Sexuality of trans women: beyond the stereotypes

“Are trans women tops or bottoms?” is one of the most frequently searched questions on Google about transgender people. It is a question that deserves a direct, non-evasive answer based on real data and not on what one sees in pornographic videos. The short answer: trans women are different from one another, just like cisgender women. There is no universal sexual role tied to being trans. But behind this question lies much more: deeply rooted stereotypes, misinformation fueled by pornography, and a superficial understanding of how the body works during transition. This article addresses everything with clarity.

Where the stereotype comes from

The primary source of the stereotype about the sexuality of trans women is pornography. In 2022, the “transgender” category on Pornhub saw a 75% increase in searches, becoming the seventh most popular category worldwide. By 2025, it had risen to the second most viewed category overall.

The problem is not that this pornography exists, but how it represents trans women. The vast majority of pornographic content featuring trans women focuses on a single aspect: the presence of the penis and its use in an “active” (insertive) position. This representation does not reflect reality; it responds to a specific fantasy of the audience. A 2025 study published in the Journal of the American Psychoanalytic Association analyzed the fetishization of trans women by heterosexual men, highlighting how pornography constructs a distorted image that reduces trans women to their genitals [6].

A 2019 study published in Communication Research Reports investigated the relationship between pornography consumption and attitudes toward transgender people: the results show that those who feel shame about their attraction to trans women tend to have more negative attitudes toward them [7]. Shame does not protect: it fuels prejudice.

The result is a vicious cycle. Pornography creates a one-dimensional image. Viewers internalize it as reality. Trans women then find themselves managing distorted expectations in real relationships, with partners who expect to replicate what they have seen on screen. This is not merely annoying: it is a form of violence.

The reality: sexual preferences are individual

Scientific research says one thing very clearly: the sexual preferences of trans women are just as varied as those of any other population. There is no fixed “role.”

A study published in Archives of Sexual Behavior in 2017, which examined the sexual preferences and relationships of transgender people in the post-transition period, documented a wide range of sexual practices [1]. Some trans women prefer a receptive role in intercourse, others an insertive role, many alternate, and a significant number do not practice penetrative sex at all, preferring other forms of intimacy.

The European multicenter ENIGI study (European Network for the Investigation of Gender Incongruence), conducted by Cerwenka and colleagues in 2014 on 380 trans people in Belgium, Germany, the Netherlands, and Norway, revealed a frequently overlooked finding: many trans women do not allow partners to touch their genitals during intercourse [8]. This single finding dismantles the stereotype of the “active” trans woman who uses her penis as the central element of the encounter. For many, the opposite is true: the genitals are a source of discomfort, not pleasure.

A 2018 thematic review published in Clinical Psychology Review synthesized the sexual experiences of trans people during transition, confirming that sexuality transforms over time and cannot be reduced to fixed categories [10]. Sexual practices change with hormone therapy, with surgery, with the evolution of the relationship with one’s own body, and with partners.

What changes with hormone therapy

Feminizing hormone therapy has profound effects on sexual function, and this is something anyone seeking information needs to know.

According to the guidelines from the UCSF Gender Affirming Health Program, estrogen and anti-androgen therapy produces significant changes within the first months: a short-term reduction in libido, decreased spontaneous and nocturnal erections, reduced testicular volume, and changes in the consistency and quantity of ejaculatory fluid [9].

In concrete terms: the majority of trans women on hormone therapy experience a significant reduction or complete disappearance of erectile function [9]. The penis becomes less responsive, erections more difficult to obtain and maintain, and the physiological mechanism that makes an “active” role possible is progressively altered. This is not an unwanted side effect for many trans women: it is an expected and welcome change, because it reduces dysphoria related to the genitals.

The longitudinal ENIGI study of 2020, published in the Journal of Sexual Medicine by Defreyne and colleagues, followed 401 trans women during the first three years of hormone therapy [2]. The results show that sexual desire decreases in the first three months, but after 36 months it rises to levels above baseline for partnered sexual desire [2]. Hormone therapy does not extinguish sexuality: it transforms it. Many trans women report that sex becomes qualitatively different, with pleasure that is more diffuse, less genital, and more emotional.

A fundamental point: even when erectile function is reduced, this does not mean an absence of pleasure. Penile sensitivity remains, and many trans women report orgasms through clitoral stimulation (of the glans) even in the absence of an erection. Sexual pleasure does not require an erect penis.

With or without surgery: two different realities

The situation changes further for trans women who have had vaginoplasty.

A 2025 study published in the Journal of Sexual Medicine by Kitic and colleagues evaluated the impact of vaginoplasty on the sexual health of trans women who underwent penile inversion surgery [4]. The data are significant: 82% of patients report the ability to reach orgasm after the procedure [4]. Seventy percent rate their post-operative sexual self-esteem above 7 out of 10 [4]. The most telling figure: 93% of participants say they would have the procedure again [4].

