Research on transgender health and wellness after gender affirming surgeries can be helpful for transgender people who want to learn more about what their options for medically transitioning are.
Knowing the potential outcome of these interventions can help inform and guide the decisions of people who are considering getting these surgeries— and it can also help inform cisgender healthcare providers too.
As someone who had bottom surgery myself (I had ALT phalloplasty) I took a deep dive into the current research on the procedure before making my decision, and while the research was helpful, talking to people who had the surgery I was planning to have equally important.
That being said, if anyone is considering getting peritoneal flap vaginoplasty, this new study should have interesting results and is worth reading!
There isn’t enough knowledge out there about this topic, especially given the relative newness of the peritoneal pull-through procedure as a vaginoplasty option.
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Here is the primary author’s Twitter summary of the study:
“Retrospective review of 199 peritoneal flap vaginoplasty patients
⏲️Median time to orgasm = 6 months
Any smoking history = correlated with less orgasm recovery
Among those with minimum one-year follow up (89%):
Orgasm pre-op not significantly correlated with orgasm post-op
Rate of post-op orgasm was 86%, however,
Not all anorgasmic patients were attempting to orgasm
Patients continue to become newly orgasmic past one year
Interventions for anorgasmia post-surgery include:
Pelvic floor physical therapy for scars, hypersensitivity, or dilation difficulty
Testosterone rx (orchiectomy is hormone intervention!)
Sex therapist with ️⚧️ competency
❤️Trauma informed care
We examined a rudimentary outcome (orgasm: yes/no). There is so much more to learn about the sexual health of transgender women and nonbinary people after surgery! It is a privilege to work for this community under the mentorship of Dr. Zhao and Dr. Bluebond-Langner at NYU Langone”
(It costs $31.50 to purchase access to the full article, but if you are in school you can request that the research librarians help you gain access to a copy of the full text of the study)
Hi everyone! I’m posting today to specifically point out an awesome resource that more people should be aware of.
The Gender Affirming Letter Access Project (GALAP) is an organization of independent clinicians who help transgender people access gender-affirming medical treatment like hormone replacement therapy and surgery by providing free letters using the informed-consent system.
The providers listed in the GALAP directory have pledged to complete at least one free informed-consent session and subsequently write at least one free letter per month.
This is super important because many people aren’t able to get insurance coverage for the treatment they need without getting a WPATH-compliant letter, and that can make it difficult for someone to be able to start their transition.
For example, many low-income trans people aren’t able to afford multiple therapy sessions which makes getting the WPATH-compliant letter difficult for them.
Similarly, trans people living in rural areas face more barriers in being able to find therapists near them who are trans-friendly and currently accepting new patients.
In my own personal transition, I’ve needed to get…
1 letter from a mental health provider to start HRT
1 from a mental health provider plus 1 letter from my testosterone prescriber to have top surgery
Letters from 2 different mental health providers respectively plus one from my testosterone prescriber to get a hysterectomy
Letters from 2 different mental health providers plus one from my testosterone prescriber to get the first stage of phalloplasty
Letters from 2 different mental health providers plus one from my testosterone prescriber to more to get the second stage because my first set of letters had expired in the meantime
And I’ll need 2 more for the third stage because I’ll be switching insurances and need to re-start my approval process
For anyone keeping a tally, I needed to get 10 mental health letters saying that I am trans and need to transition before I could get the medical care I needed, not including the “proof of HRT” letters.
It’s ridiculous— If I had needed treatment for any other reason, I wouldn’t have needed to jump through so many gatekeeping hoops where cisgender medical professionals were the arbiters if I was trans enough and deserve care.
For example, my stage 3 phalloplasty surgery is just having an erectile implant placed because I have erectile dysfunction. This is true of all post-phalloplasty patients as a result of the way our penis is structured.
If I were a cisgender man getting the same surgery for erectile dysfunction and having the same device implanted, I would not need to see two mental health professionals first who would judge me on my gender identity before deciding whether I should be allowed get the implant.
The urologist would just use their best medical judgement in determining whether the surgery would be a good idea and then explain the risks and benefits of the procedure and let me decide if I wanted to go ahead and do it. Then the doc would send the insurance the preauthorization info and codes for the procedure based on the diagnosis, and no required mental health evaluation or therapist letter would be involved at all.
But because my surgery is a “gender affirming surgery” for “treatment of gender dysphoria,” I have to see two therapists first and they will judge if I’m “trans enough” and then they have to write a letter saying that I need the surgery because I’m mentally ill (aka diagnosed with “gender dysphoria”) before my insurance will cover the surgery that’ll let me have an erection.
In my opinion, that’s paternalistic, demeaning, unnecessary and a waste of everyone’s time. And it isn’t just weird, invasive, and annoying— it can determine whether you’re able to access necessary medical care.
