This article has been clinically reviewed by Teddy Tinnell, MSN, RN and Mai Fleming, MD.
For this article, we are going to be using anatomical language to refer to body parts, but we celebrate any words you use to self-identify. The language we use for our bodies matters, just like how we ask others to touch and experience our bodies, and respecting this is a part of healthy and active consent.
What is bottom growth?
Bottom growth refers to genital changes that occur when people assigned female at birth start testosterone gender-affirming hormone therapy (GAHT) or hormone replacement therapy (HRT). Bottom growth refers to the process of clitoral hypertrophy, which happens when the clitoris (or t-dick, dick, cock, cockpit, or whatever else you might call it) grows in both length and width.
Testosterone stimulates the development of erectile tissue in the clitoris, similar to the growth that folks assigned male at birth (who aren’t on hormone blockers) experience during their first puberty. For some people, bottom growth is one of the first changes experienced on testosterone HRT, usually starting within the first three months.
Bottom growth can help alleviate some people’s feelings of gender dysphoria with their genitals. This can especially be true for many transgender men or other trans people who start testosterone HRT. But know that the changes (for everybody) can take time to get used to. Over time, bottom growth can become a euphoric experience that raises confidence both in and out of the bedroom.
For other people on the masculine spectrum, such as nonbinary or genderqueer people, bottom growth may be a physical change that is tolerated alongside other, more desired, effects of testosterone HRT. No matter how you feel about your bottom growth, know that you are not alone in your experience. Sometimes, it can also be helpful to interrogate and unpack your fears and insecurities around the changes that come with medical transition. Sometimes these feelings can be good indicators of what feels right for us in our transition, but other times they can be internalized messages we’ve received about transgender people at large. Make sure to surround yourself with a supportive community when working through these feelings.
Does bottom growth hurt?
It’s important to note that when a person first starts experiencing bottom growth on testosterone HRT, it can be uncomfortable. Beyond the psychological or emotional feelings that come with your genitals changing, the physical sensation of bottom growth can also cause discomfort. Because the clitoris is usually previously concealed by the clitoral hood, the new exposition and growth might be hypersensitive at first. You might also get more frequent or prominent erections. You might also notice that your orgasms will feel different, with perhaps more peak intensity and a greater focus on your genitals rather than a whole-body experience.
You may feel as if you have to adjust your junk often, or that there is pressure, burning, itching, or slight pain down there. It’s important to know the difference between these sensations related to bottom growth on testosterone HRT and the symptoms of STIs. Usually, the discomfort of bottom growth will resolve itself after the first six months of starting HRT. However, you still may need to try different underwear cuts (with more space for growth) or shower more frequently to keep discomfort to a minimum. Sometimes reducing the amount of time spent packing or holding off on packing for the first few months of heightened sensitivity can also help. Manscaping (or masc-scaping) by experimenting with different pubic hair styles might also help create an extra layer of protection between your genitals and the fabric of your underwear.
Different ways to maximize your bottom growth
There are some strategies that people use to try and maximize their bottom growth. Because of the gaps in clinical research when it comes to studies on hormones and transgender health, especially trans men, we rely on the anecdotal knowledge of our community and the feedback and experiences that our clinicians hear. While there is no guarantee that these methods will work—all bodies are different—there are some ways that you can try to maximize the amount of bottom growth you experience, before or after starting T.
Pumping is an option for people who are looking to increase size, whether for a temporary amount of time before sex or for more permanent changes. Pumps come with a cylinder that goes on the clitoris and is hooked to a pump that creates a vacuum seal on the genitals. This allows the clitoris to grow because the tissue is stretching past its usual size due to increased blood flow. Pumps can be used before starting T or while on T, and it’s always a good idea to use lube when pumping to decrease discomfort.
Using a pump might not change your size when flaccid, but many people report the size of their erections growing in time with consistent pumping. If you are looking for a good starter pump, New York Toy Collective sells an easy and effective Trans Masc Pump. Make sure you select a pump that has a cylinder twice as long as your bottom growth length and at least 50 percent wider than your width.
