New study quantifies trans women’s changes in sexual response on HRT

Trans people’s firsthand experiences of sexuality and its changes throughout transition have typically received less attention in scientific literature than topics such as our experiences of intimate partner violence and our sexual behavior in the context of HIV/STI risk. The effects of hormone therapy on the level of sexual desire of trans women and trans men over time have only recently been reported; another study in the early 2000s found that trans women show no correlation between their levels of testosterone and their erectile function. Much of the information on sexual changes associated with transition is instead circulated in the form of community knowledge and personal experiences.

Fortunately, a recent abstract by Garcia & Zaliznyak (2020) offers self-reported information from trans women on many of the specific sexual changes we often experience, such as the timing of orgasms, the qualitative changes in orgasm, alterations in body sensations, and how soon these typically occur after starting HRT.

The authors, working at the Division of Urology at Cedars-Sinai Medical Center in Los Angeles and the Cedars-Sinai Transgender Surgery and Health Program, surveyed 126 trans women on changes in their sexual experience during solo sexual activity; 70 had not received any genital surgery, 26 had received vaginoplasty, 15 had received only an orchiectomy, and 8 had received vaginoplasty without the construction of a vaginal canal. Those with no genital surgery were the youngest with an average age of 35.9, followed by those who received vaginoplasty; trans women who had vaginoplasty without a vaginal canal were the oldest at an average of 52.4 years.

Difficulty with achieving orgasm while on HRT is frequently reported by trans women, and this study reflected that. Trans women without any genital surgery reported that their time to reach orgasm increased by an average of 7 minutes, with this change occurring after an average of 7.3 months of hormone therapy. However, those who had undergone vaginoplasty reported an increase of only 2.7 minutes to reach orgasm after 7.4 months, while those whose vaginoplasty did not include a vaginal canal notably reported waiting an average of 17.3 months on HRT before experiencing this change.

Trans women have often described orgasms increasing in their duration or intensity after starting HRT. Among trans women with no genital surgery, orgasms were described as becoming an average of 27.5 seconds longer after 9.4 months; similarly, those who had undergone vaginoplasty experienced an increase in length of orgasm of 24 seconds after an average of 5.1 months. 71% of those with no genital surgery stated that they experienced an increase in overall sexual satisfaction after 7.7 months of HRT, as did 77% of those who underwent vaginoplasty after an average of 7.3 months.

Specific physical changes in what an orgasm feels like have also been reported by many trans women, with this typically being described as shifting from genitally-focused to more fully embodied. A majority of trans women in this study reported experiencing these changes: 70% of those with no genital surgery said that they now experienced orgasms as felt in new or additional parts of their body after an average of 11.1 months of HRT, while 71% of those who underwent vaginoplasty also reported this change after an average of 9 months. Additionally, 65% of trans women with no genital surgery stated that their orgasms shifted from a singular peak to multiple peaks, after an average of 9.9 months of HRT, and 52% of those who underwent vaginoplasty reported experiencing this change after an average of 7.1 months.

To be clear, this is all self-reported information which trans women were asked to provide in detail down to minutes or seconds, often recalled months or years after the fact, rather than any direct physiological measurement. Confirming the reliability of self-reports of far more basic sexual behaviors, such as whether or not one has had protected or unprotected sex in the past three months, can be notoriously challenging, including among sexual minority populations (Schrimshaw et al., 2006). At the same time, it’s noteworthy that trans women reported experiencing changes in the direction of longer time to reach orgasm and longer duration of orgasm, and consistently recalled similar timeframes for the onset of these changes after starting HRT – changes that have often been discussed by trans women and transfeminine people in our own communities. Quantitative data such as this helps to confirm that these specific experiences of sexual changes are indeed commonplace, and can help to give those starting or considering starting HRT an idea of the kinds of shifts their sexuality may undergo. ■