The GALAP also addresses how requiring a letter is a form of gatekeeping which can negatively impact multiply marginalized minorities, stating, “We are aware that people who do not fit a certain narrative about what it means to be ‘transgender’ often receive subpar care and face more barriers to receiving the care they need. We acknowledge that this greatly impacts people of color and indigenous communities, nonbinary people, and neurodivergent people.”
The provider will have an interview session with you, using the informed consent approach in their interviewing, and then will write a letter, again using the informed consent approach in their letter writing process.
The interview session, the letter (and any additional copies of the letter) are all supposed to be pro-bono, which just means it’s free. They aren’t supposed to charge you for anything, like additional time on letter writing outside the therapy session, any clinical consultation they need to perform, or any communication with your surgeons and medical staff.
I believe that majority (or possibly all) of the providers in the directory will only provide informed consent letters for legal adults as the wesbite says “writing letters for youth brings up complexities since minors may assent but not consent without parent/guardian support to move forward with any medical interventions,” so it’s a resource that is more useful for those who are 18 or older.
You’ll also need to discuss with your letter writer if they are comfortable officially diagnosing you with gender dysphoria if your medical provider/s and/or insurance company requires a formal a diagnosis of Gender Dysphoria to access gender-affirming medical services.
You should also check whether your letter writer needs particular credentials.
My insurance said:
“One of these letters must be from a psychiatrist, psychologist, nurse practitioner, psychiatric nurse practitioner, or licensed clinical social worker with whom the member has an established and ongoing relationship.
The other letter may be from a psychiatrist, psychologist, nurse practitioner, physician, psychiatric nurse practitioner, or licensed clinical social worker acting within the scope of his or her practice, who has only had an evaluative role with the member.”
Your insurance company may have more rigid requirements and need a letter from a medical doctor or doctor of osteopathic for example, and may not accept a licensed clinical social worker, or they may allow any mental health practitioner.
So it’s good to double-check that the person you’re contacting in the directory has the license you need for your requirements.
The GALAP site says:
“Just because someone has signed The GALAP pledge or uses our name and logo on their website unfortunately doesn’t guarantee that they are honoring our pledge’s totally FREE letter writing (and session) commitment.
When reaching out to request a letter, we encourage you to ask the therapist/letter writer:
1) Is this entire letter writing process (including the time it takes to meet) completely free, as in keeping with The GALAP pledge? 2) Have you written surgery letters on behalf of trans and nonbinary folks before that have been accepted by surgeons and/or insurance companies?
While we can’t monitor or endorse therapists who sign the pledge, you can find out if they will honor the pledge BEFORE you meet with them.”
The (current as of 04/2022) list of states that currently have a provider who has agreed to write free letters is below:
Most providers can only provide a letter to people residing in their state(s) of licensure, and there are some states that don’t have any providers listed at all, so hopefully more providers will sign the pledge and get listed in the directory in the future.
But even as it is today, this is a super-useful resource for trans people who are looking to medically transition, and hopefully more people become aware of it and are able to make use of it going forward!
Our post on how to start HRT in the USA has linked to the GALAP website so this isn’t the first time I’ve mentioned their directory, but I felt like the GALAP directory deserved its own post, so here it is!
If you haven’t heard the news already, soon you’ll be able to self-select the gender marker you would like printed on your U.S. passport!
Here are the two key changes:
The government no longer require medical documentation to change the gender marker on your U.S. passport!
The government now allows you to choose “X” as a gender marker on your U.S. passport!
What does it mean to self-certify or self-select your gender marker on your passport?
Basically, now you don’t need to provide any documentation (medical or other) to change your gender marker on your passport.
So even if the gender you select on the application for a new passport doesn’t match the gender on your previous passport or other documents, you don’t need to supply any evidence or proof that you have been diagnosed with gender dysphoria or have medically, socially, or legally transitioned, or anything else.
This removes a big hurdle for trans people who want to update our IDs; there used to be a lot of hoops to jump through because people used to need a doctor’s note which not everyone had access to.
Now, you no longer need to provide medical certification or a physician’s letter if the gender marker you select for your U.S. passport does not match the gender on your citizenship evidence or photo ID.
Instead, you simply self-select the gender you would like them to print on your U.S. passport, by selecting “male (M)”, “female (F)”, or “unspecified or another gender identity (X)”.
Does this mean all of your legal gender markers have to match?
Beyond removing the unnecessary and burdensome gatekeeping, these changes actually open up new options for transgender people.
Because your citizenship evidence or identification document does not need to match the gender you are requesting, you can actually have multiple legal gender markers.
That means your passport can say “X” even if you aren’t able to legally change your gender marker to X on your state ID or driver’s license because that isn’t an option in the state you live in yet.
Similarly, your passport can still say “X” even you aren’t able to update your birth certificate with an “X” because that isn’t an option in the state you were born in.
