Taking testosterone as part of gender-affirming hormone therapy (GAHT) initiates widespread changes throughout the body. While many of these transformations are visible, testosterone also affects internal systems and tissues. This article will specifically explore the effects of testosterone on the vagina and surrounding genital tissues, providing detailed information on the anatomical, functional, and health-related changes individuals may experience.
Anatomical and Structural Changes
Clitoral growth, often referred to as “bottom growth,” is a prominent physical transformation. It is among the most common and permanent effects of testosterone, with some individuals noticing an increase of an inch or more in size. As the clitoris grows, its appearance may become more prominent, and the clitoral hood might enlarge or remain relatively unchanged, making the external bud more visible.
The vaginal lining undergoes changes, a process commonly known as vaginal atrophy. Due to the suppression of estrogen by testosterone, the tissues of the vaginal wall become thinner, drier, and less elastic. This thinning can make the tissues more delicate and prone to micro-abrasions or small tears.
The labia minora and majora can also undergo alterations. The labia may become larger, longer, or darken in pigmentation. These tissues may also feel swollen or more substantial.
Cessation of menstruation is a significant systemic change. Testosterone typically halts the menstrual cycle within three to four months of starting therapy. While irregular bleeding or spotting can occur, especially with certain testosterone formulations, this usually resolves over time, often within 18 months.
Changes in Sensation and Sexual Function
Testosterone commonly leads to an increase in sex drive, leading to heightened sexual arousal. This shift in libido can significantly alter an individual’s experience of sexual desire.
Vaginal atrophy leads to a noticeable decrease in natural lubrication. Reduced lubrication can cause discomfort during sexual activity, potentially leading to friction, pain, or even small tears in the delicate vaginal tissues. Using external lubrication becomes a common strategy to mitigate these effects.
Clitoral growth can result in heightened sensitivity. This increased sensation may initially feel overwhelming for some individuals, though it often becomes a source of pleasure over time. The character and intensity of orgasms might also change, with some individuals reporting a different quality to their orgasmic experience.
Managing Vaginal Atrophy and Health
Vaginal atrophy can present with several uncomfortable symptoms. These may include itching, burning, general discomfort, and pain during sexual activity, medically termed dyspareunia. Some individuals may also experience bleeding or tearing of the vaginal tissues, particularly with internal friction.
Testosterone therapy can alter the vaginal pH, making it less acidic. This shift in pH can disrupt the natural balance of bacteria, increasing susceptibility to infections such as bacterial vaginosis (BV) and urinary tract infections (UTIs). The urethra, like the vagina, is also responsive to estrogen, contributing to the increased risk of UTIs.
Managing vaginal atrophy and related health concerns involves specific treatment options. Localized estrogen therapy, available as low-dose creams, vaginal tablets, or rings, is a standard and safe approach. These treatments deliver a small amount of estrogen directly to the vaginal tissues, helping to restore tissue health and lubrication without causing systemic effects or interfering with the masculinizing effects of testosterone. Vaginal moisturizers can be used regularly to maintain tissue hydration and comfort, while lubricants are applied during sexual activity to reduce friction and improve comfort.
Considerations for Gynecological Care
Individuals who have a cervix still require regular gynecological care, including pelvic exams and Pap smears, to screen for cervical cancer. This need persists regardless of hormone use or sexual activity, as testosterone therapy does not alter the risk of these cancers.
Pelvic exams can be a source of discomfort due to vaginal atrophy and may also trigger gender dysphoria for some individuals. To make these examinations more tolerable, discuss concerns with the healthcare provider beforehand. Requesting a smaller speculum, ensuring ample lubrication is used, or considering a short course of localized estrogen treatment prior to the appointment can help alleviate discomfort.
Finding a healthcare provider who is knowledgeable and respectful regarding transgender health is beneficial for ensuring appropriate and comfortable care. An affirming provider can help navigate the unique health considerations associated with testosterone therapy and provide support throughout the process.