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So here we are: I’m back in productive mode, working hard once more, no longer distracted. Just like I knew I would, for this cyclical rhythm has become second nature, almost too predictable for comfort.

Living with a chromosomal aneuploidy comes with its unique challenges, physical, cognitive, and psychological. In this particular case, there’s the additional challenge of managing testosterone therapy, an intervention which causes some ambivalence amongst us.

Some shun it completely, but then find themselves living with osteoporosis and various autoimmune disorders. Some — like me for many years — take a more lackadaisical, inconsistent approach, often taking it only when reminded to by their significant other, not entirely convinced whether it is either necessary or good for them at all.

Others — more like me since my Great Crash — engage in treatment almost religiously, following their timetable of interventions precisely, cognisant that it brings them a kind of normality in life, in which they can almost reach their full potential, becoming ambitious, motivated and focussed on their goals in life.

But the last comes with a caveat for me. Over the years, I’ve noticed a distinct pattern in how I feel and function after each testosterone injection. For the first six weeks, I experience a surge of motivation, productivity, and focus. This, in turn, leads to a boost in self-confidence, during which I tend to conclude that I’m operating at a level far below my true potential.

However, as the weeks progress, I begin to encounter symptoms that strongly resemble those found in ADHD—difficulty concentrating, restlessness, distraction, and a frustrating lack of motivation. Not just the normal procrastination which affects everyone, but a debilitating inattentiveness which undermines every activity.

It was only after I restarted regular testosterone therapy a couple of years ago that I began to notice this pronounced pattern of motivation followed by intense procrastination. Naturally, I hypothesised that these symptoms were due to my testosterone levels waning as the injection wore off. I was so frustrated by the loss of motivation that I asked my GP whether he could review my treatment and space injections closer together, so as to avoid this cyclical crash.

But, of course, my GP is a man of evidence-based practice, and he cannot just prescribe an intervention because his patient says so. In fact, he told me, my blood tests showed that my testosterone were at a normal level at that point, and not really waning to my natural baseline at all. He offered an alternative perspective: that testosterone might simply be masking underlying symptoms during the initial phase, rather than causing actual improvement.

Testosterone has long been known to play a role in mood regulation, energy levels, and cognitive processes. Research shows that individuals with my condition often benefit from testosterone replacement therapy in areas like mood, verbal memory, and overall cognitive clarity. This I see in myself during the first half of my injection cycle.

However, research also notes that fluctuations in hormone levels can lead to mood changes and cognitive challenges. Interestingly, there’s also evidence that testosterone plays a broader role in cognitive and emotional regulation. It’s possible that the hormonal shifts I experience amplify these tendencies during the latter half of my cycle.

So it’s possible that the symptoms I experience are directly related to the natural decline in testosterone after the injection. Hormonal fluctuations are known to impact mood, energy, and cognitive abilities. Many men with this condition describe similar cycles of improved focus followed by periods of mental fog as their hormone levels decrease.

Although this theory feels intuitive to me because the timing of my symptoms aligns closely with the cycle of the injection, it doesn’t explain everything. This was the point at which my GP started posing questions back to me. Could there be another underlying factor you haven’t considered? But if I thought he might then offer explanations, I was mistaken, for it turned out he considered me the subject matter expert here.

Well, I offered, we don’t really know the full effects of the chromosomal abnormality on executive function. He nodded approvingly. But I only have the research papers I’ve read on PubMed to go on, so, er… He interjected here to say that would be his main source too for a condition as obscure as mine. It was as if to say we were both in the same boat. But of course, he’s the scientist, presumably more capable of understanding and interpreting such research. That’s why I made an appointment.

Sadly not. If I thought I might leave the medical centre with more answers than I came in with, I’d just leave more perturbed. The closest we’d get was him looking up the status of my referral to a specialist clinic that went nowhere. As to plausible explanations, or potential interventions, I was on my own. All we could agree on was that people with my condition often have symptoms similar to various neurodevelopmental conditions, but probably wouldn’t meet the diagnostic criteria to access support.

In the end, I’m left not with any solution for this predicament I find myself in — approximately six months of every year during which my productivity flatlines — just a potential understanding. Which is to say, perhaps I just have to be more forgiving of myself during the downward spiral, recognising that it seems to be part of my normality. But that is very hard to do, given my work ethic (not necessarily practice), which recognises that an employee should be trustworthy and capable, dutifully fulfilling their contractual obligations at all times.

Right now, my colleagues have me at my best. They will get 150% out of me. I will produce my best work, so engaged that I will work into evenings and weekends to make things better. I am the competent, knowledgable worker they need, always on standby to help others produce their best work too. Grand. But come six weeks from now, and I will be hitting a brick wall again, staring at my work, egging it on to do itself. These the cycles of life, living with a chromosomal aneuploidy. Maybe I will forgive myself. Maybe I will just live in fear of my accounting. This my great trial.