Because the gender you select for your passport does not need to match the gender on your supporting documentation, you’ll still be able to have your passport use your preferred gender marker regardless of the gender marker on your other forms of ID.
That means you can have a driver’s license that says “M” and a passport that says “F,” for example; the mix-and-match gender marker option isn’t restricted only to people who want an “X”.
Some people might like to have that flexibility earlier in their transitions when they aren’t consistently passing and want to have more than one option for their gender marker on legal identification.
For example, a non-passing trans man wants his driver’s license to show “M” because he identifies as male. While he knows that having “M” on his license would out him as being transgender because he isn’t passing yet, he doesn’t mind that because he feels safe in the state he lives in and the places he goes to and wants his ID to reflect his male gender identity. But when he travels overseas to a less-accepting area, but he wants to keep the “F” on his passport so he can have the option of going into the closet for his own safety in transphobic/homophobic places.
In other cases, some genderfluid or bigender people, for example, might like the validation that comes with having disparate binary gender markers on different forms of ID instead of having an X.
But the legal/logistical consequences of having mixed gender markers on different documents may turn out to be inconvenient at some point because of the difficulty in reconciling the various markers. So I personally would recommend keeping your gender markers congruent for now, and either update them all or leave them all the same. But it’s up to you of course!
I currently have “X” on my birth certificate and “F” on my driver’s license because I couldn’t update my license to “X” where I live since it wasn’t an option yet, so I do have mixed legal gender markers and it hasn’t been an issue yet.
What’s the deal with the photo needed for the passport?
While you don’t need to have the gender on your birth certificate and/or driver’s license changed before you can get the gender marker changed on my passport, the photo you submit with your passport application must look similar to the photo on your ID.
This means that you can’t be fully female-presenting on one ID and fully male-presenting in the photo of your other ID to the point where the two photos of you look like you’re siblings and not the same person.
So you’ll have to choose a single “look” that’s similar on both documents, whether you chose to try and aim for a more neutral/androgynous look or go fully masculine or fully feminine for both.
You will need to submit a new photo when applying for a passport, and the photo must look similar to your current appearance, must look similar to the photo on your ID, and must meet the passport photo requirements.
So, can I just go out and get a new passport card with an X right now?
Not yet. There’s a difference between a passport book and a passport card.
So before folks get too excited about the possibility of getting an X all their passport-related documents, I’d keep in mind that it actually isn’t an option on all passport-related documents yet because the government says that they won’t have their systems fully updated until sometime late next year. Oof.
Starting on April 11, 2022, you can select male (M), female (F), or unspecified or another gender identity (X) as your gender marker if you are applying for a U.S. passport book and selecting routineservice.
But it isn’t until late 2023 that the government anticipates completing additional technological updates so that the X gender marker will be available on the following documents they issue:
Passportcards
Emergency passports printed at embassies and consulates
Expedited and emergency passports issued at passport agencies and centers
Consular Reports of Birth Abroad (CRBAs)
So before late 2023, if a person visits the public counter of a passport agency needing a passport for immediate travel, like if they suddenly need to go overseas for a family funeral for example, they will have to select a binary gender marker (M or F).
Similarly, U.S. embassies and consulates will not be able to offer emergency passports with X gender markers until all technological updates are complete in late 2023.
If someone who has an X gender marker on their passport then loses their passport while traveling overseas, they will need to select a binary gender marker (M or F) to be issued an emergency passport for the return home.
But once they have completed their travel, they have up to one year from the date of issuance to apply for a free replacement routine passport with an X gender marker using Form DS-5504.
Ok, cool, but how do you actually update the gender marker on your passport?
“Well, the government is in the process of updating their Form FillerandForm Eligibility Wizard tools to incorporate the X gender marker, so you can’t use the online website that you’d normally use.
Then you need to follow the steps listed on their ”Apply in Person“ page.
Children under age 16 must always apply using Form DS-11 and appear in person with both parents or legal guardians (if they have two legal parents/guardians).”
Well, what about people who currently have a limited-validity passport?
“Under the previous passport policies, if you were in the process of transitioning to a new gender when you applied for your passport, you may have received a limited-validity passport (issued for less than the full validity period of 10 years for those 16 and older and five years for children under 16).
But the government no longer requires medical documentation or a physician’s letter as evidence of a gender transition.
To replace a limited-validity passport with a full-validity passport in this situation, you’ll need to submit Form DS-5504.
To use this form, you must apply within two years of your previous passport’s issuance date. You do not have to pay fees unless you are requesting optional, expedited service.
If your limited-validity passport was issued more than two years ago, please use Form DS-11 and follow the steps on our Apply In Personpage.
Please note that expedited service is not yet available if you are applying for a passport book with an X gender marker.”
Anything else?
For folks who are looking to update their legal gender markers, whether it’s on your driver’s license, birth certificate, passport, social security record, or anything else, I’d highly recommend exploring the Trans Equality Document Center. It’s the resource that I used myself when I legally changed my name!
