Testosterone use among transgender men increases sexual activity interest, pain/discomfort

Key takeaways:

• Participants who currently used testosterone had a higher interest in sexual activity and more vaginal pain and/or discomfort during sex.
• Most participants reported genital pain and/or discomfort during sex.

Testosterone use among transgender men and gender-diverse people was linked to higher interest in sexual activity and also pain or discomfort during sexual activity, researchers reported.

“There is limited research on the sexual function of transgender men and gender-diverse people assigned female at birth,” Diana M. Tordoff, PhD, MPH, postdoctoral scholar at the Stanford University School of Medicine, and colleagues wrote. “What does exist suggests that, although testosterone gender-affirming hormone therapy is associated with increased desire and arousal, a high proportion of transgender men also reported dyspareunia, a common symptom of vaginal atrophy.”

Tordoff and colleagues conducted a cross-sectional analysis, published in the American Journal of Obstetrics & Gynecology, of data from 1,219 transgender men and gender-diverse people (median age, 27.1 years) aged 18 to 72 years. Researchers utilized data from the PRIDE study, an online, prospective, longitudinal cohort study involving sexual and gender minority people in the U.S. All participants were assigned female at birth and were categorized as never (n = 516), current (n = 602) and former (n = 76) testosterone users. Researchers measured sexual function across eight Patient-Reported Outcomes Measurement Information System (PROMIS) Sexual Function and Satisfaction domains.

Overall, median duration of testosterone use was 37.7 months. In the analysis, 68.9% of participants reported having sex within the past year, 59.4% were in a relationship and 89.5% reported any sexual activity, including masturbation, in the past 30 days. During this time, 64.6% of participants reported genital pain and/or discomfort during sexual activity. The most often reported pain and/or discomfort was in the vagina/frontal genital opening (52.2%), the clitoris (29.1%) and labia (24.5%).

Current testosterone users reported higher interest in sexual activity (beta = 6.32) and more vaginal pain and/or discomfort during sexual activity (beta = 1.8) compared with never and former users.

Researchers observed no associations between current testosterone use and sex life satisfaction, lubrication, labial pain and/or discomfort or orgasm pleasure.

“The relationship between receipt of testosterone gender-affirming hormone therapy and sexual function is complex, and likely includes both physiological and psychological factors,” the researchers wrote. “However, given the high burden of dyspareunia observed among transgender people assigned female at birth, there is a need to assess its impact on the overall quality of life, identify effective and acceptable interventions and reduce barriers to accessing treatment for transgender people experiencing dyspareunia.”