It’s either my alarm clock or 5.1 speakers, both of which would be somewhere over 20 years old.

Follow international medical guidelines (i.e. WPATHv8) as a baseline, actually listen to trans people, and be willing to deviate based on patient need.

Have the trans community involved in governance in a non-tokenestic way, e.g. seats on the board.

For me I noticed minor benefits after 4 days, and it took about 2 weeks for it to more fully kick in.

Personally the other side effects ended up with me going off it. The focus benefits stayed, though the low mood it turned out it was causing took 3 weeks to go away after I stopped.

my male genitals are not working well

This is a common side effect.

For estradiol pills, patches, and gel are your options if you can’t do needles.

Pills aren’t recommended for over 45s or those with a history of blood clots, due to increased risk of blood clots.

When I was on it I found it helped with distraction, but not task initiation, and the various dosages made no difference. Given that and some of the side effects I ended up going off it.

Guanfacine handled the task initiation for me, but not the distraction.

The downside is that the adverse effects of the meds can prevent you from being able to do much, so its about finding just the right dosage for your body.

In my experience it is still possible, and you can even get a bit more control as to what you hyperfocus on.

I know the feeling of medication sucking, I’m 11 months in on finding the right medications and think I’ve finally hit the end of that journey. My body is weird in fun ways including, it turns out, being extremely sensitive to stimulants. The first bout of tachycardia was not fun, but by the fourth one it’s more an annoyance on the pathway to finding the right medication. These days I even need to be careful if/when I have my single cup of caffeinated tea per day. For me 3mg Intuniv and 5mg methylphenidate hydrochloride instant release in the morning seems to be optimal, the former for task initiation the latter for distraction. The methylphenidate often is still working through to the following morning.

I got to my late 30s before even realising I had ADHD (the gender dysphoria I also didn’t realise I had didn’t help), and by then had independently developed basically all of the standard coping strategies:

• I always update my calendar with events, for example booking my next dental appointment is in there as a recurring event
• I have a big todo list always open on my computer to add things on, both to page out things from my brain and to track things I want to do (with deadlines where there is one). This will often duplicate the calendar events.
• Internally, even with the above I still fret about not missing events. So it is extremely rare that I will miss an event.
• I have a running shopping list on my phone, great for ensuring I don’t miss something. Or buy something I’ve already gotten a replacement for.
• I have a reasonable food/groceries stockpile, so even if I forget to buy say flour I’ve pretty much always an extra bag which’ll give me a few weeks/months grace
• I keep some easily cooked frozen food in the freezer for the days I’m just not up to cooking properly
• I avoid buying food which I know I’d snack on excessively
• I will place things so I remember tasks. If I need to say wash my clothes, I’ll leave the basin out on the kitchen table to remind me.
• The only bills I don’t pay automatically are ones where the provider doesn’t offer that
• If my brain gets distracted and I move off a thought/task, my brain cycles though things fast enough that I’ll usually come across it again within a few hours and then handle it - plus remember that I forgot it so will be more driven not to get distracted again

One of the issues I face is that if there something that I feel must be done (e.g. take my meds, following some of the above coping strategies, or do some specific work with a deadline) I will do so via sheer force of will even if that ends up harming my mental health. I am a bit better at managing my workload these days.

The fact that despite all of the above strategies and being objectively and outwardly very successful, that ADHD was clearly a major detriment to my life and mental health is why I aggressively sought medication.

Realising that ADHD was the culprit for many of my behaviours also helped, so I now roll with my brain jumping all over the place rather than beating myself up over it and other ADHD behaviours. So for example if I have an idea for doing something that’s stuck in my mind, I’m just going to do it and not try to force myself to do the task I was “meant” to do.

I hope some of that is useful to you.

I’m vaguely in a similar boat, I had developed basically all the ADHD coping strategies and seem to have masked very well. I basically force myself to be organised so I don’t for example miss appointments, and not necessarily in a healthy way.

I only realised I had ADHD about a year ago in my 30s. I got the diagnosis in the end, and medications have been helpful though we’re still working on finding just the right combination.

If the medications help then that’s good, and if not hopefully something else will.