Sexuality and Transgender People

The sexuality of transgender people is a topic surrounded by curiosity, embarrassment, and too often by misinformation. There is a distorted image, fueled by pornography and prejudice, that reduces transgender people to their genitals or portrays them as sexually dysfunctional. The scientific reality tells a different story: trans people have varied, complex, and satisfying sex lives, just like anyone else. This article examines what the evidence says about desire, pleasure, sexual orientation, effects of medical transition, and intimacy in relationships. It is not a manual: it is a starting point based on real data.

Sexuality Is Diverse, Even Among Trans People

The first thing to clarify is that there is no such thing as “trans sexuality.” There is human sexuality, and trans people experience it with the same variety as everyone else. There are heterosexual, homosexual, bisexual, pansexual, and asexual trans people. There are people with a very active libido and people who have no interest in sex. There are people in stable relationships and people who prefer casual experiences. None of this is determined by being trans.

What is specific to the trans experience is the relationship with one’s body during the transition process, and how this relationship influences sex life. Gender dysphoria can make it difficult to experience sex with ease, but transition, both social and medical, tends to significantly improve sexual satisfaction and overall well-being [5].

Effects of Hormone Therapy on Sexual Desire

Hormone therapy is one of the most frequently asked questions when discussing trans sexuality: what happens to libido? The short answer is that hormones affect desire, but in different ways and at different paces. For details on all effects of hormone therapy, see the article on medical transition.

Testosterone (Trans Men and Transmasculine People)

The ENIGI study, one of the largest prospective longitudinal studies on trans people in Europe, followed 364 trans men during the first three years of hormone therapy [2]. Results show a significant increase in sexual desire in the first three months of testosterone therapy, in both solitary and relational components [2]. After 36 months, overall desire stabilizes at levels comparable to baseline, while solitary desire remains higher [2]. In practice: testosterone increases libido, especially at the beginning, then the body adjusts.

Many trans men describe this change as one of the most immediate and notable effects of hormone therapy. The increase in desire can be intense and require an adjustment period, both individually and within a relationship.

Estrogen and Antiandrogens (Trans Women and Transfeminine People)

For trans women, the picture is different. The same ENIGI study documented a decrease in sexual desire in the first three months of therapy with estrogen and antiandrogens [2]. However, in the long term (36 months), relational (dyadic) desire tends to recover, reaching levels above baseline [2]. Solitary desire, on the other hand, remains lower [2].

This finding is important: the initial reduction in libido does not mean a permanent loss of desire. It means the body goes through an adjustment phase. Many trans women describe the change as qualitative as well as quantitative: desire becomes different, less impulsive, more connected to emotional intimacy. Not necessarily less present, but experienced in a different way.

What This Means in Practice

Hormone therapy does not “turn off” sexuality. The systematic review by Mattawanon et al. (2021) confirms that sexual dysfunctions are present in trans people, but are linked to multiple factors: not only hormonal, but also psychological, relational, and social [4]. Hormone therapy can give rise to new challenges (initial decrease in libido, genital dryness, changes in erotic response), but it can also resolve pre-existing problems related to dysphoria.

Sexual Function and Pleasure

One of the most direct questions people ask: do trans people experience sexual pleasure? The answer is yes. But sexual pleasure is not a switch: it is a complex experience that depends on the body, the mind, the relationship, and the context.

Pleasure and Satisfaction: What the Data Show

The ENIGI study on sexual pleasure (Gieles et al., 2023) compared Amsterdam Sexual Pleasure Index scores between trans and cisgender people [10]. Results show that trans people report significantly lower scores compared to cisgender people [10]. This does not mean that trans people do not experience pleasure, but that factors such as body dysphoria, social stigma, and lack of specific sexual education can reduce the ability to fully enjoy one’s sexuality.

Factors associated with greater sexual pleasure include: body satisfaction, general happiness, and quality of the couple relationship [10]. In other words, when transition improves the relationship with one’s body, sexuality benefits too.

Sexual Dysfunctions: Frequency and Context

The study by Kerckhof et al. (2019), conducted on 518 trans people at gender clinics in Ghent, Amsterdam, and Hamburg, documented that the most common sexual dysfunctions are: difficulty initiating or seeking sexual contact (26% in trans women, 32% in trans men) and difficulty reaching orgasm (29% in trans women, 15% in trans men) [3].

