FTM Sex Talk

xoxo,

sami

This is a compilation of frequently-asked questions with very brief answers, and links to more in-depth explanations from when they have been previously answered--please check here before to see if your question has been answered before sending it to us! This document will be updated with new questions and answers as frequently as possible.

I'm on testosterone. Can I still get pregnant? Yes. Testosterone is not a form of birth control, and surgical sterilization is the only absolutely sure means by which to avoid pregnancy. If you’re having sex that might result in pregnancy and want to avoid becoming pregnant, contraception is advised.

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I am on/want to go on testosterone, but I want to carry a child/be a biological parent. What can you tell me about this? Pregnancy will cause feminization to your body. Remaining on testosterone while pregnant will adversely affect the fetus (causing birth defects and/or miscarriage). Other options including the harvesting/freezing of your eggs.

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How do I deal with having a period? Are there ways to stop menstruating if I'm not on testosterone? Some forms of birth control can halt menstruation.

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What types of birth control are available for me as a person taking testosterone? What about emergency birth control? IUDs, progestin-only pills, and condoms are all good options. IUDs, Plan B, and Ella are all forms of effective emergency contraception.

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How do I (vacuum) pump? Does it work?

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How big will my dick get/when does does growth end and begin? The average size is commonly reported as 1-1.5 inches, but these sizes are often self-reported and may be exaggerated. When growth begins is usually within the first few months to weeks on testosterone, but when growth begins and ends is variable from individual to individual.

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What is DHT and how do I use it?

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I recently started testosterone and my dick is uncomfortably sensitive--when will this end? How do I deal with it in the meantime? This is temporary! A change in underwear and using a suitable moisturizer can help.

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I want to go on T but I don't want bottom growth. What do I do? If you absolutely do not want bottom growth, you should not go on testosterone, as it is an unavoidable change.

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How do I deal with dysphoria during sex/masturbation?

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Why am I bleeding during/after penetration of my front hole? Atrophy is the most likely cause of this happening, but it could also be that you aren’t “warmed up”/aroused enough, or there’s insufficient lubrication.

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What is vaginal atrophy?

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I'm having awful cramping when I orgasm. What's going on? You may be having uterine contractions--if they’re unbearable or if this continues to happen, you may want to see your doctor.

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Is it normal for there to be changes on testosterone in how wet or not that I get when I'm aroused? Yep, totally! You may also not have any changes.

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I can't orgasm. Is something wrong with me?

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What will happen to my sex drive/orgasms/how I have sex if I get a hysterectomy and/or oophorectomy?

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Are orgasms possible after bottom surgery? Yes, absolutely. It is very, very rare nowadays with modern methods of bottom surgery to lose the ability to orgasm.

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Is ejaculation possible after bottom surgery? Under certain conditions, yes.

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Can I keep my front hole/forego a vaginectomy if I have metoidioplasty or phalloplasty? Yes, some surgeons will do this. Crane and Chen can also perform urethral lengthening and allow you to forego a vaginectomy, though this can come with an increased risk of complications.

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What can you tell me about new developments in healthcare that might be used in bottom surgery?

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How does scrotoplasty work? What are my options?

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Where can I find photos of [pumping results/bottom surgery results/growth from testosterone]/experiences of people who've had bottom surgery?

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How can I have penetrative sex post-phalloplasty/what kind of erectile devices are available? Hydraulic pumps, the semi-rigid rod, and external sleeves are the currently-available options.

Hey dude, I used to go through this same exact thing–for years–until about three years ago/two years on testosterone… this sort of awful, guilty feeling deep in my gut after I’d get off/I’d be physically sated, but mentally and emotionally, I’d feel way worse off than before.

That doesn’t happen to me anymore, which I attribute partly to being far along enough in transition that I have a mostly positive relationship with my body/experience far less dysphoria than I used to, but also to having come to terms with being a gay man, working through past traumas, and really good, communicative sex with a partner who loves me/I love him–basically, I’ve gone from associating orgasms with shame/dysphoria/loss of control to something healthy and enjoyable. If you have access to therapy (I didn’t, early on), that would probably be helpful. My other suggestion is to try and picture positive imagery (“go to your happy place”) when you’re masturbating–eventually, orgasms might not be associated with those negative feelings. I think that anti-depressants also may have helped me, so you may want to consult with your GP or a psychiatrist about options. However–and this is different for everyone–a possible side effect of anti-depressants is genital anesthesia (not being able to feel your junk/losing the ability to orgasm) and loss of sex drive. This is usually an undesirable side effect for most people, but for me when I was at my worst/my dysphoria was absolutely unbearable, it came as a relief–I was able to just shut those feelings off.

