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Genital Changes

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  • Many people experience a decrease in libido as their T levels decrease, but the intensity of this decrease can vary significantly between people.

  • Some people may even experience an improved libido due to a dramatic decrease in dysphoria.

  • While libido is more likely to lower, this does not mean you cannot have a healthy and fulfilling sex life. It may, however, require some changes, such as:

    • Adapting to the ways your libido has changed in its manifestation

    • Creativity when it comes to the ways you have sex (especially if you are used to penetrating and can no longer easily do so, at least not using your genitals!)

    • Sometimes it might require you to work on your ability to fantasise, without testosterone driving non-specific sexual urges as it once may have and instead requiring development of a specific fantasy or desire.

  • Changes to manifestation of sex drive &/or sexual desire: many people describe changes in the way their sex drive and relationship to sex feels, along with shifts in how they experience sexual desire for other people. 

  • Sexual Sensation: due to a combination of these mental changes and the physical changes to the genitals, your experience of sexual sensation is likely to change.

    • This is likely to include changes in intensity: with some people finding their genitals (and/or their body more widely) become more sensitive to touch, whilst others experience an overall decrease in touch sensitivity.

    • You are likely to also experience a shift in what kinds of touch and stimulation you enjoy (both during masturbation & sex), which may be accompanied by a change in how you mentally experience and process this touch.

Libido & Sexual Experience

Will my libido revert if I stop taking E?

Yes, you will typically find your sex drive slowly increases back to what it was like pre-HRT. You will also likely find the changes to how your libido manifested will revert, but your experience of physical sensation may revert, may not, or may do so partially.

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  • Onset:

    • Testicular atrophy usually begins within a few months of starting hormone therapy.

  • Effects:

    • Size

      • HRT causes both the penis and the testes to shrink.

      • Penis: For those who experience significant atrophy, they may find their penis shrinks as much as multiple inches, whilst those who avoid atrophy may not see any reduction in size.

      • Testicles: The extent varies among individuals.

  • Erectile Impacts

    • The ability to achieve and maintain erections typically reduces, with this intensifying over time.

    • Erections may become less frequent and shorter in duration.

      • In addition, they often become less firm.

    • Spontaneous erections, such as morning erections, may become less common and/or stop entirely.

    • Pain during erections

      • Due to the skin atrophying from no longer getting regularly stretched by becoming erect, it now begins to feel painful during an erection.

Atrophy

Will atrophy revert if I stop taking E?

Yes, you will typically find your ability to get and retain an erection will return, along with your erections being firmer and lasting longer. You will also experience a return of spontaneous erections. All of this will help stretch out the skin again, lessening the pain you may have experienced during erections. Additionally, the size of your testes and penis would likely return to a similar size as prior to HRT.

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How Atrophy Can Be Avoided/Lessened:

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  • Many find if they masturbate or have sex regularly that atrophy is mitigated or even nonexistent

    • Some people have described finding that even just getting erect a few times a week, even with no further stimulation, was sufficient to help them avoid atrophy

    • The phrase “use it or lose it” has become a common one regarding genital atrophy for this reason

  • While shrinkage may be a desirable outcome for some, it is important to note that this shrinkage is what is responsible for the pain that then occurs when people with atrophy do have an erection

    • This pain may interfere with your ability to experience (or focus on) pleasure whilst erect​, to varying degrees of severity

  • It is generally a good idea to consider what is most important to you: whether you want shrinkage, even if this may come with some pain at times, or whether you would prefer to retain your size and/or your ability to get erect and/or avoid painful erections.

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Fertility

  • Hormone therapy significantly reduces sperm production, lessening your fertility, or even rendering you completely infertile, whilst you are taking HRT. 

    • However, it is important not to consider HRT birth control if you are having sex with a partner who produces eggs, as even if the chance of pregnancy is very low, it cannot be guaranteed that you are totally infertile whilst taking HRT.

  • Whilst it is impossible to guarantee, many transfeminine people who have taken HRT (even for many years) have found their fertility has returned upon stopping HRT, and their partner has successfully carried a healthy baby to term.

  • However, because the preservation of fertility after many years on HRT cannot be guaranteed, it is suggested that if having a biological child is very important to you, you should consider getting your sperm stored using a sperm bank before beginning HRT.

    • If you didn’t do this before beginning HRT but find yourself regretting not doing so relatively early into your time on HRT, you can stop HRT and store your sperm then, with the general thought being that length of time on HRT increases the likelihood of it impacting your fertility.

      • There is no point after which you cannot stop HRT and store your sperm, but general advice is the earlier the better.

Will any potential infertility revert if I stop taking E?

Anecdotal evidence indicates it is common for people to find that they are fertile if they stop taking their HRT, even people who have been taking it for many years. However, there is no guarantee of this and no studies offering any conclusive evidence that fertility is reliably reversible.

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Ejaculate

  • Semen Volume:

    • The volume of ejaculate usually decreases as sperm production declines.

      • While prolonged masturbation or sex can still result in a fair quantity, ejaculate can also be minimised to just a couple of drops.

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  • Ejaculate Appearance:

    • As well as the volume decreasing, after roughly 2-4 months on HRT, ejaculate will often become clear & more of a gel-like consistency compared to pre-HRT.

Will the changes to my ejaculate revert if I stop taking E?

Yes your ejaculate will return to its prior consistency and volume.

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Increased risk of injury:

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  • Due to your skin becoming softer and more delicate, it also becomes at a greater risk of damage such as microtears and soreness, such as from chafing that could arise during a good grinding session!

    • So it’s a good idea to get friendly with lube if you are having the kinds of sex that might risk genital chafing. If there is already a significant amount of natural lubrication from your partner that will ensure you are lubricated too, then no need to worry!

    • But it’s generally a great idea to keep some lube around for any time that isn’t the case, so there's never any reason to stop having fun!

Other Changes

Will the increased injury risk revert if I stop taking E?

Yes, as your skin would stop being so soft and delicate the risk of chafing injuries would return to the same level as they were before HRT

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