When ADHD Isn’t ADHD: The Hidden Role of Low Testosterone in Teen Executive Function
A Story That Might Sound Familiar
Many of us have worked with students who check every ADHD box: distractibility, impulsivity, emotional outbursts, trouble planning ahead, and inconsistent follow-through. Parents come in convinced they know the diagnosis. But sometimes the testing doesn’t line up.
I once heard about a family in that very situation. Their teenage son displayed all the hallmarks of ADHD, yet the evaluation showed he didn’t meet criteria. His executive function challenges were undeniable — impulse control, decision-making, and shifting between tasks were daily struggles — but the ADHD label didn’t fit.
Years later, as a young adult, he sought his own medical care. That’s when the missing piece came into focus: low testosterone. A hormonal factor had been quietly contributing to the ADHD-like struggles all along.
How Low Testosterone Can Mimic ADHD
ADHD is often the first explanation when a teen struggles with executive function. But low testosterone can look remarkably similar. Symptoms may include:
Difficulty sustaining focus
Impulse control struggles
Low motivation and inconsistent effort
Challenges with decision-making and planning
When these line up with EF weaknesses, it’s easy to assume ADHD is the cause — and overlook a medical contributor.
Symptoms and Signs to Watch For
Overlap with ADHD/EF struggles:
Impulsivity or emotional reactivity
Trouble sustaining attention
Mood swings or irritability
Fatigue or “mental fog”
Red flags suggesting a hormonal component:
Delayed or stalled puberty
Slower height or muscle development compared to peers
Ongoing fatigue despite rest
In older teens, concerns with libido or sexual development
Research suggests that somewhere between 2–20% of adolescent males may experience testosterone levels lower than expected for their age. It isn’t the majority, but it’s common enough to keep on your radar when ADHD explanations don’t fully add up.
What Coaches and Educators Can Do
You don’t need to diagnose low testosterone — that’s not your role. But you can play a powerful part in observation and advocacy.
Notice patterns. If a student’s EF struggles look ADHD-like but don’t respond to typical supports, keep that curiosity alive.
Look at the whole picture. Pairing EF challenges with delayed puberty, persistent fatigue, or physical development issues is a cue to suggest medical follow-up.
Encourage collaboration. Share your observations with parents and remind them that a pediatrician or endocrinologist can run simple lab tests.
Keep scaffolding. Continue providing EF supports — structure, planning tools, regulation strategies — while families pursue medical evaluation.
What Parents Can Do
Coaches and educators can also pass along these practical steps to families:
Track observations. Keep notes on focus, motivation, energy levels, and any physical signs (growth, puberty, fatigue). Patterns are helpful for doctors.
Schedule a medical check. Ask the pediatrician about hormone testing, especially if EF supports haven’t been enough or if puberty seems delayed.
Pursue parallel supports. Even while awaiting medical answers, EF coaching and school-based strategies help the teen function better day-to-day.
Stay patient. Executive functions are still developing into the late 20s/early 30s. With both medical and skill supports, growth is still very possible.
Keep communication open. Partner with teachers, coaches, and medical professionals so that the student has a consistent web of support.
Final Thoughts
Executive function challenges can stem from many sources. For some teens, low testosterone may be part of the puzzle. While ADHD is much more common, this hormonal angle highlights the importance of staying open-minded when symptoms don’t fit neatly.
As coaches and educators, your influence is twofold: you help students strengthen their EF skills in the present, and you guide families toward resources that might uncover hidden factors. By equipping parents with steps they can take, you amplify your impact.
And remember: EF skills aren’t set in stone. They continue developing well into the late 20s and early 30s — giving students a wide window for growth when the right supports and interventions are in place.
👉 Call to Action for Professionals: Stay curious, keep notes, and don’t be afraid to raise the possibility of medical contributors when EF struggles don’t quite align with ADHD. Your voice may be the bridge that helps a family connect dots they never thought to consider.