“I work with BTAC (Black Trans Advocacy Coalition) and do a lot of work for our subgroup BTMI (Black Transmen Inc.) We have a lot of dope resources to offer to the community and I just wanted to share them with y'all.
For starters, we have lots of grant programs! We have a Binder grant where we’ll hook you up with a binder if you don’t have one. You can find more info on how to apply for that grant here: https://blacktransmen.org/binder-program
Finally, we have a top surgery fund grant! We’ve awarded up to $1,000 bucks before to guys getting top surgery. There are a couple requirements for this one though. You have to be in the US. Have to be 18 or older, and you also must already have approval for surgery from your chosen surgeon. You can find more info on how to apply for that here: https://blacktransmen.org/top-surgery-grant/
We also have some dope virtual resources! Every 1st and 3rd Wednesday of the month, we host a virtual support group/space called Akanni. This is for all and any Black trans dudes. More info on that call and how to join them here: https://blacktransmen.org/akanni-mens-support-group
Lastly, we got a mentorship program and are currently taking applications for Empowerhim guides (mentors) and mentees! More info here: https://blacktransmen.org/akanni-mentoring
Hello, my name is Lee! I’m going to be joining the mod team.
I’m 16 years old.
I’m a nonbinary person, and a demisexual lesbian. My pronouns are they/them/theirs. I have ADHD and I’m Autistic. I’m biracial (black and white), and AFAB. Right now, my special interest is Star Trek.
My personal blog is @questingqueer and I’m on the Meet the Admins page now, and I’m excited to start answering questions.
Chrissi says:
Hi Lee!
Lee says:
Hello, my name is Lee! I’m updating this again because I’ve been on the mod team for a while and my transition has progressed a bit further.
Now I’m 22 years old.
I’m still a nonbinary person, and now I also use the labels genderqueer, transmasculine, transsexual, and transgender.
While my sexuality hasn’t changed, I no longer identify as a lesbian; I just label my sexual orientation “queer” now.
My pronouns are they/them/theirs, but in certain situations, like when I’m at work, I also use he/him/his despite not identifying as male-aligned or male-proximal.
I still have ADHD and I’m still Autistic and biracial; obviously those things won’t ever change!
I now say that I was AFAB instead of saying that I am assigned female at birth because I’m no longer female and no longer “at birth”. I’m past all that, so now I use the past tense because the term describes something that happened to me years ago, not something still I am.
My special interest… is still Star Trek…
Since I wrote that intro post as a mostly-closeted pre-everything teen, my transition has progressed a fair amount:
I was outed as trans in 2015
Ilegally changed my name in August 2016
I started testosterone gel in June 2017
I had inverted-t incision top surgery in October 2017
I had a hysterectomy without oophorectomy in July 2018
I had ALT phalloplasty without vaginectomy or urethral lengthening in May 2021
I had glansplasty and scrotoplasty in January 2022.
Here are the transitioning steps I hope to take in the future:
Having medical tattooing done
Having a pump erectile device (the Coloplast Titan OTR) placed
Having a silicone testicular implant placed
Legally changing my gender marker to X on all of my forms of identification when that becomes an option where I live
Other things about me: I live with my partner (mod Devon), I graduated college a couple of months ago, I recently got hired at a new job, and I hope to apply to medical school this year.
Hello everyone! I’m Lee, a transmasculine person who is approaching 5 years on testosterone, and I’m here on your dash on this fine Transgender Day of Visibility to conduct a survey on the effects of testosterone on clitoral growth.
The lack of knowledge about some of the most basic aspects of medical transitioning is a real problem, and because it’s Transgender Day of Visibility, I’d like to bring this topic up again because the bodies of post-transition people are often invisible in medical literature which means the community has to turn to anecdotes they’ve heard from others to inform their expectations.
There was a 1986 study that investigated this question by collecting data from 30 patients who were AFAB and on testosterone, but the researchers only followed up with the patients for 1 year and 5 months (and some sources, like the WPATH guidelines, suggest that clitoral growth continues for 2 years.
A more recent 2014 study investigated the same question and included 97 patents, but their sample was limited to people who had self-selected to undergo metoidioplasty, which may have biased the results as people who didn’t have enough clitoral growth to be good candidates to be able to easily stand to pee and clear their fly with metoidioplasty might have chosen to get phalloplasty instead, which means they wouldn’t have been included in this study.
There are a few more data points out there, but the sample size tends to be small and is often limited to patients who had metoidioplasty which may not be representative of the typical growth that people on testosterone can expect to experience on average.
The purpose of my pilot survey is to gather data that can help inform the expectations of transgender people who are considering taking testosterone regarding the average size of the clitoris after a period of time on testosterone.