It’s important to make sure that you are pumping safely. When you begin pumping, soak the pump in warm water and use a warm towel on your junk to heat everything up. Dry off your genitals and the pump and apply a small amount of lube to both. Start at a lower pressure that you can gradually build on. The gauge on your pump should read no higher than 5 pounds. Although pumping may feel unfamiliar at first, if you feel pain then this is a sign that you should stop. Pumping shouldn’t hurt nor should the cylinder be completely full when you pump. If the cylinder is full, it’s a good idea to size up. There is the possibility of blood vessel or tissue damage with too much aggressive pumping, but as long as you take care and go slow, these can be avoided.
You can pump as frequently or infrequently as you like, and you should find a cadence for pumping consistently that works for you. You can begin with short intervals, five or 10 minutes at a time, and slowly work your way up to longer periods of time. Note that you shouldn’t pump for more than 30 or 45 minutes at a time, or you will risk severe bruising or nerve damage. Be mindful of the frequency and duration in which you are pumping and do not exceed four to five pumping sessions a week nor more than three times a day. Pumping increases blood flow, which can ultimately increase sensitivity over time. For information on more advanced pumping or pumping with larger cylinders, check out Trans Guys FTM Pumping Primer.
DHT cream (which stands for dihydrotestosterone cream) is a synthetic version of testosterone. Some surgeons will recommend applying DHT cream topically before getting bottom surgery to encourage stimulating the maximum genital growth in transgender people. DHT is a metabolite of testosterone and is not to be confused with Testogel or Androgel, as it is more potent.
DHT is sold under brand names such as Andractim among others. As of 2016, Andractim is not approved for medical use in the United States by the FDA. Some people do order DHT online from overseas pharmacies though we cannot endorse this as shipping a controlled substance across country borders is illegal.
However, if DHT cream is not available you can always ask your healthcare provider for a compounded testosterone cream that can be applied to the clitoral area. It is believed that the body naturally converts a good amount of this T into DHT locally in the genital tissue, so it essentially has the same effect as a DHT cream.
Testosterone cream is different from the Androgel or testosterone gel prescribed for testosterone HRT. Transdermal testosterone gels are water-based and typically contain a high percentage of alcohol, while compounded testosterone creams are an emulsion of water and oil. This means that testosterone cream can be less irritating when applied to your genitals vs. testosterone gel.
However, some clinicians will still prescribe testosterone gel if a cream cannot be compounded. Some side effects of using T gel on your genitals may be irritation or local changes in skin color. If your healthcare provider prescribed testosterone cream, you will have to pick it up at a compounding pharmacy because there aren’t any FDA-approved commercial testosterone creams.
While bottom growth is driven by testosterone levels in the blood, you may not find much growth by applying testosterone cream or gel locally. The biggest side effect is that testosterone and DHT does not just stay in the local area where it is applied, but gets absorbed into the bloodstream. Since DHT is a more potent form of testosterone and the main driver of hair loss on top of the head and body hair darkening, this may enhance male pattern balding. You may have increased risks of hair loss if using a testosterone cream or DHT topical cream.
Also, you will want to keep an eye on your levels when using topical creams to ensure that your testosterone levels don’t become too high—as this will eventually convert the testosterone into estrogen. Some providers may adjust your systemic dose to account for the additional amount of T you are getting through the topical cream, while others may just watch your levels closely and make adjustments as needed.
It’s important to note that both gels and creams leave residual testosterone on the skin’s surface that may transfer to other people during sex or via skin-to-skin contact. Make sure to wash your hands after applying gels or creams to any area of the body. Gels absorb faster than cream, so the likelihood of transferring testosterone to another person via compounded testosterone cream is higher since it takes longer to dry. Therefore, if you’ve applied cream to your genitals, it’s important to shower before making sexual contact with another person, between six to eight hours after applying the cream.
And finally, If these strategies for maximizing bottom growth aren’t enough, you can always consider a more permanent change, such as getting metoidioplasty or phalloplasty, two different types of gender-affirming bottom surgery.
For those ready to get started at FOLX for testosterone, the process begins here. For existing FOLX members with questions about their dosage, don't hesitate to message or schedule time with a clinician. And for those who’ve just got some more questions related to LGBTQ health and beyond, read up on testosterone here, and feel free to reach out to us at firstname.lastname@example.org.