Content Note: This article discusses gender-affirming healthcare but should not be taken as medical advice—please exercise discretion and consult your doctor before pursuing any course of action.
"What happens when you take testosterone?", I remember searching the internet for guidance when I was first considering gender-affirming hormone replacement therapy (GAHT). I knew several people in my life who were taking or had taken testosterone (T) off and on; however, I felt too nervous to ask any of them about their experience. It felt too personal, too invasive to ask. As folks outside of the cisnormative box, we already face questions and commentary from people about our gender, our bodies, and especially our genitals. Even though I had been identifying as a nonbinary person for some time when I started exploring whether GAHT was right for me, I didn't want to be another person invading trans people’s privacy.
Altruism may have been the reason I didn't ask my community for their lived experiences, but if I'm honest, I was also hesitant because of what it might suggest about me: that I was uninformed, or that I'd ask embarrassing questions. I also worried that friends might be excited for me, and then I'd feel pressure to follow through on this thing I wasn't sure about. Looking back now, after almost three years on T, I recognize that it would have been fine. My friends would have answered my questions the best they could and tried to point me in the direction of finding answers where they couldn't. They wouldn't have judged me, and while they would have been excited, they wouldn't have pushed me to make a decision. If someone in that same position came to me now, I would gladly sit down with them and answer their questions this way.
Part of the reason why person-to-person sharing is so important is because there's limited information available about GAHT with T. There is a surprising amount of research on the use of T for hormone replacement therapy in peri- and postmenopausal cisgender women. However, those studies are not generally focused on areas of interest for people pursuing GAHT. The information accessible online for us is primarily individual blogs or sterile one-page medical sites. The information shared in these places, while important, generally offers anecdotes, or recycles the same limited facts—clinically distilled and absent of any joy and pleasure that comes with GAHT.
As folks outside of the cisnormative box, we already face questions and commentary from people about our gender, our bodies, and especially our genitals.
This lack of comprehensive information led me to create a community-based study examining the effects of T on people's experiences with sex and pleasure. I hadn't run a social sciences study since undergrad, and I didn't have the formal structures of an Institutional Review Board (IRB) to back my work. However, I believe there is a lot of value in simply listening to a community about their experiences and valuing that as genuine evidence. The knowledge is already in our community; we just need to give it a platform.
With that in mind, I created an informal anonymous survey and promoted it to my communities through social media and direct outreach. Of those who responded, a number agreed to be contacted for follow-up, and so I was able to do a handful of qualitative interviews. In the end I was able to receive the stories of thirty-six trans people, ranging from folks who had been on T for three months to up to fifteen years. Most people were currently using T, but a small minority had ceased, and therefore were able to speak to the experience of what changed after stopping T.
The experiences people shared with me fell into two main categories: one, how physical and psychological changes impacted their relationship to sex and pleasure, and two, what they wished people knew about T or having sex with people who have taken it. I’ll talk about the latter in another article, but I’m going to focus first on the impact on sex and pleasure.
Some of the physical changes that occur when someone with a vulva and uterus begins GAHT with T are relatively well known, others less so. There’s a great website, Folx Health, that has a decent library of digestible pieces on GAHT. Folx is where I went first when I was early in my journey. However, I also found this library a bit limited in the level of detail provided. Changes people reported in my study included: increased body hair, head hair loss, increased sweating, changes in energy levels, increased acne, skin changes including itchiness, thickness, and oiliness, changes in scent, voice pitch changes, increased muscle mass and strength, body fat redistribution, clitoris and clitoral hood enlargement, pH balance changes impacting bacterial vaginosis (BV) and yeast, changes to sensitivity for genitals, changes in lubrication levels, front hole atrophy, menstruation cessation, and changes in orgasm. Only some of these changes are mentioned when you look through Folx, or similar resources. Not everyone who takes T will experience all of these changes, but I believe everyone considering this decision deserves to make an informed choice. People should know what’s possible with T, and also consider which changes might be likely for them based on their genetics.
I believe there is a lot of value in simply listening to a community about their experiences and valuing that as genuine evidence.
When it came to genital changes, people did share a balance of positive, neutral, and negative experiences that impacted their relationships to sex and pleasure. Most of the negative experiences were temporary, like intense sensitivity and pain, or increased yeast and BV infections during the first few months of T. However, the most common negative experience shared didn’t really have to do with the genital changes. Rather it was how other people made assumptions about how they would like their genitals to be touched, often leading to pain, discomfort, or gender dysphoria. This was especially true during the early stages of bottom growth (typically three to six months), when the clitorophallus is particularly sensitive to touch. A number of people did report front hole atrophy—something I had been really worried about myself before starting T—but just as many shared that they experienced more lubrication and physical arousal than before GAHT, making sex less painful and more enjoyable.
Positive, genital-based experiences centered around ease of orgasm, increased lubrication, and some folks newly discovering they could squirt! This is one of my favorite facts about T: the Skene’s Glands, which are homologous to prostate tissue and are responsible for producing ejaculate, grow under T. This can result in more lubrication when aroused and leads some people to have ejaculating orgasms! I haven’t actually found any research that explores the correlation or causation of changes in orgasms for people on T, but there is research demonstrating that prostatic metaplasia (the growth of those prostate-like cells) is extremely common for people who use T.
People who shared their stories with me shared at length about the impact of changes to their genitals on their relationship to sex and pleasure. This makes sense—most people define sex as something involving their genitals, so naturally, any changes to those genitals would also change the experience. However, something that stood out to me as less frequently acknowledged by other information sources was the impact of psychological changes on relationships to sex and pleasure. Many people in the study shared that once they began T, their comfort and interest in sex increased drastically. They reported gender euphoria, which led to increased confidence and satisfaction with being touched sexually. They reported decreased mental health symptoms like anxiety, depression, and suicidal ideation, which had interfered with sex in the past. They described shifting from a more responsive desire model to a spontaneous one, which made their desire for sex more frequent. Additional changes that impacted the relationship to sex and pleasure included more ease reaching orgasm, increased energy which made sex more accessible, and sometimes changes in attraction, which led to discoveries of new interests in bed. Ultimately 92% of participants rated their experiences with sex after starting T as significantly positive.
People who shared their stories with me shared at length about the impact of changes to their genitals on their relationship to sex and pleasure.
Most participants reported positive experiences with sex and pleasure after starting GAHT with T. However, even with all of these trends in the data, the conversations I had with participants continued to come back to the same core message: trans people are not a monolith. This is still true even when we’re focusing on trans men, transmasculine people, or the broader population of those who take T for GAHT. What feels affirming, sexy, and pleasurable for one person will be different for someone else, even if they’ve both taken T for the same amount of time. This is why we need to increase knowledge and communication skills about anatomy, sex, and pleasure.
It is also worth acknowledging that the information in this article is only based on a small snippet of the community. I want to see more community-centered research (and informal sharing) on trans experiences. Exploring what our relationships to sex and pleasure look like is an important topic, especially at a time where our basic existence and day-to-day rights are being threatened.
A Note to Our Community: The Tryst.link blog is not affiliated with or endorsing any sites, brands, or products linked here. We share resources only where we feel they might add real value to sex workers’ knowledge or autonomy—and when the benefit feels worth the risk. Do your own checks and move in ways that protect you.
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