These numbers need context. Sexual dysfunctions are also common in the cisgender population (estimated to affect 40-45% of cisgender women and 20-30% of cisgender men). In trans people, dysfunctions are often linked to specific factors such as genital dysphoria, body-related anxiety, and lack of information on how to experience sex with a transitioning body [4].

Orgasm After Surgery

For those who undergo gender-affirming surgery, the question about orgasm is central. The data are reassuring: a 2022 meta-analysis reports that 64-98% of trans women after vaginoplasty are able to reach orgasm, with a median of 79.7% [6]. For trans men after metoidioplasty, erogenous sensitivity is preserved in nearly all cases.

Modern surgical techniques are designed to preserve nerve tissue and sensitivity. The neoclitoris in trans women is constructed from glans tissue, which retains nerve endings. It may take time to regain full sensitivity after surgery, and sexual rehabilitation is an important aspect of the postoperative process.

Sexual Orientation and Gender Identity: Two Distinct Things

A very common confusion concerns the relationship between gender identity and sexual orientation. They are two independent dimensions. Gender identity is about who you are; sexual orientation is about who you are attracted to. A trans woman can be lesbian, heterosexual, bisexual, or anything else, exactly like a cisgender woman. The same applies to trans men and non-binary people.

Does Sexual Orientation Change During Transition?

The question is debated in the literature. The study by Auer et al. (2014), conducted on 115 trans people, found that 32.9% of trans women and 22.2% of trans men reported a change in sexual orientation during or after transition [7]. However, a more recent longitudinal study from the same ENIGI project (Defreyne et al., 2021) prospectively analyzed 469 trans women and 433 trans men, concluding that sexual orientation did not change over time and was not associated with hormone therapy or surgery [8].

How to interpret this discrepancy? The crucial point is what is meant by “change.” Many trans people describe not so much an actual change in orientation, but a greater freedom to express it. Before transition, experiencing one’s sexual orientation can be confused by dysphoria and social expectations. Afterward, when one finally feels comfortable in one’s body and identity, it becomes possible to explore one’s sexuality with greater authenticity. It is not a change in orientation: it is the ability, finally, to live it.

Body Image and Sexuality

The relationship with one’s own body is perhaps the most determining factor in the sexuality of trans people. Gender dysphoria, when present, can make physical contact and intimacy extremely difficult.

How Dysphoria Affects Sex

Dysphoria can manifest in many ways during sexual activity: avoiding being touched in certain body parts, dissociating during sex, avoiding situations of nudity, feeling discomfort when the body is seen or desired in a way that does not correspond to one’s identity. These experiences are documented in the clinical literature and represent one of the most significant challenges to the sex lives of trans people [5].

Does Transition Improve Body Image?

The multicenter study by Koehler et al. (2021) examined the relationship between gender-affirming therapy, body image, and sexual desire [9]. Results confirm that hormone therapy is associated with improved body image, and that this improvement is in turn associated with increased sexual desire, particularly in trans men [9].

An important finding emerges from the study by Becker et al. (2023), which compared daily sexual behavior, sexual self-esteem, and body image between trans and cisgender people [12]. Trans people show lower sexual self-esteem and more negative body image, but do not differ in daily sexual behavior [12]. This suggests that trans people find ways to live their sexuality despite body-related challenges.

Practical Strategies

Many trans people develop concrete strategies to manage dysphoria during sex: choosing positions that reduce discomfort, wearing clothes or accessories during intimacy, communicating openly with their partner about what is pleasurable and what is not, exploring erogenous zones beyond the genitals. These strategies are not signs of a “compromised” sexuality: they are forms of creative adaptation that many people, trans and not, use to experience sex in a fulfilling way.

Intimacy and Communication in Couples

Transition does not happen in a relational vacuum. For trans people in relationships, sexuality intertwines with couple dynamics, and communication becomes fundamental.

The Partners’ Experience

A qualitative study by Pigatto et al. (2022) collected the experiences of 99 partners of trans and non-binary people, identifying four main themes: positive aspects of the relationship, challenges, strategies for managing dysphoria, and expectations regarding medical transition [11].

