Sexual Health

Sexual health is important for relationships and also general wellbeing. Below we will discuss some sexual health concerns in transgender men and how to talk about them with your provider. 
It is important to take charge of your health and find a provider will understand your needs.

Get the screening tests you need

Your health care provider may want you to have some or all of the following screening exams and tests. The screenings and how often you need them depend on what organs you still have, your age and your other risk factors.

Breast tissue health: Chest surgery does not remove all breast tissue, therefore it is important to continue to screen for breast cancer. Make sure your provider knows if people in your family have had breast cancer. Ask your provider to teach you how to examine the chest area. Continue to have mammograms if this is recommended by your provider.

Pelvic health: If you still have your pelvic organs, including uterus, cervix and ovaries, your provider will recommend regular evaluation of these organs to promote healthy pelvic health, even if you are on testosterone. This can include a pelvic exam (checks for problems with internal organs), pap smear (small brush collects cells from your cervix to screen for cervical cancer) and sexually transmitted infection (STI) testing. This is important, even if you do not engage in vaginal sex. To prevent STIs, always remember to use barrier protection such as a condom or dental dam. If you have not had the HPV vaccine, talk to provider more about this as this may reduce your risk of cervical cancer.

Fertility Issues

If you have a uterus and ovaries, you still can get pregnant even if you are on testosterone and your periods have stopped. Talk to your provider about reliable contraception options if you do not wish to have a child. Examples include condoms, an intrauterine device, or IUD, and hormonal pills, implants or injections. If you want to become pregnant, either now or in the future, talk with your provider about fertility options. There are ways to help you have a child with your own genetic material. Examples include freezing eggs or ovarian tissue, and embryo freezing. These may be options for you if you want to become pregnant or if you want to have someone else, called a surrogate, carry a child for you.

Other Sexual Issues

Sexual orientation

You may find that your sexual orientation becomes more fluid as you grow more comfortable with your body and your gender identity. You may be attracted to different kinds of people. Sexual behaviors and activities that you like and do not like may change.

Testosterone and sexual function

  • Testosterone can affect your sexual function in different ways:
  • Increase in sex drive or interest in sex
  • Enlargement of the clitoris Bleeding after sex
  • Testosterone may thin the lining of your vagina which can make penetrative sex more uncomfortable and you may notice bleeding. Your provider can provide a topical cream to help with this. Also, consider using lubrication

If you have trouble talking with your provider about your sexuality, these questions may help you start the conversation. Ask him or her:

  • What words can I use to tell others about my transgender identity?
  • How can I find ways to match my spiritual and moral beliefs with my sexual values and behaviors?
  • How can I explore my sexuality?
  • How can I ask for what gives me pleasure
  • How can I talk with a sexual partner about their desires?
  • What are good ways to set safe limits on sexual behavior?

There are other resources you can use. Find a support group, online or in your community. Ask your health care provider to suggest websites or organizations for transgender people.

Used with permission of Mayo Foundation for Medical Education and Research