A thing they don’t tell you when you start amphetamine for ADHD, but they SHOULD, is that what they do is NOT make you function like a neurotypical.

What they actually do is turn you into a person with ADHD with greater capacity.

Sometimes MUCH greater capacity.

And there can be a honeymoon phase when you’re all like, “OMG! I’m saved! I can do all the things now!”

And the risk is that you will use the extra capacity to mask harder and engage in more of the same stuff that was causing burnout.

And then 3-6 months later you find yourself in the same place you started but with an amphetamine habit. Also you can sit still.

I see a LOT of people online who hit the point a few months in where they conclude they have stopped working and start desperately doing meds breaks, long supplement recipes, etc to get back the “functionality”.

And these people, more often than not, also seem to have massive internalised ableism. They never accept their own disability, instead thinking it’s their “duty” to use any means possible to “not inflict my shame on anyone else”.

And using up that extra capacity from amphetamine to do that is a nasty trap because you can’t go back. Ever.

You HAVE to accept what you are.

Just seen someone saying they support bans on trans healthcare for under 18s because “let kids be kids”.

By the time I hit puberty, I had KNOWN for a decade.

I also knew that telling anyone would be profoundly dangerous.

So I hid who I was and, am almost grateful that the neurodivergence gave the other kids something else to latch on to. They were so busy calling me a “mong” that they didn’t notice I was trans.

Because that might have got me murdered.

Or pushed me into a position where I felt I had no options other than the same end result.

So I hid it.

And I hid it really well.

And one of the things that happens when a 5 year old child is terrified of their parents, or their families, or the school bullies finding out who they really are is that they end up traumatised.

A 5 year old child. Traumatised and ashamed.

Ashamed because adults openly talked about them.

Or people like them.

And what they said was horrific. What they said made it very clear that they would regard their own kids as subhuman monsters if they ever found out.

So we hid. And an important part of ourselves died in childhood. A light that should have shone, went out.

I’ve tried my best to rekindle it.

I’ve managed somewhat but it will never be right. Not really. I’ve made peace with that.

“Let kids be kids”. Trans kids like me never got to be.

Because of people who say things like that.

Imagine being one of those academics who realised in the 80s, or even earlier, that software development needed to be an engineering discipline.

And then you watch as the tail end of Gen X and the early Millennials teach themselves to code and some of them you can convince of your worldview.

But they end up working not as engineers or scientists, but as artisans in an industry that comes to depend on them working as artisans.

And then gets greedy.

And then decided it needed a million or more artisans.

And there just weren’t.

And because nobody turned it into an actual engineering discipline you then got an industry of senior artisans with a million idiots working under them

And now the idiots are being replaced with idiot machines that somehow, despite being computers, forgot how to even do arithmetic.

And then the ageing artisans are replaced by the idiot machines redigesting their own multiply ruminated “stack overflow from
2015 in a blender” over and over and over until it’s just whatever the silicon equivalent of drool is.

Imagine being one of the people who tried to prevent this and nobody listened to you.

It must be infuriating.

Have talked to Sylvia’s psychiatrist about the possibility of him prescribing my ADHD meds rather than having to get them from the uk.

The problem is that my prescription is a hybrid Elvanse 70mg, Amfexa 20mg regime and whereas the Elvanse (lisdexamphetamine) is available here, the Amfexa (dexamphetamine) is not.

The latter is literally pharmaceutical grade speed. That’s not hyperbolic. That’s literally what it is. Some countries are a bit funny about prescribing it. Portugal is one such. They were going to before the pandemic but it seems to have fallen but the wayside.

The former is a prodrug which converts to dexamphetamine in the blood. This makes it much less attractive to addicts because you can’t snort it and it has a delayed effect.

That delayed effect makes it rubbish as a booster. It’s also fickle. Sometimes it just doesn’t work very well. I am extremely reluctant to give up my dex.

Said psych suggested a few possibilities:

1 - take Elvanse later in the day. That’s literally rationing sanity. An Elvanse 70 pill is 6-7 hours of Flowers for Algernon speed run. That’s no way to
Live. My facial expression made him discard that.

