How to Relearn Sex on Hormones

When I began hormone replacement therapy, or HRT, the first change I noticed were my orgasms.

I have experienced gender dysphoria—a discomfort with my assigned sex—for as long as I can remember. But it wasn’t until this year that I committed to medically transitioning.

I found a transgender health clinic that prescribed me estradiol and spironolactone, the standard combination prescribed to most trans women. They produce estrogen and inhibit the production of testosterone. I dreamed about all the changes I was set to experience: breast growth, a more feminine figure, less body hair and a lot more.

Now, eight months later, those things are gradually still happening. But a mere week into my new medication regimen, my orgasms were completely different. Where climaxing was once a quick, concentrated ordeal, now it was something I felt with my whole body. They were longer, more intense and came in great tingling waves. Clearly, I thought, these pills must be doing the job.

But as the weeks went by and the changes kept coming, I started to get nervous. Where I was formerly subject to random erections throughout the day, after six weeks it was a trial to make them happen at all. My sex drive plummeted. Things that usually got me hot and bothered no longer had the magic. Orgasming at all became difficult around month three.

The changes one’s body undergoes during any kind of hormone replacement therapy are massive, and that goes double for sexual health. Thankfully, after some trial and error, I discovered solutions and workarounds to most of these changes, and with some experimentation, so will you.

Finding what works

About a week after my orgasms changed, I began to notice new erogenous zones cropping up all over my body. I became much more sensitive to touch and found myself aroused more by closeness than actual physical stimulation. My sexual fantasies became less about “parts” and more about “feelings.” This is often the case for trans women, especially as breast tissue develops. Everything just feels more sensitive.

Most notably, I found myself randomly aroused much less frequently. An International Society for Sexual Medicine study found that around 62 percent of trans women noticed a decrease in “sexual desire” after starting therapy.

Trans men taking testosterone, meanwhile, are likely to notice the inverse. The same study concluded that 71 percent of trans men noticed an increase in desire. Dr. Maddie Deutsch at the University of California-San Francisco also noted that trans men are likely to notice increased blood flow to their genitals when aroused, with orgasms that are more akin to that of a cisgender man.

No matter one’s gender, though, the important thing to do when navigating these early changes is to explore.

After a few months on estrogen, I quickly realized that manual stimulation would not be enough to get me off. I was way too sensitive. But when I was given a vibrator after expressing frustration with my inability to climax, I found myself orgasming in no time at all. Having a different sensation was what worked. This gave me the confidence to explore other parts of my body, and I have since found sex to be much more enjoyable than those awkward early months.

No wrong answers

It’s important not to contextualize these changes as failures. All it means is that the treatment is working, and your body is changing. Maybe sex toys such as plugs and vibrators will get you where you need to go, or possibly you’ll require more intense manual stimulation. Perhaps you’ll simply have fewer orgasms or find your interest in sex decreasing altogether. There is no blanket advice to be given other than “explore yourself.”

The most important thing to keep in mind, though, is that there is no “right” way to have sex. Trans women should not feel obligated to engage in receptive sex any more than trans men should feel like they need to take on an ultra-dominant role in the bedroom. Just like for individuals who aren’t undergoing HRT, good sex is a game of communication and understanding.