you have somebody set with you or virtually and that's a great way to be more productive.

[C]

What is that? Can you explain more about the body, what that is?

[A]

So that is, it's, it's body doubling. It's a technique. It's. People with ADHD have a really hard time doing boring things that they have to do. So body doubling is where you have somebody just either sit with you in, in person, maybe they can read a book, they can work on something. But just having somebody there physically. And there's a lot of body doubling platforms where other people want to do it too. They're doing their own work. Own work. You're doing yours. It's something about just having somebody there. Not only like accountability, but it keeps you focused on what you're doing, even if it's boring.

[C]

Interesting.

[B]

I could use that.

[A]

It's really effective.

[C]

So animals don't count. You need a human.

[B]

He's a distract. Mine is a distraction. Yeah, I need to go out.

[C]

I need to play. Your dog is a squirrel?

[A]

Yeah. My dog doesn't help me get things done.

[C]

No, not at all. Foreign.

[B]

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[C]

Another perk of the magic wand. Waterproof is your shower. Just got upgraded. Your bath, way more indulgent and underwater. The mix of pressure and vibration is dangerously good.

[B]

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[C]

And we love that. Magic Wand isn't trying to be trendy. They've been doing this forever. They just know exactly what they're doing.

[B]

Know what they're doing is putting it lightly. Amy first timers prepare yourselves. Upgraders. You already know what I'm talking about.

[C]

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[B]

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[C]

Can we say uber picky?

[B]

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[C]

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[C]

That's cool. I didn't. Yeah, I didn't even think about it. For me, I recently discovered that just having music on for me and we had someone that was. Did talk about ADHD and sex, but it wasn't perimenopause and adhd. And she was talking about. For different types of adhd, different people, there's different distractions, different things that are like your challenge point. And for me, having music on how. Helps me to focus more and to not like. Because otherwise, if there's like this almost like this empty abyss of space, then my mind kind of wanders and some. And also it invites in more of like wandering into darkness, dark spaces. Like a. Like a low, lower energetic space. So just having any sort of music on is really helpful. Yeah, but April needs a human, it sounds like.

[B]

Yeah, well, I listen to bilateral beats sometimes. That helps me focus.

[A]

I can go on a. I could go on a whole tangent about that.

[B]

Super helpful. Same with sleeping, the binaural beats for sleep because. Because I don't know with ADHD people in sleep, but I did notice some. Some changes and it helps me drift off. So the bilateral and the bi neural have really helped anyone listening out there. The Calm app has it. That's. You can also get them on YouTube though, for free if you want.

[A]

Yeah, that's bilateral stimulation. That's where you activate the left and the right side of your brain simultaneously. It's the same thing we use in EMDR therapy. It's what your brain does when you're dreaming. It's. It's the rapid eye movement.

[C]

Yeah.

[B]

That makes sense.

[C]

The back and forth and connecting things all together. So can I just ask a personal question then for you? For you, since you are a therapist who is, you know, experienced. I don't know if you're in perimenopause or experience perimenopause and adhd. Like, what. What is your protocol for your. And we obviously just talked about like the b. Bilateral beats or whatever. But, like, what is it? Like, what really helps you individually?

[A]

What helps me would be ADHD medication, hormone therapy, something for my mood. Antidepressant. I take that just as a way. It's almost like a. A buffer. Like it keeps those low moods from happening. And I found that that works the best for me, focusing on my sleep like it's a job. Like it is a job. I have to prioritize it over everything, which means sometimes I have to say no to things. Or you know, whatever I have to do, like I have to get to sleep or else, else nothing else is going to work. I try and exercise, if it's not every day at least I take a walk every day, look at least a mile because that is so important. Just moving your body therapy that that helps. Eating obviously is good. It's, you know, trying to eat as a lot of people with ADHD forget to eat or they will go all day and then eat all the things at night. So trying to, trying to be mindful and eat throughout the day because that, you know, affects your energy, it affects your brain power. Those things, I feel like if you don't do them, nothing else really works as well as it could. Eat, sleeping and moving, those are so important to do. And they're often the ones that we forget to do or we just get too busy to do. But try to focus on those and then use the medication as a supplement too. And I think all of those things help me personally. And then the things like learning the extra tools like body doubling or setting a timer or things like that, those strategies I never had to use before, I could just kind of, I don't know, white knuckle it through or something, but I can't anymore and that's okay. So letting go of the shame that I need extra tools now which I didn't used to, and using them, learning them, using them, that, that all helps.