2 - switch to methylphenidate, the other arch stimulant. Available in sustained release form as Concerta and in instant release as the very well known drug, Ritalin.

Problem with that is as far as my body is concerned (I have tried methylphenidate. I will not elaborate on this point), it’s basically “a bit shit”.

I free to it as “a coffee tribute act”, or if I’m in a scathing mood, “shitalin”. It’s a very big the “sit in the corner and shut up” zombie drug that was always used as a threat as a kid if I didn’t “act more normal”.

3 - Elvanse with Ritalin booster. See 2 for explanation as to why this can get in the bin and stay there.

4 - Elvanse with Elvanse booster.

Ok. Not ideal. Elvanse is at least amphetamine, which is the med that actually works for me, even if the neurotypical world seems to treat it as basically raw addition fuel (weirdoes), although it’s fickle. And slow.

But I was encouraged to experiment.

So I have done

Some months ago I tired 70+30. The 30 gained my about 90 minutes and had me running back to my beloved dex at the end of that. Useless.

In November I tried 70+50. Got 4 hours extra. They were rubbish hours. And the drop was horrible.

Getting a bit despondent here.

Today I tried the nuclear option. At 10:28 I took my usual Elvanse 70 and waited.

20 minutes later I started to feel myself turning into a functional adult.

Bit rubbish and distractable for the next 6 hours. Despite being trans I do have a monthly cycle (I can see it oh my resting heart rate graph. It also syncs with Sylvia’s period which is freaky) and I’m at my low and - see previous comments about Elvanse being fickle.

At about 17:00 I started to feel what I now know is noradrenaline imbalance in my peripheral nervous system. Dopamine drops faster leaving noradrenaline to go after. It means my brain is going to follow within the next 15-60 minutes and when that does … Flowers for Algernon.

At this point I would usually take my die at Amfexa of the day.

I didn’t. At 17:20 I took another Elvanse 70.

Peripheral noradrenaline imbalance continued to climb because … Elvanse. Amfexa would fix the problem in about 2 minutes.

But it doesn’t take a big rise in serum dexamphetamine to ward the drop away. Within 15 minutes I was fine.

So the question is, how long? As a primary med, the difference between Elvanse 50 and 70 was about half an hour, so I was a little pessimistic.

But then a curious thing happened. The executive function I’d been a bit rubbish on all day came roaring back. Nice!

Got to 10pm ish and had something to eat. That causes Elvanse’s prodrug conversion to increase usually and indeed, it did.

“Have the lambs stopped screaming, Agent Starling?”

That never gets old. I sat upright I stared into space. The earworm fell silent. Intrusive distractions went away. My sensory overstimulation dropped to zero. Emotions fell into line and got fully with the programme.

And after a few minutes of enjoying the utter utter bliss of a quiet mind, I got up and tidied the living room and kitchen.

At 01:10 I felt peripheral noradrenaline imbalance. That’s it. The end was coming. I have to let it happen.

Turn coffee machine on. “Esvaziar bandeja de gotas!” (Empty drip tray). COME ON! NOT FAIR!

Urgh! Hands feel gungy. Thighs are touching. It’s horrific. Every sound is loud. Getting louder. Lights so many lights. So many. So bright. Tension. Stress. Fiddle with hair. Scratch at arms. Empty the drip tray.

Double long espresso, with maximum brew strength.

Sensory issues building. Coffee grinder runs for the first shot. LOUD.

Coffee pours.

Grinder runs again. MAKE IT STOP. PLEASE. NO. EVERYTHING EVERYWHERE ALL AT ONCE!

01:17. Jaw starts trembling. The neural pathways that make me into a functional adult abruptly cease function as the dopamine needed to regulate the synapses became simply unavailable. Emotions go haywire. I am so sad. There are air molecules touching my skin. I have internal organs. It’s all horrible. The world is noisy and bright. I think there’s supposed to be a squirrel at this point?

30 seconds later I stabilise a little below my pre-medication baseline. My brain is now the brain of a mildly confused child. The focus, executive function, emotional regulation, clarity of thought, neural interconnect that I had enjoyed 15 minutes earlier was just gone.

