Hormonal effects on externalizing problems in females across the lifespan

Developmental transdiagnostic externalizing problems—including harmful substance use, conduct issues, oppositional-defiance, and ADHD-related hyperactivity-impulsivity—have significant societal impacts, contributing to high costs in areas such as incarceration, delinquency, unemployment, and relationship challenges. These issues also exhibit notable sex differences: males tend to show higher prevalence, while females, though less affected overall, often face more severe outcomes. Despite these public health and personal costs, research on externalizing problems in females remains limited, particularly regarding the biological and hormonal factors driving these sex differences. The current paper explores how female hormonal influences across developmental stages may affect externalizing behaviors, highlighting the role ovarian hormones may play in shaping these externalizing problems. During puberty, estradiol and progesterone shifts contribute to risk-taking behaviors in females, who show distinct vulnerability patterns from males. Other important and understudied reproductive periods include puberty, pregnancy and postpartum, and perimenopause and menopause, and the menstrual cycle, overall. However, most population-level studies overlook the role of ovarian hormone fluctuations. This review advocates for the integration of hormonal phases in assessments, as hormonal shifts may exacerbate symptoms or modify treatment responses. Cycle-aligned interventions and hormone stabilization strategies could improve treatment outcomes, addressing gaps in male-focused treatment models and enhancing care for females with these disorders.