For more general information about queer sexual health please visit this page.
Hormones and Sexual Health
Testosterone: This hormone causes many changes, such as increased facial and body hair growth, deepening of the voice, etc. Hormones work a little bit differently for everyone who takes them, so your experience will be different from other folks that you know that have taken testosterone. There are many changes with testosterone that relate to your sexual health. These can include an increase in sex drive, vaginal dryness, and clitoral/phallic growth.
This growth is often referred to as “bottom growth.” For people who want to have phalloplasty or metoidioplasty, taking testosterone and having the phallus grow larger is a important step before surgery. For some, taking testosterone and having bottom growth can make the phallus much more sensitive.
If testosterone causes vaginal dryness, your provider might prescribe topical estradiol cream to apply to the vagina. While this is a form of estrogen, it does not negate the effects of testosterone, and can help you to stay healthy. All people, including cis men, have some level of estrogen naturally occurring in their body, so while it might feel odd to be taking testosterone and using an estradiol medication, it’s perfectly normal. Along with being uncomfortable, vaginal dryness can cause tears to occur during penetrative sex, which can increase the risk of contracting STIs.
When people first start testosterone, they can be surprised at just how much their sex drive is increased. While everyone’s bodies process hormones differently, this typically becomes less intense over time as they get used to being on testosterone.
Testosterone is not a contraceptive. While it does reduce fertility, it should not be relied upon as a birth control method. Even if someone taking testosterone has stopped menstruating, they could potentially still get pregnant if they are having the kind of sex that can result in pregnancy. Along with condoms, there are hormonal contraceptive methods that can be a great contraceptive option for people on testosterone. Our page on reproductive health goes into more detail, but even though you’ll see progesterone listed under “feminizing hormones” above, progesterone-based hormonal birth control is perfectly fine to take if someone takes testosterone.
Surgeries and Sexual Health