Sex Ed Failed Us: What Trans People Need To Know

Physical Changes from Gender-Affirming Hormone Treatment (GAHT)

Not everyone who identifies as trans or non-binary chooses to undergo medical transition, and that doesn’t make them any less valid in their identities. For those who do medically transition, however, gender-affirming hormone treatment (GAHT) can significantly affect how their body looks and feels, all of which can influence how they engage with sex. Both partnered sex and masturbation may feel different. And, as your body changes, your desires may change as well. It’s normal and healthy to be curious about these changes and to explore your body and sexuality in new ways.

For people taking feminizing hormones, such as estradiol, effects like breast growth, decreased testicle size, and changes in erections can occur within six months of starting GAHT. Your erections may be less frequent, be less firm when they do occur, or may not last as long, which can affect penetrative sex. Some people are not bothered by this, as they are still able to experience sexual pleasure and orgasm, just in different ways. Others take medications like Viagra to help with erections. If you are taking a testosterone blocker such as spironolactone, adjusting your medication can also help.

For those taking masculinizing hormones, like testosterone, physical effects like clitoral enlargement, often called bottom growth, and vaginal atrophy can occur within the first few months as well. In addition, you may experience additional enlargement of the clitoris when you are aroused, which can change how pleasure feels and what sex acts you enjoy. Bottom growth is a common development after starting testosterone and can lead to increased sensitivity in the genital area as well. While some people enjoy the increased sensation, others can find it uncomfortable and may have to adjust how they touch themselves or receive touch.

This can also be an opportunity to explore different sex toys, lubricants, or types of stimulation, all of which may help. In a 2024 article for Them, five transmasc people shared their experiences with bottom growth. One interviewee said, “My clit is more prominent and is easier for my partners to manipulate.” These physical changes to your body can impact not only how it functions, but also how you feel about it. Another respondent in the same article shared that “as their anatomy changed, they started fantasizing about having a penis and ejaculating, being stroked, and getting blow jobs.”

Across the board, many people taking GAHT experience a shift in how their orgasms feel. Some people taking masculinizing hormones report that their orgasms feel different after starting testosterone, and that they may feel more peak intensity in the genital area. In contrast, some people taking feminizing hormones say their orgasms are more like a “whole body” experience, feel different than they did before starting GAHT, and that they may ejaculate very small amounts or not at all. As your experience with pleasure and orgasm may feel different now, you may be curious to explore different types of stimulation, both partnered or alone, or to try different sex toys. 

Note: Plume members can enjoy discounts on trans-inclusive sex toys, such as those from Enby and RodeoH.

Mental or Emotional Changes

Many people experience emotional changes that coincide with the physical. Some people think of initiating GAHT as a “second puberty.” You might notice you are extra emotional, like your feelings are unpredictable, or like you just feel differently than you did before.

Starting GAHT has been shown to improve gender dysphoria and, in doing so, can impact your relationship with sex, too. Current research into the link between gender dysphoria and sexuality has revealed that starting medical transition can improve sexual satisfaction. Further investigation has shown that as trans and nonbinary people progress on GAHT, body changes that alleviate top or bottom dysphoria can improve satisfaction with those areas of the body during sex or sex acts that center them. In general, body confidence can have a significant impact on having pleasurable sex.

Just as GAHT can affect how you feel about sex, it can also change how you feel desire. People taking testosterone often experience increased libido after starting hormones. As your body changes from the physical effects of hormones, the way you experience pleasure, or the types of sex you enjoy, may also change.

Social Changes

In some cases, who you are attracted to can change after taking GAHT. Some people report that after transitioning, they were attracted to people of different genders than before. For one, the way that your partner views you and the way they affirm your gender (or don’t) can affect how you feel about sex. The research supports this as well — trans and nonbinary people with affirming partners report greater sexual satisfaction. The genitals a person has don’t equate to their gender. Your partners must know that and be open to learning about you as an individual and how you like to have sex.

The way that you feel about your body, your appearance, and your identity can “expand the genders you feel comfortable interacting with” in a sexual context. Some people might feel safer after transitioning, and likewise, being misgendered can hinder that safety. Other people, especially trans women and femme-presenting folks, might feel less safe, and this can shift who they are attracted to as well.

