Sexual Intercourse with a Trans Man

Talking about sexuality with trans men is necessary. Not out of morbid curiosity, but because the absence of clear and respectful information leaves a void that gets filled by stereotypes, embarrassment, and too often by negative experiences that could have been avoided. This article is intended both for trans men themselves and for their partners of any gender. It is not an instruction manual: it is a guide based on scientific data covering anatomy, the effects of testosterone, pleasure, surgery, communication, and safety. The goal is to provide the information that is missing, with the respect it deserves.

A Trans Man’s Body: What to Know

The bodies of trans men are as varied as those of any other person. Anatomy depends on the stage of the transition process: some trans men have not started hormone therapy, others have been on it for years; some have undergone surgical procedures, others have not. No configuration is more valid than another. What matters is understanding the possibilities, not making assumptions.

The Effects of Testosterone on Genital Anatomy

Testosterone produces significant changes at the genital level. The most relevant effect for sexuality is clitoral growth, clinically known as clitoromegaly. According to the study by Grimstad et al. (2021), published in Andrology, testosterone stimulates clitoral tissue — which is composed of erectile tissue analogous to penile tissue — through androgen receptors present in high density in the genital area [2]. The result is growth that can reach 2-5 cm, with the clitoris progressively taking on an appearance and behavior similar to a small penis: it becomes more prominent, becomes erect during arousal, and acquires increased sensitivity [2].

This change — often called “bottom growth” by the transmasculine community — is one of the earliest effects of hormone therapy. The first signs (tingling, increased sensitivity, slight soreness) appear within the first few weeks. The most significant growth occurs in the first 6-12 months and reaches its maximum within 1-2 years. It is an irreversible or nearly irreversible change: even if testosterone is discontinued, the size only decreases minimally.

For many trans men, this growth is a source of satisfaction that reduces genital dysphoria. The enlarged clitoris can be stimulated in a manner similar to a penis and represents a primary erogenous zone, often with more intense sensitivity than before hormone therapy.

Vaginal Changes

Testosterone also modifies the vaginal mucosa. A study published in 2023 on a sample of 1,219 trans men and transmasculine individuals documented that 64.6% of participants reported pain or genital discomfort during sexual activity, with the most common location being the vagina or anterior genital opening (52.2%) [1]. This occurs because testosterone causes thinning of the vaginal epithelium (atrophy), a reduction in protective lactobacilli, and decreased natural lubrication — changes similar to those of menopause.

A 2022 study on the vaginal microbiome confirmed that these alterations modify the integrity of the epithelial barrier, making the mucosa more fragile [7]. However, the same 2023 study highlighted an important finding: current testosterone use was associated with greater interest in sexual activity and a greater ability to reach orgasm [1]. Physical discomfort exists, but it does not cancel out pleasure — it makes it an aspect to be actively managed, not an insurmountable obstacle.

The most common solution is the use of a water-based or silicone-based lubricant during vaginal intercourse. For more pronounced atrophy, low-dose topical estrogens (vaginal creams or tablets) can restore mucosal thickness without interfering with the systemic effects of testosterone. This is a localized intervention that healthcare professionals should proactively offer, as recommended by the WPATH SOC-8 (2022) guidelines [8].

How Sexual Pleasure Works

The sexuality of trans men is not reducible to anatomy. As with anyone, pleasure is the result of the interaction between body, mind, relationship, and context. But there are specific aspects that are useful to know.

The Increase in Libido

Testosterone increases sexual desire in most trans men. The longitudinal ENIGI study (Defreyne et al., 2020), conducted on 364 trans men during the first three years of hormone therapy, documented a significant increase in libido in the first three months, both in the solitary and relational components [13]. After 36 months, overall desire stabilizes, but solitary desire remains higher than at baseline [13].

Many trans men describe this change as intense and sometimes overwhelming in the early stages. The increase in libido can change sexual dynamics within a couple, requiring mutual adaptation. It is not a “side effect”: for many, it is one of the most positive changes of therapy, because it allows them to experience desire in a body that finally feels like their own.

Sexual Satisfaction

A qualitative study from 2020, conducted specifically on trans men and transmasculine individuals, identified the key factors of sexual satisfaction in this population: comfort with one’s own body, open communication with the partner, and flexibility in exploring different sexual practices [5]. Most participants reported a satisfying sex life, regardless of their anatomical configuration [5].

One finding from the 2023 study deserves attention: current testosterone use was associated with a greater ability to reach orgasm [1]. This debunks the idea that hormonal changes compromise pleasure. They certainly modify it: sexual response becomes different, genital sensitivity changes, preferred modes of stimulation may evolve. But the ability to experience pleasure is not only maintained — in many cases, it improves.