The research highlights that couples who face transition together often develop very deep levels of communication and emotional intimacy [11]. The need to talk explicitly about desires, boundaries, body parts, and terminology creates a sexual dialogue that many cisgender couples never achieve. It is not a paradox: the complexity of the situation becomes a catalyst for greater connection.

At the same time, the challenges are real. Partners may find themselves grappling with changes in their companion’s body, with questions about their own sexual identity, with fears and insecurities. Psychological support, both individual and as a couple, can be invaluable during these phases.

Sexual Communication

The WPATH SOC-8 guidelines (2022) dedicate an entire chapter to sexual health, emphasizing the importance of open communication about sexuality in the context of affirming care [1]. Healthcare professionals are encouraged to proactively discuss sexuality with trans patients, not only in terms of function but also of pleasure, desire, and satisfaction.

This principle also applies within relationships: talking about sex is not easy for anyone, but for trans people it is particularly important. Establishing together what feels good and what does not, which body parts can be touched and how, what language to use for genitals: these are conversations that require mutual trust and that, when they happen, significantly improve the quality of the sexual experience.

Sexual Satisfaction After Transition

Data on sexual satisfaction after transition are overall positive. A 2022 systematic review on post-surgical satisfaction reports that 64-76% of trans men express satisfaction, and 64-98% of trans women after vaginoplasty express satisfaction [6].

But sexual satisfaction does not depend solely on surgery. Holmberg et al. (2019), in their review published in Nature Reviews Urology, emphasize that sexual satisfaction in trans people is influenced by a combination of factors: reduction of dysphoria, improvement of body image, quality of relationships, access to appropriate information, and presence of psychological support [5].

A particularly significant finding concerns the protective role of sexual satisfaction: in trans people, higher levels of sexual satisfaction are associated with lower levels of depression [5]. Sexuality is not a secondary aspect of well-being: it is a central component.

What Can Improve

Not everything is rosy, and it is important to say so. Some aspects of sexuality can be more difficult after medical transition: vaginal dryness in trans women, reduced sensitivity in some surgical procedures, the need for lubrication, adapting to a body that functions differently. These aspects are not insurmountable, but they require attention, information, and, when necessary, medical support.

The review by Barcelos et al. (2022), specifically focused on sexual function in trans women after surgery, emphasizes that evidence is still limited and that better assessment tools are needed, specifically designed for trans people and not adapted from questionnaires created for cisgender people [6].

Practical Resources and Support Pathways

Sexuality is an aspect of health that deserves specific clinical attention. The WPATH SOC-8 guidelines (2022) recommend that [1]:

• Healthcare professionals proactively address the topic of sexuality with trans patients
• Assessment of sexual function be part of monitoring during transition
• Trans people receive clear information about the effects of hormone therapy and surgery on sexuality
• Psychological support include, when requested, a focus on sexuality and intimacy

In the United States, major gender clinics and LGBTQ+ health centers offer multidisciplinary pathways that should include sexological counseling. Organizations such as the Fenway Institute in Boston, Callen-Lorde Community Health Center in New York, and UCSF Transgender Care provide comprehensive care. In practice, the sexuality dimension is often neglected: it is addressed only in terms of function (erection, lubrication, orgasm) and rarely in terms of pleasure, desire, and relationship.

What to Look For

If you are seeking support for your sex life:

• Sexologists with trans-specific competencies: not all sexologists have training in trans sexuality. Look for one with specific experience or who is part of a multidisciplinary team at a gender clinic.
• Community and peer groups: many LGBTQ+ organizations host discussion groups where sexuality is also discussed. Connecting with other trans people can be valuable for normalizing experiences that are often lived in isolation.
• Reliable online information: be wary of sensationalist content. Look for sources that cite scientific studies and treat the topic with respect.

Beyond Stereotypes

The sexuality of trans people is not exotic, not tragic, not a fetish. It is human sexuality, with all its complexity. Transition can bring specific challenges, such as dysphoria, hormonal effects, and post-surgical changes, but it also brings opportunities: greater awareness of one’s body, more authentic dialogue with partners, the ability to experience sex in a way that finally aligns with one’s identity.

Scientific data confirm that most trans people who undertake a transition report an improvement in overall sexual satisfaction [5][6]. Not because transition solves everything, but because it provides the conditions for a more authentic sex life.

If you have specific questions about sexuality in relationships with trans women or trans men, you will find dedicated insights in the satellite articles of this section.