This can be a social change affecting more than just your sex and dating life. For example, a trans man who previously identified as a lesbian might find that label doesn’t fit anymore, or he may not feel at home in lesbian spaces. He may describe himself as straight, queer, or use another label. Some people also find that after transitioning, they are mostly attracted to other trans people, using the term “T4T.” T4T is often used to describe romantic or sexual relationships, but it can also refer to the intimate platonic relationships between trans people, like chosen family. A relationship survey Plume Health conducted found that about 17 percent of respondents identified as T4T, or exclusively seeking relationships with other trans people. The same survey found that about 45 percent of people noticed their sexuality changing during their transition journey.

While gender identity and sexual orientation are not the same thing, they can be intertwined. Your support system is an important protective factor when going through a life transition like GAHT. You may find it helpful to talk to a therapist or go to a support group to talk it through.

Sex education for people of all genders also needs to emphasize the importance of consent and the elements of a healthy relationship. Current research finds that transgender people are 1.7 times more likely than cis people to experience intimate partner violence in their lifetime. A 2021 report summarizing three decades of research into school-based sex education highlights the importance of teaching about homophobia, transphobia, and how these systemic influences can impact the mental health and relationships of LGBTQ+ people.

Sexual Health Considerations for Trans People

Sex education can typically be heavily gendered, focusing on cisgender bodies and describing anatomy as “male” or “female.” Not only is this exclusionary of trans people, but by emphasizing only cisgender perspectives, it leaves out information that may be relevant in promoting safer sex practices. Genitals don’t equal gender. While sex education curricula can be tailored to refer to anatomy specifically by name, this still doesn’t reflect the experiences of trans people.

School-based sexual health education often lacks information about sexually transmitted infections (STIs), safer sex, and contraception that is relevant to trans and non-binary people. This can impact how trans people learn about safer sex, which can lead to greater susceptibility to STIs. Transgender people also experience greater barriers to accessing sexual health care—including STI testing—which can include stigma, lack of access, and discrimination. Other factors might influence your experience in receiving healthcare, such as misgendering, lack of provider competency in treating trans and non-binary patients, medical anxiety, or fear of stigma.

It’s important to know your STI status and to discuss that information with your partner/s before having sex. According to Plume Health’s relationship survey results, a little over half of trans respondents reported “always” checking or knowing their STI status before having sex. In terms of screening for STIs, it is recommended that providers take a trauma-informed approach to treating trans and non-binary patients and that they ask questions specific to their patients’ gender identity to provide adequate treatment. Strategies that your provider may recommend for reducing the transmission of STIs include using barrier methods, such as condoms.

All people should be screened for their eligibility for pre-exposure prophylaxis (PrEP), the medication that reduces the risk of contracting HIV, regardless of gender. Due to study limitations and FDA approval, not all medications used for PrEP are approved for trans men or AFAB people at this time. Talk to your provider about your sexual risk factors to determine the best course of action for you.

There may also be changes in your reproductive health when on GAHT, as well. People on feminizing hormones can experience decreased sperm production, which affects fertility, and people taking testosterone often stop getting their period. Your provider will discuss your fertility and future family-planning considerations with you before starting GAHT. Some people choose to freeze eggs or sperm to preserve the option of having biological children down the road if that is important to them.

It is important to note that taking hormones alone is not a substitute for birth control. If you are an AFAB person having sex with a partner who produces sperm, you can still become pregnant, even if you are taking testosterone. If you produce sperm and have a partner with a uterus, you will still need a method for preventing pregnancy whether that is a barrier method you use like an external condom or a method your partner chooses to use. To prevent an unwanted pregnancy, it is important to talk to your doctor about what birth control options are right for you. For more information on trans sexual health education, reach out to your primary care doctor or another sexual health care provider. 

Sex education should empower people to make informed choices, feel good in their bodies, and enjoy healthy, fulfilling relationships. Trans and non-binary people deserve information that actually reflects our lives, not just repurposed guidance for cisgender people. Whether you’re exploring what sex and intimacy mean for you, starting GAHT, or simply curious about your body, you deserve care, resources, and support that affirm who you are.