A sexual-health information page: it describes, shows nothing, and does not replace a consultation. It is addressed to partners of trans people as well as to trans people themselves.
First, what does not change
A trans person is a person: what they like, what they refuse, what makes them laugh or hurts them is discovered as with anyone — by talking. Desire, attachment, jealousy, routine, a failure, lack of time: everything this site says about desire and pleasure applies here. What changes is a body that may have been transformed by hormones or surgery, and a history often marked by other people's gaze. Hence two simple rules: ask, and assume nothing.
What hormones do
- Trans women on oestrogen and anti-androgens: the skin softens, the breasts develop (most often modestly), body hair thins, muscle mass falls; desire often becomes less "urgent" and more diffuse, spontaneous erections become rare or disappear and ejaculate decreases — sensitivity and orgasm remain, but different. Many trans women do not wish their original genitals to be involved, others do: it is for her to say, and for you to ask.
- Trans men on testosterone: the voice deepens, hair and muscle mass increase, the clitoris grows (often by one to three centimetres), desire frequently rises in the first months, periods generally stop within a few months; the vaginal lining dries and thins, which makes lubricant necessary and can make penetration painful if it is wanted. Testosterone is not a contraceptive: pregnancy remains possible.
After surgery
Not all trans people have surgery — most have none, or not all of it. When they do: a vaginoplasty (most often by penile inversion, sometimes with a segment of colon) creates a sensitive neovagina of variable depth, with no natural lubrication (except the colon technique), which must be dilated regularly for life to keep its depth; the clitoris is built from the glans and generally keeps its sensitivity, with orgasm reported by most patients. A phalloplasty (from a forearm or thigh flap) creates an adult-sized, sensitive penis that needs an erectile implant for penetration, with a risk of urinary complications; a metoidioplasty releases the clitoris enlarged by testosterone and gives a small penis capable of natural erection. Chest surgery leaves scars and nipples often numb for months. The page Medical transition and surgery details techniques, waiting times, complications and centres.
Dysphoria, and words
Dysphoria is the distress that the perception of parts of their body causes in many trans people; it can make certain areas or gestures impossible, one day and not the next. Goodwill does not "cure" it: you ask what is welcome and respect the answer. The words the person uses for their body — many prefer terms of the lived gender — are the ones to adopt; you do not ask about "before", the "real name" or photographs; you do not compare; and you keep to yourself the anatomical curiosity which, voiced at the wrong moment, turns the other into a clinical case. Consent, here as everywhere, is asked for every time and can be withdrawn at any moment.
Contraception, STIs, prevention
- Pregnancy: a trans man who has kept his uterus and ovaries can become pregnant even on testosterone; a trans woman who has kept her testicles can conceive, even on oestrogen, the absence of ejaculate being no guarantee. Contraception is needed in both cases if the couple does not want a child; the combined pill is not recommended for trans men (an IUD, implant or progestogen-only method suits), and testosterone is contraindicated in pregnancy.
- STIs and HIV: HIV prevalence is high among trans women worldwide (around 19% according to UNAIDS), because of precarity and exclusion more than of being trans; condoms, regular testing (free at sexual health clinics), PrEP — compatible with hormones — and vaccination against hepatitis B and HPV. A neovagina can catch the same infections as a vagina; a neo-urethra can become infected.
- Lubricant: necessary for a neovagina, often for a trans man on testosterone; water-based with condoms.
- Pain: never normal; see a gynaecologist, urologist or sex therapist familiar with trans health (CliniQ and 56T in London, the Gender Identity Clinics, Callen-Lorde in New York, Fenway in Boston, Equinox in Melbourne, Sherbourne in Toronto keep lists).
And the couple
What this page does not say — how people meet, what becomes of a couple when one partner transitions, marriage, children, families — is on the page Being in a relationship with a trans person and in the section Transgender.