Erogenous Zones and Sexual Practices

There is no universal list of “what to do” in bed with a trans man, because preferences are as individual as those of any other person. However, some information can be useful as a starting point:

• The enlarged clitoris is often the primary erogenous zone. It can be stimulated with hands, mouth, or vibrators. Sensitivity is typically very high after testosterone [2]
• Vaginal penetration is possible and desired by some trans men, not all. For those who practice it, lubricant is essential [1]. Some trans men prefer different terms than “vagina” for this body part: asking is important
• Anal stimulation is an option practiced by many trans men, especially in relationships between men, and does not involve body areas that may cause dysphoria
• The chest: some trans men, especially those who have had a mastectomy, enjoy chest stimulation. Others, especially those who have not yet had surgery, may find this area a source of discomfort
• The whole body: sexual pleasure is not limited to the genitals. The neck, inner thighs, ears, and back are all zones that can be explored

The fundamental point is that there are no fixed rules. Every body is different, and communication with the partner is the only reliable tool for discovering what works.

Prosthetics and Sexual Accessories

Many trans men use prosthetics or sexual accessories, both in daily life and in intimacy. This is a practical aspect that deserves a straightforward discussion.

Packers and “Pack-and-Play” Prosthetics

A packer is a soft penile prosthetic worn under clothing to create a masculine profile. Some models are designed exclusively for daily use, while others — called “pack-and-play” — are also functional for sexual activity. 3-in-1 prosthetics combine three functions: packing (daily profile), standing to pee (standing urination), and penetrative sexual use.

Sexual prosthetics for trans men are available in various shapes, sizes, and materials. They can be used with a harness for partner penetration, or as an extension of the enlarged clitoris for more direct stimulation. Using prosthetics is not compensation for something missing: it is a tool that expands sexual possibilities, just like a vibrator or any other accessory.

Strap-ons and Harnesses

The strap-on is probably the most commonly used sexual accessory among trans men who wish to practice penetration. Some models are designed to simultaneously stimulate the wearer’s clitoris, creating an experience of mutual pleasure. The choice of size, shape, and material is personal and may require some experimentation.

For many trans men, using a strap-on is not perceived as a substitute for a biological penis but as an integral part of their masculine sexuality. The sensation of penetrating a partner, even through a prosthetic, is described by many as deeply gratifying both physically and psychologically.

After Surgery: Metoidioplasty and Phalloplasty

Some trans men choose genital surgical procedures. The two main options are metoidioplasty and phalloplasty, and each has different implications for sexuality. For a complete overview of surgical options, we refer to the article on gender-affirming surgery.

Metoidioplasty

Metoidioplasty uses the clitoris enlarged by testosterone to create a small-sized neophallus (typically 4-6 cm). The procedure preserves the original erectile tissue, which has direct consequences for sexuality.

A study published in Frontiers in Endocrinology in 2021, conducted on 813 cases, reported that no patient reported problems with arousal, masturbation, or orgasm after metoidioplasty [4]. Erogenous sensitivity was preserved in 100% of cases [4]. A 2025 systematic review confirmed these findings: sensation was preserved in 89-100% of patients, with average erogenous sensitivity scores of 4.8 out of 5 [10].

The main limitation of metoidioplasty concerns penetration: the size of the neophallus is often insufficient for insertive penetrative intercourse [3]. Systematic reviews report penetration capability ranging from 0 to 24% of cases [3]. For those who choose metoidioplasty, partner penetration typically occurs with the aid of prosthetics.

Phalloplasty

Phalloplasty creates a standard-sized neophallus using tissue harvested from other parts of the body (most commonly the forearm or abdomen). It is a complex, multi-stage procedure that requires up to 18-24 months to complete all phases.

A 2025 systematic review published in the Journal of Sexual Medicine analyzed the sexual outcomes of phalloplasty [9]. The results show that erogenous sensitivity is present in 53-100% of cases, depending on the technique used and the type of nerve reconnection [9]. The ability to reach orgasm ranges from 50 to 93% during masturbation and from 58 to 75% during partnered sex [9].

For penetrative intercourse, phalloplasty generally requires the implantation of a rigid or semi-rigid penile prosthesis, since the neophallus does not have an autonomous erection mechanism in most cases. With the prosthesis, the capacity for penetration is high.

An important finding from the 2023 systematic review comparing the two procedures: patients with metoidioplasty report significantly higher erogenous sensitivity compared to those with phalloplasty [3]. This reflects the fact that metoidioplasty preserves the original erectile tissue, while phalloplasty reconstructs sensitivity through nerve reconnection, a more complex process with more variable results.

Dysphoria and Intimacy: Navigating Discomfort

Gender dysphoria is one of the factors that most influence the sexuality of trans men. Not all trans men experience it in the same way, and for many, transition significantly reduces it. But understanding it is fundamental to building respectful intimacy.

How Dysphoria Manifests During Sex

A 2022 study on dysphoria and sexual well-being among trans men and transmasculine individuals documented that dysphoria is one of the main obstacles to a satisfying sexuality [6]. It can manifest as avoidance of contact with specific body parts, dissociation during intercourse, anticipatory anxiety, or difficulty letting go into pleasure [6]. The study found that dysphoria is more relevant in sexual acts involving receiving pleasure than in those involving giving it [6].

This finding is significant: for many trans men, focusing on the partner’s pleasure can be more comfortable than receiving attention on their own body. This is not a sign of generosity or sexual altruism: it can be a strategy for avoiding dysphoria. A aware partner does not force, but creates the conditions so that receiving pleasure gradually becomes more accessible.