I am particularly interested in hearing from people who have been on testosterone for over two years, people who currently have (or used to have) conditions that affect their hormones levels, people who have had metoidioplasty, and people who have detransitioned or stopped taking testosterone.
But you may be eligible even if you don’t fit one of those descriptions— the criteria include anyone who was assigned female at birth (whether or not you identify as transgender or cisgender), is currently above the age of majority where you live (aka you’re legally an adult), and hasn’t had their clitoris surgically “buried” as part of phalloplasty. You don’t need to be on testosterone to respond.
So let’s all do something awkward for science and do something about the invisibility of our post-T bodies!
Please consider reblogging this post, then going to get your ruler out to fill out this survey and take some measurements when you have a free minute.
[ID: Background image is a faded trans pride flag background with a thin yellow square on it. On top of the background, purple text forming a circle reads: “Celebrate transgender lives. Transgender Day of Visibility.” In the middle of the circle, black text reads “Intersex trans people exist”]
Lee says:
March 31 is Transgender Day of Visibility, and I hope that people will use this opportunity to direct some much needed attention to the issues that multiply marginalized members of the transgender community face as we work to stand in solidarity with each other, become better allies for one another, and celebrate our resilience as a community.
[ID: Text that says “ Celebrate Transgender Day of Visibility with @transgenderteensurvivalguide. Text is written over trans pride flag background]
Lee says:
This pinned post is a transitioning starter pack for all my trans folk out there!
Your transition is up to you- we want to provide information on all your options so you can make an informed decision about what you want. If you find a resource useful, then use it! If you’re not interested in doing any of the things listed, then don’t!
Since people have been asking us how much clitoral growth people tend to experience on testosterone, I’m looking to collect some informal data on people’s personal experiences.
There is a lot of misinformation and misconceptions about the effects of testosterone on the body, so it’s important for us to find a way to educate ourselves and each other so people can make informed decisions and know what to expect!
Personally speaking, I started testosterone as soon as I turned 18. And as you all know, I did a lot of research beforehand! But there were some things that I couldn’t find statistics for online, which is why I later went on to create this survey.
I was given information by the provider who prescribed my HRT which said “your clitoris will grow bigger” but when I asked for something more specific, like what size range I should expect, or what the average amount of growth was, the nurse couldn’t answer beyond saying that I should expect “clitoromegaly” because she didn’t know either.
When I had just started testosterone, being told “this is what you should anticipate” is something that would have really helped me temper my expectations as someone who had assumed I’d magically get an unrealistic amount of clitoral growth (and later switched my plan from getting metoidioplasty to phalloplasty when I realized that the photos I had seen online were not “average” and I would end up being fully 100% average).
I’ve noticed that people who tend to post pictures of their genitals after being on T tend to be more well-endowed than those who choose not to share their photos in the same public manner, and people who choose metoidioplasty might be more likely to be on the larger side than those who choose to get phalloplasty, so just as looking at pornography doesn’t necessarily paint a realistic picture of what the average cisgender body is, neither does looking at some of the NSFW images posted online because of this self-selection bias.
So while looking at pictures and videos online might be one way for people to get an idea of what things will look like “down there” after having been on testosterone for a while, that type of content isn’t always representative of the full spectrum of bodies, or even something that everyone is comfortable looking at— it’s certainly not something that a minor could look at on a school or library computer, for example.
I know that this survey is a bit subjective— different people might be measuring their bodies in slightly different ways— but if enough people do it and the sample size is large enough, I believe it also should still average out to provide a more-or-less accurate depiction of what type of changes will happen happen on T.
I believe that this is genuinely an important issue and that is why I’m asking folks to push past their dysphoria and awkwardness, pick up a ruler and head to their bedroom or bathroom, lock the door and measure their clitoris for science!
~
This survey only applies to people who were assigned female at birth; however, you don’t need to be on testosterone to respond.
People who are eligible to take the survey include:
Trans people who were AFAB and are pre-T or non-T
Trans people who were AFAB and used to be on T but stopped taking it
Trans people who were AFAB and intersex
Trans people who were AFAB and are currently taking T
Cisgender women who have detransitioned/reidentified and used to take T but have stopped taking it
Cisgender women who are intersex and have not taken testosterone
Cisgender women who are not intersex and have not taken testosterone
The reason why pre-and-non-T people who were AFAB (including cisgender women) can be included in this survey is because their data can be used as a baseline for pre-testosterone clitoral size. However, you must be over 18 to respond!
People who are not eligible for this survey:
People who were assigned male at birth and currently have a penis
People who were assigned male at birth and had vaginoplasty/gender affirming surgery to create their clitoris
People who were assigned female at birth and had their clitoris “buried” as part of phalloplasty/gender affirming bottom surgery (unless they specially measured their clitoris before surgery and kept a note somewhere with the measurements)
~
I initially made this survey in 2018 when I was only about 1 year on T and before I had gotten lower surgery and I believe I had (badly) traced one of my own actual photos to create a drawing to demonstrate how to take the measurements.
