When trans mascs start hormone replacement therapy (HRT) as part of their medical transition, the effects of taking testosterone are laid out pretty clearly. Patients accessing HRT through the informed consent model — the method that makes accessing hormones more like getting prescription allergy medication — are provided with a form outlining what to expect: a deeper voice, bottom growth, hair growth everywhere but on top of your head, and, very possibly, an increased sex drive.
Since everyone’s relationship to sex is different, however, an “increased sex drive” can mean almost anything. Someone’s baseline horniness might go from “none” to “extant” or from “high” to “apocalyptic,” with endless shades of grey in between. And that’s just how much you want to have sex. Who you want to have sex with — and by proxy, your whole damn sexual orientation — might also change.
But though we’re well-advised that testosterone might cause us to want sex more often, there’s not a lot of information provided about how testosterone might change trans guys’ relationship to orgasm. Without much information to be found on the little HRT worksheet — or anywhere else, for that matter — a common concern gets raised: Does getting off feel different after starting T?
Again, that all depends on who you ask. “Prior to T, my orgasms were infrequent and hard-won,” says Andre, a 21-year-old trans masc in Virginia. “Now I notice that they’re more frequent, I reach them faster and they’re typically longer and stronger in sensation.”
Mike, a pseudonymous 30-year-old FTM dyke in New York, experienced a similar shift when they started testosterone more than a year ago. Before HRT, their orgasms felt more “open-ended” and like they could be “links in a chain.” Today, they feel like “show-stoppers.” This is as much a comment on a change in their refractory period as it is on being satisfied by sex — it’s the difference between getting off with a bang instead of a whimper.
It’s not just that their orgasms are more intense, though — it’s that the very sensation of getting off feels different. For Mike, orgasms are more “thrust-y” and “relief-y” on testosterone, and they liken the experience to ejaculation. As for Andre, getting off has become more of a “focused” feeling, one that’s more isolated in their dick as opposed to the more diffuse pelvic sensations they got prior to starting T.
In terms of quantity, I ask Mike if they thought they could still experience multiple orgasms (a feat that’s typically difficult for most cis men because of the refractory period that occurs after ejaculation). Their answer: They’d rather not. “I’m sure I could now, it’s just that I’m like, ‘I’m good.’” In other words, they feel less like going again after they cum.
Andre echoes this sentiment. “I very rarely had multiple orgasms before T,” they explain. “Now, I can, but I also find that I don’t really need to. I definitely notice that one orgasm does it for me. There’s a brief period of the ear-ringing, swimming sensation I’ve always associated with orgasm, but it’s much shorter now, and then I feel a pretty sharp decline in arousal. Afterwards, I always wonder: Is this what cis guys call post-nut clarity?”
That said, just because trans mascs aren’t frothing at the mouth for multiple orgasms doesn’t mean climaxes matter any less. To that point, Leo, a trans masc living in the U.K., describes himself as “more orgasm-focused” than ever since starting testosterone nearly three years ago. “Pre-T, I wouldn’t be too concerned with having an orgasm when I had sex with someone, but now I definitely feel it’s important to me,” he says.
As with many transition-related phenomena, there isn’t a lot of concrete research on the physiology of what makes orgasms feel different for trans mascs on HRT. That may be why Curtis Crane, a plastic surgeon and reconstructive urologist who specializes in gender-confirmation surgeries, chooses to cite the experiences of his trans patients rather than medical literature when we speak about it over the phone. He says he hears a lot of comments reflecting a “completion of their identity” from his patients who are exploring various avenues of medical transition. “I’d assume with anything that’s intimate, that having those feelings of completion would be very important regarding orgasm and sex,” he tells me.
It’s not a radical leap, then, to assume that sex feels different not just because of the effects of testosterone on the body, but how taking it influences the minds (and, more specifically, self-perception). “When I started using different words for my genitals, that also changed how orgasms felt,” says Leo. “If I think about ejaculation, erections and so on — and I think my sexuality plays into this — I think more about men, and I feel more masc. In that case, my orgasms feel more dick-focused.”
On a personal level, Mike says that they feel more emotionally and physically in tune with their body and their partners now that they’re on T. “I’m more present,” they explain. Still, being present in a changing body can take some getting used to. While Andre says they’re “generally satisfied” when they climax now, they’re also continuing to acclimate to the change in their sexual response cycle. “Once I have an orgasm, I lose all interest, x-out, done,” they explain. “And while I may still be sensitive, I’m not really aroused at that point.”
They’re not sure how they feel about going from a hundred to zero in a few seconds, but that’s okay for now. “It’s a strange new world,” they say.
Might as well explore.