This week, we’d like to talk about how some aspects of sexuality and physicality change when you start gender-affirming care with estradiol or testosterone. We’re going to discuss genitals, libido, and orgasms (and probably a few other titillating things, pun intended.)
Content Advisory: we’ll be using anatomical terms like penis, clitoris, and vagina in this piece.
Expert Tip: Expect Changes
Endocrinology is complicated, right? The simplest description I can think of is that hormones are like guests who come into the house and stay awhile. Houseguests, we all know, can change the energy of the house, and sometimes what goes on in the house. Steroid hormones like estradiol and testosterone are like houseguests who just happen to be independent contractors with the time and energy to tackle a few projects you’ve been meaning to get to. Eventually, they can remodel your whole house.
Yep, we’re getting a renovation.
On hormone therapy, your genitals will likely change in several ways, including size, shape, and sensation. How your genitals work and what happens during erotic pleasure also changes. Additionally, your other major sex organ, your brain, changes in response to hormone therapy too.
For Everyone
How you experience attraction may change, as well as what you find attractive. The frequency with which you get excited, and how that feels for you may change. Your experience of orgasm may change. How stimuli get to and are interpreted by your brain may change: your senses of smell, taste, and touch may just plain work differently.
For People Taking Estradiol
You will likely have fewer erections, both spontaneous ones, and intentional ones. When you have them, they will probably be less firm and won’t’ last as long. You may lose the ability to penetrate with your bio phallus. Your testicles will decrease in volume.
You will still be able to feel and experience pleasurable erotic sensations, but the hows and wheres may change. Your most sensitive spots may move or become more diffuse. You may find other areas become more sensitive, or sensitive in new ways. Your skin – all over your body – is likely to be getting softer and thinner, and your body hair is likely to get thinner. You may find that touch anywhere or everywhere on your body feels different.
If you have been orgasmic, you are likely to still be orgasmic. Your orgasms may change, and in some people, they change dramatically. You may experience a broad-body sensation rather than a concentrated one. You may find that erections, orgasms, and ejaculation are no longer as closely tied to each other. When you ejaculate, there’s likely to be less volume involved, and how your body smells and tastes (including ejaculate), especially during sexual excitement, will be different.
Last week, we talked about nerve anatomy in your genitals. As your pelvic structures change, you may find that stimulating your penile dorsal nerve, which runs the length of your penis and perineum then back up into the body towards the spinal cord, is easier and–if orgasm is a goal–more effective by perineally-focused activities rather than penis-focused activities.
We encourage you to explore and enjoy your body as it changes and try new things: textures, pressure, where you’re applying texture and pressure, and how (see last week’s article for sex toy tips!)
For People Taking Testosterone
Bottom Growth
Your clitoris may enlarge. Structurally, the clitoral head and shaft aren’t much different from a penis. They all have erectile tissue, and you may find yourself having more obvious clitoral erections than you did previously. You may be more aware of the interior structure of the clitoris, and your experience of and reaction to genital touch may be different. Your libido might grow, just like your clit.
The mucosal tissue in your vagina may produce fewer secretions: you might not get as wet as you used to. At the same time, these tissues may become thinner and more susceptible to irritation, damage, and infection. We sing the praises of lube for you and for everyone!
You may find that sexual pleasure is more concentrated and less diffuse than it was previously. How and where you feel pleasure may change. If you were previously orgasmic, you are likely to remain orgasmic, and it may become easier to orgasm although it may take different stimulation or techniques.
Your skin all over your body is likely to thicken, and your body hair might get thicker and coarser which may change how you experience touch all over your body.
You are likely to sweat more. How your sweat and secretions smell and taste will change.
We also encourage you to explore and enjoy your body as it changes and try new things: textures, pressure, where you’re applying texture and pressure, and how. We’re excited (pun intended) to share with you Johannes T. Evans’ essay on what happens to your genitals on T and some ideas for exploring those changes.
For Parents of Trans Youth
Your kids are alright.
Often parents of younger trans youth have concerns about future sexual function. We don’t have a lot of data about adult sexual function for youth who were given blockers then exogenous (from outside the body) hormones, and who do not experience endogenous (from inside the body) puberty.
However, youth are usually not pre-orgasmic when they are pre-pubescent. Masturbation is common in young children and is a normal part of development.[1] Most children have experienced orgasm before puberty. It is our clinical opinion that the ability to orgasm does not go away with blockade and then exogenous hormones.
