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dude.

chat we are SO good at this whole system thing. trust trust trust

I am going to use medical terms for bodies and genitals in a frank and honest way in this post, just to keep things clear.

First things first: it is soo treatable!

Vaginal atrophy can happen on testosterone because T lowers local estrogen in vaginal tissue. That tissue needs some estrogen to stay stretchy, comfy, and healthy. When it doesn’t get enough, it can get thinner, dryer, and more fragile, and more irritated.

That can present as;

Pain, burning, tearing, spotting, frequent UTIs, or discomfort during penetration or exams.

None of that means something is wrong with you or that you did anything wrong.

let’s get you some relief!!

The most common and effective treatment is a topical estrogen cream. This is applied inside and around the opening of the vaginal canal.

Yes, that can be dysphoria inducing, and it is okay to feel weird about it. A lot of people do whether they are trans or cis.

The important part is that this treatment is not forever! Many people only use it during flare ups or for short courses! I do!

It will not affect your transition! This is topical and locally absorbed.

This is topical and locally absorbed. It does not meaningfully enter your bloodstream and it will not estrogenize you, reverse changes, or interfere with testosterone.

This is something doctors who work with trans patients are very clear on!

If asking your PCP feels too scary, dysphoric, or inaccessible, or if cost or wait times are an issue, you can use telehealth services like Wisp if you’re in the US.

You usually pay out of pocket, but it is not nearly as expensive as seeing an in person doctor, they may need a very short video call depending on your state.

I’ve personally used Wisp and they were kind, respectful, and straightforward.

Wisp also treats UTIs, yeast infections, offers birth control, and more. It’s often very affordable.

This is not an ad, they just genuinely helped me and my wife when insurance was not an option.

You do not need to suffer through pain or infections!

A few extra things that can help or are good to know!

Vaginal atrophy is not dangerous, but it can get worse if ignored. Treating it early often means less medication and less discomfort overall.

Non hormonal vaginal moisturizers or lubricants can help with dryness and irritation, but they don’t replace estrogen if atrophy is present. They can still make daily life more comfortable tho.

Avoid harsh soaps, douching, or scented products! It’s bad for your vagina!

Pain, tearing, bleeding, or recurring UTIs are all good reasons to seek treatment. You do not have to wait until it is unbearable. You deserve a comfortable body to live in.

You deserve providers who use language that feels okay to you.

You can ask for neutral or anatomy based language, or for explanations without gendered terms. That is allowed.

This can sound scary, but it is actually very okay.

Vaginal atrophy is extremely common, not just in people on testosterone, but also in cis women after menopause, people on some medications, and anyone with a vagina as estrogen levels change with age or other factors!

Bodies change. Tissue changes. That is normal, not shameful, and not a failure! That just comes with the privilege of being alive!

Having a vagina and needing care for it does not make you less the gender you identify as.

Taking care of your body is not a betrayal of your gender.

You deserve comfort, health, and relief.

If you are getting gender affirming surgery, especially if it’s your first major surgery, PLEASE be aware that you can become SEVERELY depressed afterwards ESPECIALLY if you have a history of depression or suicidal ideation.

Post op depression is a natural reaction to the crazy mix of hormones your body goes through after major surgery as well as the stress and anxiety of recovery. Think of it like an adrenaline crash, but dragged out longer.

For me it kicked in about 6 weeks after top surgery and the worst of it lasted until about 10 weeks post op. EVERYTHING felt IMPOSSIBLE. None of the skills I’d been practicing worked. I thought everything was going to be bad forever. I didn’t attempt, but I was in the hospital. If it wasn’t for my support system I probably would have attempted.

This is not regret, but it can feel like it. I remain happy about my results to this day (going on six years later).

This is not you failing to maintain your mental health, but it can make you feel like a failure.

Things are not hopeless, but through the haze of this depression they can feel hopeless.

It can be terrifyingly sudden or it can sneak up on you. I didn’t even realize what was going on until after the depression finally passed and my mental health went back to normal.

I am writing this post because nobody told me about this before my top surgery. I was caught completely off guard. For my subsequent surgeries being aware has made all the difference. Being able to treat those symptoms as an expected and normal part of the healing journey has made them far easier to deal with. Because even when my emotions go to dark places I *know* they will pass. I have been able to tell the bad thoughts to take a bad seat and focus on healing.

Transgender community, please please please do NOT use this product! It will kill you if used, please do not use it whatsoever.