Now Tumblr has now banned NSFW content and they took the link to the original reference photo set down as a result (despite my appeal!), so there is no visual to demonstrate how measurements should be performed, and I’ve since had lower surgery so my set-up is different than what people’s now.
If anyone has artistic talent/literally any drawing skills and wouldn’t mind donating their time to work with me to illustrate the procedure for taking measurements, I would really appreciate it if you sent an ask!
I also have the feeling there are probably a good number of ways that I can improve this survey so I’ve put a question at the end to ask for feedback on what y’all think of the survey and how I can make it better.
~
While reblogs are both welcome and encouraged, I’d also appreciate it if you shared this link on any non-Tumblr social media that you may have; I don’t really go on the Reddit forums or the Facebook groups or whatever, and it would be cool if this survey made its way to those spaces as well.
Here’s a description that you’re welcome to use when posting this:
“Hello! My name is Lee. I’m a transmasculine person on testosterone and I’m conducting a survey on the effects of testosterone on clitoral growth. The purpose of this survey is to gather data that can help inform the expectations of transgender people who are considering taking testosterone regarding the average size of the clitoris after a period of time on testosterone. I am particularly interested in hearing from people who have been on testosterone for over two years, or who have stopped taking testosterone. If you were assigned female at birth, you may be eligible to take this survey. The link to the survey is here: https://bit.ly/T-growth”
Can you give more info on what happens to my downstairs bits on T?
Your period will stop, your clitoris will get a bit bigger, and your vaginal walls will get a bit thinner and things may be drier down there.
Menstruation stops within in 2-6 months on an average testosterone dose and then it’s gone as long as you stay on T
Clitoral enlargement is one of the earliest changes people tend to notice, and it starts around 3-6 months on an average dose of T, and continues to grow for 1-2 years
But it all depends on the individual, as some people experience some changes faster than others regardless of their testosterone levels
—
“Bottom growth? Huh?”
People sometimes say “bottom growth” as a euphemism for what doctors call “clitoromegaly” and what we’ll call “clitoral growth”. Trans folks may use “lower growth” or similar terms because they may not want to refer to their genitals with certain words because of dysphoria.
“What is the clitoris?”
The clitoris is the nerve center of the genital area for AFAB people. It’s an organ that exists for sexual pleasure, and it’s very sensitive. It’s located in front of your urethra and vagina. @whoneedssexed is a good resource if you want to learn more about sex or your body and how it works.
Some folks call it a “t-dick” or refer to it as their junk or their penis, and you can call it whatever makes you the most comfortable, but we’ll use the word clitoris here just for clarity.
“Wait, the clitoris grows? How much?”
Your clitoris will grow on testosterone! The average size it ends up seems to be around 1.2 inches give or take. Some folks have even ended up with a 3-inch length, but this is pretty rare!
I started testosterone on low-dose T and I still experienced clitoral growth within the first few months. Genital growth isn’t something you can opt out of if you take testosterone; again, if you take T, you can’t prevent your clitoris from growing because it’s one of the first changes you get.
Clitoral growth from testosterone comes from the stimulation of the androgen receptors in your clitoris.
It is possible that you will have a larger growth if you have a rather large clit already, but it isn’t guaranteed.
If you’re pre-T and already have a larger clitoris, then there’s a chance that you won’t experience as much growth because your androgen receptors have already maxed out, so there’s not as much room left for change so you’ll end up with an average size.
There’s also the chance that you’ll end up a larger clitoral size than average if you start with a larger size and continue to have a normal growth, so you might not have more growth than usual but you’d still end up bigger.
So basically pre-T clitoral size isn’t necessarily going to indicate what size you’ll end up on after testosterone.
“Does it hurt?”
Sometimes. You don’t usually feel pain from it growing or feel it grow, and it doesn’t grow long enough to affect your sitting. Once you get used to it, it doesn’t really feel like anything unusual. It became normal pretty quickly, and I only really notice the difference when I shower and during sex.
Some people do experience some pain from the new growth rubbing on their underwear when it first starts to happen, but wearing wearing tighter underwear (made of soft fabric, without seams) so that your body isn’t brushing against loose fabric and it’s more “contained”/held closer to your body can help.
To prevent chafing, you can also use something body-safe on your glans as a protectant/barrier. Some people apply a little cocoa butter (the raw kind that you have to melt a little in your hands, not Palmer’s), coconut oil, or silicone lube so it doesn’t rub.
And not everyone experiences pain from chafing- I didn’t experience any pain or irritation from clitoral growth at all besides one incident when I went swimming after a month or two on T and the chlorine in the pool hurt a bit.
“Do I need to clean it?”
Yes, every time you shower you should carefully clean your clitoris gently with warm water, just like cis men are supposed to clean their penises if they’re uncircumsized.