A second multicenter study from 2025, conducted by Duflot and colleagues in France, confirms positive results: over 85% of trans women who underwent surgery are sexually active, with high levels of aesthetic and functional satisfaction [11]. A 2022 meta-analysis reported an overall post-operative sexual satisfaction rate of 79.3% [5].

After vaginoplasty, the sexuality of trans women becomes comparable to that of cisgender women in terms of the dynamics of intercourse: receptive penetrative sex with vaginal sensitivity, clitoral stimulation (reconstructed from the penile glans), and all other forms of intimacy. The question of “role” in sex is no longer even a question.

For trans women who have not had and do not desire surgery, sexual practices are equally varied. Many favor forms of intimacy that do not involve the genitals. Others include the genitals according to their preferences. The choice is always individual.

Dysphoria and intimacy: the issue no one mentions

There is an aspect that the question “tops or bottoms?” completely ignores: body dysphoria. For many trans women, sexual intimacy is complex territory not because they do not desire sex, but because the relationship with one’s own body can make it difficult to let go.

The 2024 meta-ethnographic review published in BMC Public Health synthesized the sexual experiences of trans and gender non-conforming people, identifying dysphoria as one of the main obstacles to satisfying sexuality [12]. The discomfort can manifest in various ways: avoidance of genital contact, difficulty reaching orgasm, dissociation during intercourse, anticipatory anxiety.

The 2019 ENIGI study by Kerckhof and colleagues measured the prevalence of sexual dysfunctions in 518 trans people (307 trans women, 211 trans men) at 4-6 years from the start of their clinical pathway [3]. The most common dysfunctions in trans women are difficulty initiating sexual contact and difficulty reaching orgasm, regardless of the type of treatment received [3].

This means that when someone asks “are trans women tops or bottoms?”, they are already starting from a wrong assumption: that trans women have sexual encounters centered on penetration as the main element. For many, penetration is not even on the table — not due to inability, but as a conscious choice related to their bodily comfort.

The good news: research shows that medical transition, over time, improves the relationship with one’s body and with sexuality. The study by Defreyne and colleagues documents an increase in partnered sexual desire after the first years of hormone therapy, suggesting that as transition progresses and alignment between body and identity increases, intimacy becomes more accessible and satisfying [2].

The harm of fetishization

The fetishization of trans women is not a compliment. It is a reduction of the person to a sexual object defined by an anatomical characteristic. And it has concrete consequences.

When a partner approaches a trans woman with expectations derived from pornography, the implicit message is: “I desire you for your penis, not for who you are.” This produces isolation, distrust toward potential partners, and difficulty building authentic relationships.

The 2025 study by Lemma analyzes how fetishization by heterosexual men creates a paradox: trans women are simultaneously the object of intense sexual desire and social stigma [6]. The same man who searches for trans pornography in private may publicly deny any attraction, or worse, react with violence when his attraction is discovered. This phenomenon, known as “trans panic,” has consequences that extend well beyond the sexual sphere.

Trans women do not exist to satisfy fantasies. They have their own sexuality, which need not conform to the expectations of pornography or anyone else. Respect starts here: treating trans women as people with desires, boundaries, and autonomy, not as categories on a porn site.

Consent and communication

As in any sexual encounter, the foundation is informed consent and open communication. This is even more important when one or both partners have a body that does not match social expectations.

Some fundamental rules for anyone in a relationship with a trans woman:

• Do not assume anything. Sexual preferences are discovered through conversation, not assumption.
• Do not ask about genitals as a conversation opener. A person’s anatomical configuration is not a first-date topic.
• Respect boundaries. If a trans woman says she does not want to be touched in a certain area, it is not a challenge to overcome. It is a boundary to respect.
• Do not project pornographic fantasies. If your interest in trans women originates exclusively from pornography, stop and reflect on what you are actually seeking.
• Educate yourself. Understanding the effects of hormone therapy, the meaning of dysphoria, and the surgical options available is not the responsibility of the trans woman you are dating. It is your responsibility.

For further insight into relationships with trans partners, we refer to the article on common myths about trans people.

The answer to the question

Trans women are not “tops” or “bottoms” as a category. They are individual people with individual sexual preferences that change over time, with transition, with partners, and with the evolution of their relationship with their body.

Hormone therapy profoundly modifies sexual function, often making the insertive role impractical or undesired [2][9]. Surgery further transforms the possibilities [4][5]. Dysphoria influences what one is willing to do and what one is not [12]. And above all, personal preferences matter more than any category.

The stereotype of the “top” trans woman exists because pornography created it and the audience internalized it [6][7]. Science tells a different story: a story of diversity, change, and sexual autonomy that does not lend itself to simplifications [1][10]. If one truly wants to understand the sexuality of trans women, one must start by listening to trans women themselves, not by looking at the search results of a porn site.