Practices that Respect Dysphoria

Qualitative research identifies several strategies that couples adopt to manage dysphoria in intimacy:

• Negotiating language: many trans men prefer specific terms for their body parts. “Chest” instead of “breasts,” “front opening” instead of “vagina,” or other personalized terms. Asking which words to use is not embarrassing: it is respectful
• Establishing clear boundaries: some body zones may be off-limits, and these boundaries can change over time or even within the same session. Ongoing communication is essential
• Using accessories or clothing: some trans men prefer to wear a binder (chest compression garment) or a t-shirt during sex, or to use a prosthetic. These are not obstacles to intimacy: they are tools that make it possible
• Choosing strategic positions: some positions can reduce the visibility of body parts that cause discomfort, making intercourse more comfortable
• Maintaining a safe environment: soft lighting, continuous verbal communication, and the certainty that one can stop at any moment without judgment

A 2022 study on couple experiences (Pigatto et al.) showed that couples who adopt these strategies not only manage dysphoria better but develop levels of communication and emotional intimacy above average [12]. The need to speak explicitly about desires and limits creates a sexual dialogue that many cisgender couples never achieve.

Communication: The Foundation of Everything

Communication is not an accessory to good sex: it is the condition for it. This applies to all sexual relationships, but it takes on particular importance when one partner is a trans man.

What to Communicate

The WPATH SOC-8 (2022) guidelines dedicate a chapter to sexual health, emphasizing that healthcare professionals should proactively address the topic of sexuality with transgender individuals [8]. The same principle applies within the couple:

• Which body parts can be touched and how
• What language to use for genitals and for the body
• What feels good and what does not, without assuming that preferences remain constant
• How one feels in that moment: dysphoria has highs and lows, and a practice that is welcome one day may not be the next
• What to do if something is not right: establishing a clear signal to stop without it becoming a drama

How to Communicate

The study by Pigatto et al. (2022) identified that couples with higher levels of open communication reported greater satisfaction both sexually and relationally [12]. Effective communication in this context means:

• Ask, don’t assume: do not take for granted that you know what your partner likes based on their gender identity or body
• Listen without judging: if your partner tells you that a certain practice causes discomfort, the correct response is not “why?” but “okay, what do you prefer?”
• Be specific: “I like it when…” is more useful than “anything is fine”
• Normalize the conversation: talking about sex should not happen only when there is a problem. It should be a natural part of the relationship

Prevention and Safety

Prevention of sexually transmitted infections (STIs) follows the same rules that apply to everyone, with some specifics related to anatomy and hormone therapy. For a complete in-depth discussion, we refer to the article on sexual health for transgender people.

Condoms and Barrier Methods

The CDC guidelines for transgender individuals (2021) recommend the same prevention strategies that apply to the general population: correct and consistent condom use, periodic STI testing, and access to vaccines (hepatitis A and B, HPV) [11].

During vaginal intercourse, the condom is particularly important for trans men on testosterone therapy. Vaginal atrophy thins the mucosal walls and reduces natural lubrication, making the mucosa more vulnerable to micro-tears that can facilitate the transmission of infections [7]. The combined use of a condom and water-based lubricant is the most effective strategy.

During oral sex — whether received or given — a dental dam or a cut condom provides a protective barrier. For oral sex performed on the enlarged clitoris, a small condom or a cut condom can be used as a barrier.

Contraception

A point that cannot be underestimated: testosterone is not a contraceptive [8]. Trans men who have vaginal intercourse with partners who produce sperm can become pregnant, even during testosterone therapy. Testosterone suppresses ovulation in most cases, but not in a guaranteed way, especially in the first months or in cases of irregular use. Those who wish to avoid pregnancy should use an additional contraceptive method: a condom, an intrauterine device (IUD), or another barrier method.

Screening

Trans men who retain the uterine cervix should continue cervical cancer screening (Pap test) with the same frequency recommended for cisgender women. Testosterone does not eliminate this risk. For a complete overview of recommended screenings based on anatomy, we refer to the article on sexual health.

There Is No “Right” Way

Sexuality with a trans man is not a category unto itself. It is human sexuality, lived by people with specific bodies, histories, and desires. There is no universal manual, because there is no universal trans man: there are trans men with a vagina and trans men with a neophallus, trans men who love penetration and trans men who find it intolerable, trans men with an explosive libido and asexual trans men.

Scientific data confirm that the majority of trans men report a satisfying sex life [5], and that medical transition tends to improve both body satisfaction and the ability to experience pleasure [1]. Not because transition solves everything, but because it offers the conditions for living sex in a way that is consistent with one’s own identity.

The only rule that always works is also the simplest: talk. Ask what feels good, what does not, what one wants to explore. Listen to the answers with respect. And remember that the best sex is not the kind that follows a script, but the kind in which both people feel seen, desired, and safe.

For more on the relational and everyday aspects of being in a relationship with a trans guy, you can read our article on dating a trans guy. For the general aspects of transgender sexuality, we refer to the guide on sexuality and transgender people.