Pull back the foreskin/hood and make sure you rinse and (gently!) rub off any smegma around your glans and corona. And just to be clear, it’s only your external genitals you want to clean - your internal genital area is self-cleaning and will not appreciate water or (especially!) soap interfering with it. Soap isn’t necessary and can make hygiene problems worse by throwing off the PH balance in the area, but if you really want to, get something gentle and unperfumed.
“What does it look like?”
Right now, I don’t have many good non-sexual lower growth links to share because of Tumblr’s adult content purge.
There’s one Imgur post here showing lower growth standing and sitting, which only represents one person’s body but it’s a good non-sexual clitoris picture which sounds like an oxymoron but isn’t.
You can see some bottom growth pictures on Reddit’s FtMPorn forum too, which is explicitly trans-centric. But most of those pictures are sexual pictures, so you will see what lower growth looks like, but they have sexual captions and sometimes the person in the picture is wet/aroused and occasionally a toy/penis penetration is involved so you get a little more than what you’re looking for on that forum and you really need to be prepared to See Some Things.
There’s another Reddit group here but it isn’t a group moderated by and for transgender people, it’s mostly targeted towards cis women who want clitoral growth, so the mod’s intentions might be a little more kink/fetish-y than education for the trans population. But it does have pictures.
This is someone’s drawing reference guide on clitoral growth changes, for any artists out there/folks who don’t want to see actual genitals.
You can see pics of people’s before/after pics of clitoral growth then metoidioplasty surgery on the TransBucket website as well, but you won’t look like this unless you get surgery- some people see meta results and assume that just testosterone will give them testicles which isn’t the case.
“Does it affect peeing?”
No, clitoris growth does not affect how you use the bathroom. Your clitoris grows larger, but you pee through your urethra- not your clitoris.
Your urethra stays the same unless you get surgery to have a urethral lengthening as part of lower/bottom surgery.
Some people believe that pumping can cause small increases in clitoral size over time, but other people say that the effect is temporary and limited to a short time after pumping.
DHT is short for dihydrotestosterone, and it can cause growth in the clitoris after you’ve been on testosterone for 2 years and gotten all the growth you’ll get without intervention.
While the clitoris does grow on testosterone, it doesn’t always reach the maximum size possible for it because the androgen receptors aren’t filled.
DHT can sometimes add a few centimeters or even an inch of growth, which is really a significant difference with a surgery like meta where every centimeter matters.
People getting a meta are sometimes recommended to take DHT for 3 months before the operation to maximize lower growth, but there’s currently no easy legal way to access DHT in the USA.
It used to be available online through the All Saint’s Clinic and other vendors, and some folks have gotten it locally through compounding pharmacies.
“Will my clitoris go back to its original size if I stop testosterone?”
No. If you stop testosterone, your clitoris will keep around the same growth it had reached on T, and shouldn’t increase or decrease much in size.
I have heard anecdotally from a few people who took my informal survey that stopping testosterone changed their clitoral size a little bit, so it’s possible that topical estrogen may impact size a small amount too.
Here are their responses on this question:
I did not lose or gain length after stopping testosterone: 18 people
I lost less than .5 cm in length after stopping testosterone: 8 people
I lost 1 cm in length after stopping testosterone: 3 people
I gained less than 1 cm after stopping testosterone: 1 person
As you can see, the majority (60%) said they didn’t experience any changes in clitoral size after stopping testosterone, but of course this is a hella small sample size and an informal survey and you’d still be on T so the situation isn’t quite the same, so take that with a grain of salt.
A de-transitioned person who stopped T told me that in their experience, their clitoris didn’t get as hard/erect in the same way as it did when they were on T so it doesn’t look as large as it did before, so a few people I’ve heard of take Cialis or a similar erectile dysfunction medication when they want to have sex if that difference bothers them.
“Wait, I can take erectile dysfunction medications?”
You need to talk to your doctor about it, but yes, you can.
When you have a certain amount of clitoral growth, you can have erections. These erections aren’t typically noticeable if you’re wearing pants, and honestly you usually can’t even tell if someone is wearing underpants.
But when you get to be familiar with your own body, you’ll be able to tell the difference between when it’s “hard” and sticking out a little versus “soft” and not as prominent. I can tell the difference on my own body and I can see the difference on my partner (who is also on testosterone).
Erectile dysfunction medication typically won’t make your clitoris any longer, but it will make it a little firmer.
Most folks on T don’t do this because it isn’t necessary, but it’s more common for people who stopped T (as mentioned above) and for post-metoidioplasty folks who have been advised to try it earlier on post-op to prevent retraction, or who want to maximize their “firmness” for sex to make penetration easier.
Erectile dysfunction medication can also affect your blood pressure, so again, if you have high blood pressure or low blood pressure make sure you talk to your doctor about the best way to make sure you’re healthy while taking the medication. (In my EMT training, we are instructed not to assist with administering nitroglycerin for chest pain if someone has taken erectile dysfunction medication).