[B]

And how does one go about. Because I know how, I'm in California and the diagnosis came from a psychiatrist because you have to see someone that isn't just your gp, but you have to get a referral from your gp and is that the way if someone's feeling, this episode's resonating with them and they're feeling like maybe they have the ADHD happening in their life, in their life, is that the way to go? Should they get a referral from the doctor and see a psychiatrist or self diagnosis a thing if they don't want to go to a doctor, what do you suggest for folks out there that want to want to know if they're adhd?

[A]

It kind of depends on what you're looking for from the diagnosis. So if medication is something that you are interested in, then you do need a formal diagnosis in order to get medication. If you aren't interested in that, I think self diagnosing, learning, you know, about yourself is perfectly fine. A lot of women find healing and understanding that route that is, there's nothing wrong with that. Now if you do want a formal diagnosis it's so different in every state. And I don't know if there's listeners in other, other countries, but it's very different in other countries too. So in some states or countries you need to see a psychiatrist. Like you said, sometimes you'll go to a psychiatrist, they'll send you to a psychologist to do testing and then back to the psychiatrist for medication. Some you can go to your regular family doctor, they'll do an assessment and give you the medicine. So it is so different by a state, country. And then actually the doctor that you see, what I tell women, just start with the doctor that's closest to you. If it's your family doctor, your gynecologist, whomever the doctor is that you have an in with, say I think I may have adhd, what would you recommend I do for an assessment? And some of them will say we'll do right here or I'll send you to a psychiatrist. I know they'll do the testing and get you medication or oh, you need to see a psychologist and do the whole testing. So, so yeah, just start with the doctor closest to you and ask.

[C]

Yeah, that's helpful. And also if you don't have someone accessible, there's a lot of. You can see doctors online now for various things. I don't know if they can prescribe the medication for adhd, but there are a lot of options. Okay. We are wrapping up soon. But what about, is there any information about ADHD and menopause? So like anything that we should know when people enter into their over retirement. Yeah, easier. Is there anything that we know about that, that.

[A]

So I, I wish that I could have you. Good news. So the research shows that the symptoms of ADHD get better because your hormones aren't fluctuating wildly anymore. Right. So they're, they're. Your hormones are more leveled out so your ADHD symptoms improve. Theoretically, every woman that I've talked to in menopause says that is not true, that it gets worse or some of them have said you just get used to it. So we don't have enough research to be able to say, but if you're somebody that is drastically affected by the roller coaster, the up one day, down the next, the that then I think you're going to have a much easier time in menopause when everything is stable. But as far as the severity of, you know, brain fog or being distracted, that may not improve.

[C]

I guess this is why Hormones. Yeah, get your hormones checked. And now a lot of doctors are not treating even like looking up it's not. You don't even have to have blood panels. They're treating more to symptoms. Right. So. Which is great.

[A]

Oh, yeah.

[C]

Describe your symptoms. They're like, okay, here's how we can work with you. So go definitely check your hormones whether, no matter who you are, especially when we're like, you know, 35 and up and the body's really changing, like, let's know about our bodies.

[B]

Yeah. I am a big fan, though, of the blood work getting done because I feel like sometimes the doctors go straight to estrogen right away and not the testosterone route. It seems the case with a lot of birth control pills or birth control. And so getting your blood work done to actually see what is happening with your. With your hormones is, in my opinion, really important because I think that you'll get the right treatment faster instead of a longer road to feeling better and more like yourself and an improved version of yourself, really. I feel like I'm a much more. Not only stable, happy, driven, and like even my muscle retention is better with, with the hrt, but I feel like a better version of myself post being treated. And it saved my relationship too. It really did. And it didn't quite help with adhd, but maybe a little bit. Maybe a tiny bit. But the dopamine thing is I can relate to that and I can see how my dopamine fluctuates and it's like chasing the dragon. Like, oh, how do I get that feeling good back? And I. I haven't ever thought about antidepressants or anything, but don't they often

[C]

describe, prescribe Wellbutrin or something? Wasn't that something they tried to get you on?

[B]

Try to put me on Wellbutrin at first.

[C]

Well, Butrin's for so many things. They use it also for, like, I know someone that it was prescribed for nicotine addiction too.

[B]

I have, I have like six or seven friends off the top of my head, girl girlfriends that are on Wellbutrin.

[C]

Yeah.

[B]

And it's helped out.