It’s a lot like being two different people. One of them has to parent the other.

Oh, and the one that’s writing this has no bloody impulse control. That’s fun. I’m also twitchy as hell.

I drank the coffee. I’m now on my fourth shot of espresso. It doesn’t get me back to that beloved state but it takes the edge off and it will help me sleep.

Anyway, experiment a success. My drops are pretty much all like that so whatever. I got almost fifteen hours, and the latter few were really nice.

I’m sticking with the UK for now but I might make an appointment with the psych and present 70+70 as a hypothetical.

I feel like 70+50 he’d have no issue with but 70+70 might make him suck his cheeks a bit.

But … doesn’t ask, doesn’t get.

That. Sodding. Book. (Flowers for Algernon)

Goddam it.

What did I have to go and read it for?

On 11:00 on the 16th of April last year I took a pill.

I did not understand what I was doing then. I had no way of understanding what I was doing. What it was about to do to me was something I had no reference frame for.

So dopamine and noradrenaline functioning in the population is a normal distribution, more or less.

Somewhere beyond the second standard deviation downwards from the mean, there is a line. On one side of that line lies 96% of the population. I’m the other side. Probably quite a long way on the other side.

At 11:15, I crossed that line, for the first time in my life.

I don’t know if I vocalised but my first thought was, “huh?”

I was sitting on the loo at the time by the way.

Suddenly I understood. I understood all of it.

That pill, Elvanse, 30mg, a dose that I would barely even notice now, was in a very real way the fruit from the tree of knowledge.

I can’t un-know what I know.

Immediately before that point I was overweight and gaining, abusing alcohol more and more with each passing month, had blood pressure pushing grade 1 hypertension, blood markers that were starting to scream something about Type II diabetes, and was engaged in an experiment to disprove the idea that you can’t live on a diet made up exclusively of wine and cheese triangles.

I was also objectively a really bloody nice person even though I hated myself quite profoundly. I didn’t deserve to.

I am, today, objectively better in pretty much every respect. My weight is ideal. I eat well. I don’t drink alcohol. My cardiovascular health is beyond what a 52 year old has any right to expect. My relationships are so much better. I am not in a hostage situation with my own emotions any more. I am not constantly tormented by my own nervous system and the belief that everyone secretly hates me. I sometimes LIKE myself. I get housework done. I drive better. I move better. I have a new therapist who I get on really well with and who is helping me immensely.

And in a few hours I am going to become that person I was before 11:15 on the 16th of April and I resent that.

What does that say about me?

Tomorrow: repeat. Sunday: repeat. Monday: repeat.

And so on. Speed running (hah!) the bloody book every day.

And I KNOW.

And I can’t ever not know.

And if this is ever taken from me, the pain from wanting it will be indescribable. I’ll also turn to alcohol again within, I was going to say 2 weeks. I suspect it would be more like 2 days.

Medicine does not understand the structural problems in my brain enough to fix them. It found this treatment by accident. It’s suggested that if you start it early enough in life you MIGHT get some baseline structural improvement.

Might.

Some.

We evangelise to those who are the way we were, you know. We know the pain and we so desperately want them to have the ability to be free of it and even love themselves, the way we now can. Most of them find this a bit weird and incomprehensible. I did too when it was me.

“I will look into it when I’m less overwhelmed”

“But that’s what it fixes! That’s like going out into a snowstorm to get something from the shop in shorts and a T shirt and saying you’ll put your coat on when you get back!”

Incomprehension

But even then knowledge has a price, and there are no refunds. Some of that knowledge is knowing that I spent five decades going out into that snowstorm undressed when I didn’t have to.

(Ok, maybe some of them. I was born in the 70s after all)

Would I did it again if I knew beforehand what it was going to do?

Yes. I would. I would be compelled to.

But part of me wishes I didn’t know.

I’d hate myself. I’d get diabetes. And cancer. And die far too early, never understanding why I yelled at the people I loved as I drank myself to death, and tormented by a life of executive paralysis and emotional tempests, while wanting to crawl out of my own skin.

But I wouldn’t have known anything better was possible.