I know ordering the meds online can seem tempting, but like the Mayo Clinic website says, “Check to see if an online pharmacy is legitimate. Never order medications from an online pharmacy if there’s no way to contact the pharmacy by phone, if prices seem too good to be true or if you’re told no prescription is necessary. Some illegal businesses sell counterfeit versions of legitimate medications, which can be ineffective or dangerous. In the U.S., the National Association of Boards of Pharmacy can tell you whether an online pharmacy is licensed and in good standing.”
Donotorder any medication that does not require a prescription from a doctor- this is illegal and the medication is probably fake or dangerous. Similarly, herbs and “natural” ED treatments are a scam and also possibly dangerous, and they will not work or be effective at all.
If you have any health issues or disabilities at all, make sure you’re talking with your doctor about the safety of erectile dysfunction medication given your particular conditions.
“What’s vaginal atrophy?”
T can cause atrophy of the vagina and and uterus, and vaginal atrophy is symptomized as irritation, itchiness, dryness, and bleeding when penetrated.
It sounds scary, but it isn’t! Vaginal atrophy is treatable if you go to your doctor and get a topical estrogen cream or pill for the area.
From the Mayo Clinic: Vaginal estrogen therapy comes in several forms. Because they all seem to work equally well, you and your doctor can decide which one is best for you.
Vaginal estrogen cream. You insert this cream directly into your vagina with an applicator, usually at bedtime. Your doctor will let you know how much cream to use and how often to insert it. Typically people use it daily for one to three weeks and then one to three times a week thereafter. Although creams may offer faster relief than do other forms of vaginal estrogen, they can be messier.
Vaginal estrogen ring. You or your doctor inserts a soft, flexible ring into the upper part of the vagina. The ring releases a consistent dose of estrogen while in place and needs to be replaced about every three months.
Vaginal estrogen tablet. You use a disposable applicator to place a vaginal estrogen tablet in your vagina. Your doctor will let you know how often to insert the tablet. You might, for instance, use it daily for the first two weeks and then twice a week thereafter.
I also have talked to a trans guy who took topical estrogen and still continued to experience more clitoral growth, so if you start topical estrogen while you’re still experiencing clitoral growth (which can often continue for 2 years), likely it won’t matter in your ultimate size.
I was briefly on topical estrogen for atrophy myself (more info on that is here), and it did not impact my clitoral size, and I also continued to take testosterone during that period and did not “detransition”.
Right now, there haven’t been any studies on how topical estrogen impacts clitoral growth in transgender people, but I would personally hypothesize that it wouldn’t prevent growth.
“A screening visit concerning reproductive preventive health care is recommended between the ages of 13 and 15, but the appointment doesn’t necessarily have to be with a gynecologist. Many pediatricians and family physicians are comfortable with this, so whom a teenager should see will vary depending on the circumstances.
A first gynecologist visit should happen at the age of 21 for cervical cancer screening, however, anyone who is younger than 21 and is sexually active should be seeing a provider who is comfortable with gynecologic care for annual chlamydia screening.
Other reasons to see an OB/GYN before the age of 21 include irregular periods, heavy periods (soaking onto clothes is a good proxy for being heavy), or period pain that is interfering with daily activities despite the use of over the counter pain medications, such as acetaminophen or ibuprofen.”
No, it used to be recommended that everyone on testosterone get a hysterectomy but now it turns out that hysterectomies aren’t automatically medically necessary for everyone on T.
There are many other questions on the Bottom surgery (genital surgery) page so the links above are just a sample of questions you might be interested in!
“How will this affect my sex life?”
You can still masturbate and have all kinds of sex while on T, and you can still orgasm. Some people say that they orgasm quicker after being on T, some say it takes longer- but I’ve never heard of someone losing the ability. You may have to relearn your body and technique now that your clitoris is bigger, but hey- it’s more of a good thing!
However, your vagina may not self-lubricate as much anymore so you might want to use more lubricant for anything that involves vaginal penetration.
You may also be able to shallowly penetrate a partner a little bit with your clitoris, but this is typically difficult for folks unless they gained a lot of growth. But it is possible for some people, and using prosthetics that attach to the clitoris like the Hot Rod can be an aid for people as well.
If you want to see the range of clitoral sizes possible, take the anonymous clitoral size survey and you can see everyone else’s responses at the end including the responses from people on T. You can take the survey with or without being on T.
Fun fact: it turns out I can see what Google searches brought people to this page:
Since people have been asking how much clitoral growth people get on testosterone, I’m looking to collect some informal data on people’s personal experiences.
I’ve put a question at the end to ask for feedback on what y’all think of the survey and how I can make it better.
This survey only applies to people who were assigned female at birth; however, you don’t need to be on testosterone to respond.