It really depends on your surgeon and your own priorities. Any surgeon will want to know that you understand the risks going in, that you know you might lose function to some extent in that arm due to nerve damage, graft failure, blood supply issues, etc. — but these problems aren’t very common (I’d recommend asking your surgeon for their rates of this type of complication). Most people come out of forearm phallo with little to no lasting effect on the mobility and strength in their donor arm, but if you’re one of the unlucky ones and you’ve used your dominant arm, you could find yourself in a situation where you struggle to perform basic tasks like writing. If you work in a job where you need to use your arms/hands, or you have a skill or hobby that requires dexterity (like woodwork or piano), it’s worth considering how you would cope if you lost the ability to do those things. Anyway, I know the London team will occasionally agree to use a dominant arm so long as the patient understands all of the above, but you’ll need to ask your specific surgeon to see what their protocol is. I hope this helps!

You can try to get a prescription for DHT, which is topical testosterone containing just the specific sort of T responsible for dick growth AND hair loss. However, obviously it can cause hair loss, and there isn’t conclusive evidence it works to increase growth in trans men, only anecdotal stories of which I’ve heard everything from ‘grew 2 inches’ to ‘just stung and made my hair fall out’. I also have no idea whether DHT would affect your voice as well, it could do — there’s no research.

More generally, I’d advise that if you’re looking to try and get a very specific balance of traits like this you make sure you use gel testosterone rather than shots, as you can stop much more quickly — the testosterone will leave your body faster than injectable forms — reducing the likelihood of continuing changes you don’t want. But it’s also worth remembering that hormones are not predictable or easily controllable. You will need to accept that you probably won’t be able to get exactly the characteristics you’re looking for with none of the changes you don’t want — there will likely be some compromise. Slightly different question but you may find this post helpful as well.

Depending on what your priority is (ambiguous voice vs dick growth), you could also wait it out until your dick is where you want it to be, then stop T and see a specialist speech therapist - much like trans women often do - to train yourself to speak higher.

I hope this helps!

Only testosterone reliably and safely causes lower growth. There are lots of people who use pumping (using a specially designed vacuum pump) to increase size, but it’s controversial whether this has long term effects and there are questions as to whether it causes tissue damage. You can also use a special topical testosterone cream called DHT (Dihydrotestosterone) to increase size, but again there’s no conclusive research on whether it works for trans men, and you can’t get it in every country. I hope this is helpful!

It’s impossible to predict how T will affect you personally, or how a low dose will differ from a full dose for each person — unfortunately, because it’s still an uncommon way to use hormones there just isn’t the research yet to be able to say. I would imagine that taking less T would mean slower changes, that seems logical to me. I wouldn’t guess that some changes just wouldn’t happen at all, and I certainly wouldn’t bank on it. I hope this is helpful!

It’s really hard to say. Changes on T are impossible to predict, and in general pre-T characteristics are not a good indicator of what your changes will be like. 

One thing that might happen though, is that your endo/doctor should check your hormone levels (along with other blood tests) before putting you on T, and with the characteristics you’re describing it’s possible they will find that you have unusually high testosterone which could need investigating before they’ll give you a prescription.

Possible causes of high testosterone in AFAB people include PCOS, Congenital Adrenal Hyperplasia, or an intersex condition — but you won’t know unless you see a doctor and get it checked out.

Usually, this will just mean that your endo is careful to ensure your dosage is correct (i.e. they don’t give you a standard dose if that would result in your levels being too high). But it’s worth bearing in mind that it may delay things if it’s unexplained, so if you’re able to see a doctor about it sooner rather than later that would probably be sensible. I hope this helps!

Hey! I would say it’s best to at least check in with someone about whether they’re happy for you to buy them something like this, and about what their preferences might be (size, color, functions - do they want just a packer, or a pack and play, or an STP, etc.). It’s a nice idea and gets across that you’re comfortable with them expressing themselves, but I would say it’s sensible to check first. I hope this helps!

I think if you find it helpful to look at cis penises then there’s no reason for you to stop looking at them, and if your girlfriend is worried you’re gay then that’s something you both need to work on separately from this issue. Lots of people watch porn which doesn’t match up with their sexuality (lots of lesbians watch gay male porn, lots of straight men watch gay porn), and this isn’t even porn we’re talking about. If you’re loyal to your girlfriend and have done nothing to make her question that, then there’s no reason for you to stop yourself from looking at something that you find helpful. Talk to her, explain that this has no reflection on your attraction to her and loyalty to the relationship, and hopefully she’ll be reasonable about it. I hope this helps!

Here it is!

Thanks,