If you are new to gender-affirming hormone therapy (GAHT), you might wonder what kinds of physical changes to expect. People who use testosterone as part of their gender transition notice all kinds of exciting and new transformations. Some of these changes are obvious, like a lower voice and new facial hair. Others may be subtle, like emotional shifts related to T. Everyone’s transition is different, but most people experience profound changes within the first year on T. By the third year on a full dose of testosterone, the “masculinizing” effects of this medication should be apparent.
When you start testosterone, your healthcare provider can help explain what to expect in terms of bottom growth. This blog is written to support transgender, nonbinary, and other folks taking testosterone who want to know more about how their gender-affirming hormone therapy may affect bottom growth.
One of the most profound—but least-discussed—changes that people experience on T is “bottom growth.” In the first year of testosterone, sexual and genital changes are common. This can include increased sensitivity, growing genitals, orgasm changes, and other developments. These changes vary from person to person. Here are some common questions and concerns that people have when they start their testosterone prescription.
How big will my clitoris get when I take testosterone?
Bottom growth is when your clitoris, labia, and/or vulva grow in size. (Everyone uses different words for this part of their body. Some people find that certain terms feel gendered because of their affiliation with “feminine” or “female” body parts. In this article, we are using these clinical terms because they are easily understandable, commonly used, and accessible.) Testosterone causes clitoral growth that is significant in some people. The clitoris can grow in length and circumference. The average person notices about 1-4 cm of growth. The amount of growth each person experiences is influenced by their individual body’s response to testosterone. For example, some people notice an inch of growth or more, though more than that is uncommon.
While taking T, the labia and vulva may also grow. Some people notice that the labia, which are the two pairs of lips on the outside of the vagina, get bigger, longer, or darken. These changes are normal.
Bottom growth will make your clitoral erections more obvious, too. When you are aroused or stimulated, your erectile tissue will expand, just like it did before you began using T. As you experience bottom growth, your erect tissue will be more obvious.
Will testosterone change my sexual function?
Gender-affirming hormone therapy (GAHT) affects every system of the body. From your skin and hair to your emotions, testosterone will create changes throughout your body. That includes your sexual function and genitals. Changes to your sex drive are a normal and common experience on T. You might feel more interested in sex or find that you want to masturbate more often. Your fantasies might change, as well as your attraction to other people.
Many people find that, as their body begins to align with their gender identity, they feel happier—and more attractive, too! DK Green, a trans man who is also a psychotherapist, says that self-acceptance opens up new possibilities in the bedroom. He says, “Then you can start talking about, what do you like, what would you like? What are your fantasies about when you masturbate? What is it that you’re designing?”
At the same time, testosterone can also cause vaginal dryness. This medication will make the skin that lines the vagina thinner and can also change your vaginal pH and susceptibility to infections. It might take longer to feel “turned on” and lubricated in the way you’re used to. If you practice penetrative sex, condoms, gloves, or other barriers will help protect you from the increased risk of STI transmission. Thicker lubricant or a longer-lasting silicone lube can make sex more comfortable for you.
What does bottom growth feel like?
Most people who take testosterone notice bottom growth by the way it feels, long before they notice any visible changes. The clitoris is a sensitive structure that is about four inches long and has approximately 8,000 nerve endings. The clitoris is made of erectile tissue and extends out from the vulva. The visible part of the clitoris can look like a small bud or button, while the rest of the structure is hidden inside the body.
As testosterone affects your different body parts, you may feel like your clitoris is larger, firmer, or more responsive. Increased blood flow to your sex organs might make your clitoris look deep red or pink. Your labia may also look or feel swollen. As your clitoris grows, your clitoral hood may grow or it may remain about the same, making the external bud more visible. Some people switch from wearing briefs to boxers to manage this sensation change.
Testosterone may also change your sensation of orgasm. Rather than feeling the slow, building surge of an orgasm, you might find that the experience is abrupt and more intense. Your ability to have multiple orgasms might change, or you might feel so sensitive that you don’t enjoy direct touch. Zaps and tingling sensation are a sign of growth that will subside as your bottom growth slows. Hypersensitivity is more common in the first 3-6 months on testosterone and tends to stabilize after some time.
What if I don’t want bottom growth as part of my transition?
Some people worry that bottom growth will worsen their gender dysphoria. Others are not comfortable with the idea of increased libido. Some folks are survivors of sexual trauma and feel scared about any changes related to their genitals. If bottom growth is potentially triggering for you, be open with your clinician about your transition goals. You don’t have to give up using gender-affirming hormone therapy. While not everyone needs or wants to take testosterone, those of us who do know that T is a life-saving medication. Every person deserves to feel safe, comfortable, and affirmed. Testosterone can create the sensation of gender euphoria, which is the overwhelming joy that people experience when their gender expression matches their gender identity. Your healthcare team can provide individual guidance about dosing recommendations or recommendations that might limit bottom growth, so that you have the best experience possible with GAHT.
Every medication has side effects, including testosterone. Some of these effects may be more desirable than others. For example, some people look forward to having more “masculine” facial features as T subtly shifts the fat and tissue of their body. Other people love their lowering voices or their new sense of energy. At the same time, the same person who wants and needs to be on T might not look forward to facial hair.
Unfortunately, it’s not possible to pick and choose which of the side effects of T you will experience. That includes bottom growth. Hormones work over a period of time, not overnight. Taking a higher dose of T will make your hormone levels higher and result in more pronounced changes. If you are not sure how testosterone will change your body, or you’re worried that the medication may give you some side effects you can’t deal with, reach out to our care team to get resources and support.
How come people don’t talk about bottom growth?
Our culture stigmatizes sex, and avoids talking about pleasure—which means that topics like bottom growth, masturbation, transgender sex, T4T, and clitoral stimulation are treated like they are off limits. Many of us only see our trans bodies represented in porn because trans sexuality is not part of the mainstream discussion about sex. However, it shouldn’t be this way!
Having an open, honest conversation about sex and bottom growth will help you get your questions answered. Your clinician at Plume is open to these conversations and here to talk to you about any of the changes you’re going through. If you don’t have access to a clinician, you can still find support for bottom growth. The trans community is a wealth of information. There are some online resources, such as transmasc forums on sites such as Reddit. Chella Man, a queer, Deaf, genderqueer artist, documented his changing body for Them. His story—and nude photos that show his personal journey with testosterone—are a wonderful resource for people who wonder about FTM bottom growth.
If you ever wonder, “is my bottom growth normal?” or “what’s the timeline for bottom growth,” feel free to contact Plume’s care team to ask one of our healthcare providers. Many of us are trans ourselves and have been through the same changes you’re experiencing. Your gender journey is unique and you deserve to feel empowered as you move forward toward the sense of peace and fulfillment you’re seeking. As your body changes, you have an amazing opportunity to learn more about yourself, your mind, and your heart.
