This article has been clinically reviewed by Teddy Tinnell, MSN and Kate Steinle, MSN, WHNP-BC.
Deciding to start testosterone hormone replacement therapy (HRT) is an exciting step in your journey toward selfhood. Many transgender men, transmasculine people, non-binary and other gender non-conforming folks take testosterone to alleviate gender dysphoria and align their bodies with their internal knowledge of who they really are. In the first year of starting testosterone gender-affirming hormone therapy (GAHT), you will experience a whole range of physical, psychological, and emotional changes. Alongside these changes, you might also notice that the way you experience your relationship with your sexuality and desires shifts as well.
It’s important to know that there is an extraordinary amount of diversity of experience in sex, love, and relationships throughout the human experience. We are complex, diverse, and varied people who experience attraction and desire differently. This is just as true for transgender and non-binary people on testosterone GAHT.
We know that gender is a nebulous spectrum full of individual and unique experiences, as is sexuality. There aren’t many medical studies or clinical research gathered on the sex lives and sexualities of transgender people on T. Our community must have access to viable information, as our lives and experiences are so underrepresented. We are sharing some of the common experiences of our community and anecdotal information that our clinicians have received in providing care for transgender and non-binary people.
1. Your sex drive and libido might increase
It’s common for people on testosterone GAHT to experience an increased sex drive while on T. Your libido might be extra high during the first two to three months of starting or restarting testosterone HRT. This could result in a change in the frequency and intensity of sexual urges or otherwise, what some people describe as, “just feeling horny all the time.” Know that this is a completely normal experience. You might find yourself wanting to masturbate more often or feeling an increased urge to be sexual. These changes are also usually temporary, as your libido should level out after your first six months of starting or restarting testosterone HRT.
While you might not have been entirely prepared for these changes from testosterone HRT, there are things you can do to help you navigate your increased libido. These include creating and finding new avenues for self-pleasure. You can also consider increasing the amount of sex you’re having with either new or established partners. It’s important to remember to practice safer sex when having casual sex or sleeping with multiple partners to protect yourself and others against sexually transmitted diseases and/or unwanted pregnancy. (Check out this Library article about birth control and HRT for more information.) If an increased sex drive is concerning or negatively impacting your life in any way, make sure to speak with a trusted clinician who can help you figure out next steps.
2. You may experience bottom growth and heightened sensitivity
Bottom growth is a phrase that describes the clitoral hypertrophy that happens as the clitoris grows in length and width as a result of taking testosterone GAHT. If you experience bottom growth on T, it is usually one of the physical changes that people notice first. You might experience some hypersensitivity initially, especially when your growth brushes up against underwear or other fabrics. Some people find that wearing different underwear styles or using lube or moisturizer can help with discomfort.
Alongside the growth down there, you may also experience heightened sensitivity. This is because new parts of your clitoris are being exposed, which takes some getting used to. or some people it can feel amazing to have access to a whole new realm of stimulation. For others, especially those who experience bottom dysphoria, this can also be challenging in some ways.
Make sure that you communicate with your partners about what does and doesn’t feel good sexually. It might take some experimenting with different motions or techniques to find out what feels good. Remember to be patient with yourself and adopt a spirit of curiosity through these changes. You are going through a second puberty, so give yourself space and permission to sexually explore new ways of doing things and be a teenager again.
3. Penetration can become more painful
Another way that your sex life can change after testosterone GAHT is that penetration from a partner or toy might become more painful as you may experience front hole / vaginal atrophy as a result of T. Front hole atrophy happens when the estrogen-dependent tissues around or inside your front hole become thin and easily irritated, and sensitive to internal friction, such as penetration.
Lower levels of estrogen decrease the body’s ability to make lubrication, which may cause small tears in the vaginal walls and pain during sexual penetration of any kind. STIs can also travel more easily through these small tears, so it’s important to use barrier protection and always talk to your partners about your sexual history. Make sure to use lube whenever possible. If you are looking for other ways to manage front-hole atrophy, talk to your clinician about estrogen rings, tablets, or topical creams.
Some people may also develop pelvic pain after being on testosterone GAHT for several months. This may be a pre-existing symptom before medical transition or something that begins after starting testosterone hormone replacement therapy. If pelvic pain is something that you experience, pelvic floor therapy is a type of physical therapy that targets pelvic floor muscles, ligaments, and connective tissues to manage pelvic pain, irritation, and overall discomfort. You can always speak with your FOLX clinician or schedule a virtual healthcare appointment if this is something you experience.
4. What you’re into or who you’re attracted to sexually can shift
Changing the biochemistry of our bodies through hormone replacement therapy can bring about a whole range of new feelings, thoughts, and experiences. As you develop a new relationship with your body, you might also find yourself discovering new ways of relating to your sex life and sexuality. For some people, this might look like finding pleasure in new activities or kinks that felt inaccessible to you before. The quality or quantity of your orgasms might change, including what they feel like in your body when you experience them or what it takes to get there. You might also find your body functions differently sexually, and it might take some time to develop new relationships with these parts of your body.
Some people also experience a shift in the modality of what turns them on. For example, you might find your turn-ons shifting from a more audio-centric realm to a visual one or vice versa. You might find yourself more into physical touch and sexual acts, or you might find yourself needing more of an energetic and emotional build-up before you can engage sexually. No matter what, be patient with yourself and curious about any shifts in your desire. It’s okay to be figuring things out as you go.
While sexuality and gender identity are two different things, some folks might find that with shifts in their gender (both in how others may view them and how they may view themselves) come shifts in their sexual desires or attractions. You may find that in inhabiting a different gendered expression, you experience attention from new types of people. If you used to identify strongly with a particular sexual orientation or terminology, you might notice that your relationship with those communities or that identity might shift as you start presenting a different way.
You may also find that you are attracted to different types of people than you were before. This may be in the fantasy realm or the types of porn you watch, or it may be something that you feel driven to explore in real life. Some people find themselves drawn to partnerships where there is less of a need to explain themselves or their bodies, which could include dating or sleeping with other transgender, non-binary, and gender non-conforming people. While this isn’t everyone’s experience, it’s important to meet yourself with compassion and understanding as you navigate any other life changes that surround your gender transition.
5. You may feel less dysphoric in your body
Now that you’ve started testosterone HRT, you might feel more at home in your body. Hormone replacement therapy can greatly alleviate the amount of gender dysphoria that you experience on a day-to-day basis. While it often takes some time to get used to all the new changes in your body, allow yourself to embrace the newness and loosen your expectations. As your body and comfort within your body change, you might find yourself feeling less restrictive, more embodied, and approaching your sex life with more confidence and fewer blocks.
Some people might find that their dysphoria shifts to different parts of their bodies now that they’ve started hormone replacement therapy. It’s important to get to know your body again after any milestone in your gender transition, be that hormones, surgeries, or any other changes. Make sure to be gentle with yourself during the process and approach things (if possible) from a level of playfulness and curiosity. If you are worried or concerned about your sexuality and changes in your sex life, make sure to speak with your trusted clinician to figure out solutions. Our queer and trans-specialized team of clinicians is here for you every step of the way.
For those ready to get started at FOLX for testosterone, that process begins here. For existing FOLX members with questions about their testosterone dosage or route, message or schedule time with a clinician. For those with more questions related to trans health and beyond, read up on testosterone here and feel free to reach out to us at firstname.lastname@example.org.