[A]

A lot of doctors use Wellbutin. Wellbutrin as a non stimulant option for adhd. It's an snri, so it acts a little differently than ssri, which is like your typical antidepressant.

[C]

Yeah.

[A]

Wellbutrin typically doesn't cause weight gain or loss of libido, which SSRIs do.

[C]

Yeah, yeah, we don't. Yeah, we want that libido. At least. I do.

[B]

Well, the good news and the good. This is why it's. It's awesome. This day and age, you have a lot of options. You have the Internet. You have access to even folks that do. I know you do counseling, EMDR therapy, you do a ADHD executive function coach. And I know you're based in Texas. And I'm wondering if people out there listening, if they can, you can tell us more about your work, number one. And then if you have ways to find you the work that you're doing, how can folks get more from Mandy Dixon?

[A]

You can find me on Instagram. I try to post a lot of things on there that's just educational and where you can learn more information. If you're interested in working just specifically with me, if. And you're in Texas and you're looking for therapy, I can see you if you're a resident in Texas, because that's where I'm licensed. If you're looking for things like coaching, like what we talked about, like learning about body doubling or timers or structuring your day, those kind of more forward focus things. You know, I have this issue and this is how I want to solve it. That's what coaching does. And I have a special kind of coaching that I do as well, which is a provider prep talk. So that's if you are getting a doctor to listen to you, you don't know how to communicate to your doctor. You're frustrated because we, we, we've probably all been there where we go to the doctor and we leave and we're crying in our car because we didn't say what we wanted to say or they dismissed us and we were just like, okay, you know, so I hear that a lot from women. So that's an hour and a half with me. We go over your symptoms of perimenopause, all of that adhd. We build you a script of how to talk to the doctor. If you need resources for finding a doctor, we'll walk you through that. That way you can really be prepared to, to be able to go into your appointments and get the care that you need.

[B]

It's amazing.

[A]

And that's just like, that's just a one time thing.

[B]

That's not okay. And Mandy Dicks. It's Mandy with an I. Everyone. Dixon LPC is your website, right? Mandy Dixon, lpc.

[A]

That's for therapy. And then our licensing makes us have two websites for coaching and coaching and therapy. And the other one's Mandy Dixon co. Yeah.

[B]

Okay.

[C]

And then. And your Instagram profile is awesome. That's actually how I discovered you. I was like, she's speaking My language. So if anyone is resonating with the parabens, menopause, and also if it's just perimenopause and not adhd, go check it out. It's a mixture of entertaining, very informative. You have a lot of really cool stuff on there. So thank you so much for the work you do. It's really important.

[A]

Thank you.

[B]

We'll have the links to all of Mandy's Instagram handle, TikTok and her websites on our show notes. So check Mandy out and get yourself feeling good, feeling like your best self. I know that this episode, I've been looking forward to it when I saw it on our. On our roster for quite some time because it's bam, bam. Two things that are really present in my life. And with Amy too. Amy's like, you have to be on this show. Like, let's make sure.

[A]

Speaking to us.

[B]

Yeah, absolutely. So thank you. I feel again, selfishly seen and heard and almost had to shed a tear. I was like, oh, thank God there's someone out there talking about this. So keep doing what you're doing and sharing this, normalizing this with. With not only our listeners, but the world. Mandy, thank you so much. We appreciate you.

[A]

Well, I love it. You know, I've always been called loud and dramatic, and so now I'm, like, using it for a good reason. So perfect. Love it.

[C]

Yeah, it's paying off.

[A]

It's paying off my whole life for this.

[C]

Yeah, we are. We are the. The talkers. We're, like, known for talking really fast and talking a lot, and we found podcasting, so it's perfect, right? Look at us. Look at all three of us doing. Living the dream over here.

[B]

And we. And you know what? To our listeners, we really love you and you help us live the dream of sharing shameless sex with the world. If you rate us, that will help more people find more shameless sex. So give us five stars. We love good reviews. We do read them and we. We love you. So please, please keep listening to Shameless Sex. Tell your friends and check out Mandy Dixon and get yourself therapy if you need it, or get yourself whatever you need. The perimenopause is going to come for some of you, so just be ready, okay? You're going to be strapped in with all the tools that you need. But for everybody out there, we will see you next Tuesday for another episode of Shameless Sex. Ciao for now.

[C]

To learn more, go to shamelesssex.com and

[B]

for 15% off some of our favorite sex toys, use code shameless [e-mail].