• White linen of an unmade bed. (Bonita Cooke) ( (Bonita Cooke))Source: (Bonita Cooke)
Hormones, pleasure, and stigma: How medically-transitioning trans women negotiate sexual intimacy and satisfaction.
Shoshana Rosenberg

24 Apr 2018 - 11:52 AM  UPDATED 24 Apr 2018 - 11:52 AM

Despite widespread transgender visibility in today’s media landscape, our collective understanding of trans women’s lives remains foggy. One significant aspect of trans women’s lives that receives contradictory information is the interaction between hormone therapy and trans women’s sexuality.

The script that comes with your script

Many trans women use hormone therapy to reduce dysphoria and achieve certain physiological and psychological effects. Hormone therapy is prescribed by a clinician, and is usually taken as a daily dose of oestrogen and testosterone-blockers. Although this treatment has existed for nearly 100 years, the current medical discourse around the effects of hormone therapy on trans women’s sexuality still boils down to ‘erectile dysfunction’.

I have personally experienced this narrative - my first consultation with my GP involved a lengthy explanation of the negative impact hormones will have on my fertility and erectile function. During my six-month checkup, I decided to disclose that my experiences of sex had in fact vastly improved. Their response? “Oh, that’s surprising, I’ve never heard of that happening”. It seemed that even my well-educated and empathic doctor assumed that my medical transition would exclude me from one of the most significant human experiences.

Certain members of our community, often medical professionals themselves, also have a hand at pushing this idea. On the ABC show You Can’t Ask That, leading transgender clinician Dr. Rosie Jones stated that most trans people “have either bad sex or no sex”.

So is it true? Are trans women’s lives entirely devoid of sexual intimacy and pleasure? Do our hormones turn us into eunuchs? And if so, are we somehow a little less human for it?

Life as a transgender woman in India
“The one thing I want to tell the public is, you should give us an opportunity and only then we can tell you who we are and what we can do.”

Researching trans sexuality

I interviewed 12 trans women who have been on hormones for over a year about their experiences of sex and intimacy. Some interviewees had been on hormones for as little as 16 months, and others as long as 16 years. There was also a broad age range, from early 20s to early 60s.

My findings confirm what authors such as Julia Serano and Mira Bellwether have already stated in their own reflections and research. Not only are trans women capable of experiencing sexual intimacy and maintaining sexual function, but often our pleasure and satisfaction increases substantially following medical transition.

All hands and mouths

A common thread in my interviews was that while hormones have decreased the amount of times interviewees experienced sexual arousal over a day/week/month, the level of pleasure during sex increased dramatically. Several interviewees describe developing a heightened sense of pleasure from the less overtly sexual aspects of intimacy, such as massages and kissing.

Half of the interviewees also describe a wide shift in the kind of behaviours they considered to be central to a sexual act; one participant stated, “it can be all hands and mouths and maybe it doesn’t actually have to be my penis”. Sex ultimately became less about particular acts and more about initiating or deepening a psychological bond with the other person(s). Most partnered participants commented that, in turn, this allowed for a greater connection with intimate partners across the board. However, sexual practices were not the only thing significantly affected by hormone therapy.

Orgasms, sensations, and radical changes

One of my most significant findings was the diversity of experiences around the way people’s orgasmic experiences shifted. Although not very common, a few interviewees have experienced an inability to climax, namely due to high hormone therapy doses (particularly testosterone blockers). While some simply accept this as part of their transition experience, others have addressed the issue by shifting their doses until they reached a satisfying balance between climactic capacity and the other more positive effects brought on by hormone therapy.

In contrast to these experiences, many interviewees describe a significant positive change in orgasms. While they may have become less immediate, or difficult to attain, orgasms have also become more complex and satisfying. This reflects what Julia Serano defines as shifting from “boygasms” to “girlgasms”; from short and urgent climaxes to elongated and deeper ones.

This shift in orgasm was also connected to what many of the interviewees describe as an increase in erogenous zones. Spots on the body that had previously had little-to-no association with sex suddenly became focal points of sexual pleasure and play. Necks, thighs, backs and arms were just a few of the body parts that had substantially climbed the ranks of sexually-arousing areas. Some interviewees even described these new erogenous zones overtaking the place of genitalia as a means of achieving pleasure or even orgasm; one person described being able to climax from nipple contact alone.

Trans 14-year-old speaks about the experience of coming out to her entire school
“Being transgender is just one part of you and there’s so much more to the inside of someone."

Cumming to a conclusion

These stories all confirm what trans women have always known and continue to proclaim: that we experience sexuality with as much depth, diversity and satisfaction as the general population. Hormone therapy is a powerful and highly transformative aspect of many trans women’s transition. However, the people who largely control the public’s understanding of hormone therapy, and trans women generally, are still the medical professionals who treat us. This means that despite some research supporting our claim to normalcy, medical discourse at large continues to portray trans women as dysfunctional, sexless, and by extension ill-fitting within society.

Restoring our place in humanity

It is always important to note the stories our society tells about marginalised people. In Australia, trans women experience some of the highest rates of mental illness and both physical and non-physical abuse. These experiences are deeply connected to the negative stereotypes and stigma associated with transitioning. As long as trans women continue to be portrayed as somehow separate or fundamentally at-odds with society, we cannot be fully accepted and understood. Although sexual intimacy is just one aspect of our lives, it is something that most people view as fundamental to forming close bonds. In understanding the complexity and depth of trans women’s intimate experiences, we make more space for them to be included in our collective story.

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This article is a non-academic sister publication to Shoshana Rosenberg and P. J. Matt Tilley’s article “‘I Couldn’t Imagine My Life Without It’: Australian Trans Women’s Experiences of Sexuality, Intimacy, and Gender-Affirming Hormone Therapy”