Lee says:

Hello everyone! I’m Lee, a transmasculine person who is approaching 5 years on testosterone, and I’m here on your dash on this fine Transgender Day of Visibility to conduct a survey on the effects of testosterone on clitoral growth.

The lack of knowledge about some of the most basic aspects of medical transitioning is a real problem, and because it’s Transgender Day of Visibility, I’d like to bring this topic up again because the bodies of post-transition people are often invisible in medical literature which means the community has to turn to anecdotes they’ve heard from others to inform their expectations.

There was a 1986 study that investigated this question by collecting data from 30 patients who were AFAB and on testosterone, but the researchers only followed up with the patients for 1 year and 5 months (and some sources, like the WPATH guidelines, suggest that clitoral growth continues for 2 years.

A more recent 2014 study investigated the same question and included 97 patents, but their sample was limited to people who had self-selected to undergo metoidioplasty, which may have biased the results as people who didn’t have enough clitoral growth to be good candidates to be able to easily stand to pee and clear their fly with metoidioplasty might have chosen to get phalloplasty instead, which means they wouldn’t have been included in this study.

There are a few more data points out there, but the sample size tends to be small and is often limited to patients who had metoidioplasty which may not be representative of the typical growth that people on testosterone can expect to experience on average.

The purpose of my pilot survey is to gather data that can help inform the expectations of transgender people who are considering taking testosterone regarding the average size of the clitoris after a period of time on testosterone.

I am particularly interested in hearing from people who have been on testosterone for over two years, people who currently have (or used to have) conditions that affect their hormones levels, people who have had metoidioplasty, and people who have detransitioned or stopped taking testosterone.

But you may be eligible even if you don’t fit one of those descriptions— the criteria include anyone who was assigned female at birth (whether or not you identify as transgender or cisgender), is currently above the age of majority where you live (aka you’re legally an adult), and hasn’t had their clitoris surgically “buried” as part of phalloplasty. You don’t need to be on testosterone to respond.

So let’s all do something awkward for science and do something about the invisibility of our post-T bodies!

Please consider reblogging this post, then going to get your ruler out to fill out this survey and take some measurements when you have a free minute.

The link to the survey is here: https://bit.ly/T-growth

Lee says:

It’s not TDOV anymore, but the survey is still open for people who are willing to reply!

The link to the survey is here: https://bit.ly/T-growth

Can you give more info on what happens to my downstairs bits on T?

—

“Bottom growth? Huh?”

People sometimes say “bottom growth” as a euphemism for what doctors call “clitoromegaly” and what we’ll call “clitoral growth”. Trans folks may use “lower growth” or similar terms because they may not want to refer to their genitals with certain words because of dysphoria.

“What is the clitoris?”

The clitoris is the nerve center of the genital area for AFAB people. It’s an organ that exists for sexual pleasure, and it’s very sensitive. It’s located in front of your urethra and vagina. @whoneedssexed is a good resource if you want to learn more about sex or your body and how it works.

Here is a diagram of where it is if you’re a visual person, but know that it’s a diagram of genitals.

Some folks call it a “t-dick” or refer to it as their junk or their penis, and you can call it whatever makes you the most comfortable, but we’ll use the word clitoris here just for clarity.

“Wait, the clitoris grows? How much?”

Your clitoris will grow on testosterone! The average size it ends up seems to be around 1.2 inches give or take. Some folks have even ended up with a 3-inch length, but this is pretty rare!

I started testosterone on low-dose T and I still experienced clitoral growth within the first few months. Genital growth isn’t something you can opt out of if you take testosterone; again, if you take T, you can’t prevent your clitoris from growing because it’s one of the first changes you get. 

Clitoral growth from testosterone comes from the stimulation of the androgen receptors in your clitoris. 

It is possible that you will have a larger growth if you have a rather large clit already, but it isn’t guaranteed.

If you’re pre-T and already have a larger clitoris, then there’s a chance that you won’t experience as much growth because your androgen receptors have already maxed out, so there’s not as much room left for change so you’ll end up with an average size. 

There’s also the chance that you’ll end up a larger clitoral size than average if you start with a larger size and continue to have a normal growth, so you might not have more growth than usual but you’d still end up bigger. 

So basically pre-T clitoral size isn’t necessarily going to indicate what size you’ll end up on after testosterone.

“Does it hurt?”

Sometimes. You don’t usually feel pain from it growing or feel it grow, and it doesn’t grow long enough to affect your sitting. Once you get used to it, it doesn’t really feel like anything unusual. It became normal pretty quickly, and I only really notice the difference when I shower and during sex.

Some people do experience some pain from the new growth rubbing on their underwear when it first starts to happen, but wearing wearing tighter underwear (made of soft fabric, without seams) so that your body isn’t brushing against loose fabric and it’s more “contained”/held closer to your body can help. 

To prevent chafing, you can also use something body-safe on your glans as a protectant/barrier. Some people apply a little cocoa butter (the raw kind that you have to melt a little in your hands, not Palmer’s), coconut oil, or silicone lube so it doesn’t rub.

And not everyone experiences pain from chafing- I didn’t experience any pain or irritation from clitoral growth at all besides one incident when I went swimming after a month or two on T and the chlorine in the pool hurt a bit.

“Do I need to clean it?”

Yes, every time you shower you should carefully clean your clitoris gently with warm water, just like cis men are supposed to clean their penises if they’re uncircumsized. 

Pull back the foreskin/hood and make sure you rinse and (gently!) rub off any smegma around your glans and corona. And just to be clear, it’s only your external genitals you want to clean - your internal genital area is self-cleaning and will not appreciate water or (especially!) soap interfering with it. Soap isn’t necessary and can make hygiene problems worse by throwing off the PH balance in the area, but if you really want to, get something gentle and unperfumed.

“What does it look like?”

Right now, I don’t have many good non-sexual lower growth links to share because of Tumblr’s adult content purge.

There’s one Imgur post here showing lower growth standing and sitting, which only represents one person’s body but it’s a good non-sexual clitoris picture which sounds like an oxymoron but isn’t.

You can see some bottom growth pictures on Reddit’s FtMPorn forum too, which is explicitly trans-centric. But most of those pictures are sexual pictures, so you will see what lower growth looks like, but they have sexual captions and sometimes the person in the picture is wet/aroused and occasionally a toy/penis penetration is involved so you get a little more than what you’re looking for on that forum and you really need to be prepared to See Some Things.

There’s another Reddit group here but it isn’t a group moderated by and for transgender people, it’s mostly targeted towards cis women who want clitoral growth, so the mod’s intentions might be a little more kink/fetish-y than education for the trans population. But it does have pictures.

This is someone’s drawing reference guide on clitoral growth changes, for any artists out there/folks who don’t want to see actual genitals.

You can see pics of people’s before/after pics of clitoral growth then metoidioplasty surgery on the TransBucket website as well, but you won’t look like this unless you get surgery- some people see meta results and assume that just testosterone will give them testicles which isn’t the case.

“Does it affect peeing?”

No, clitoris growth does not affect how you use the bathroom. Your clitoris grows larger, but you pee through your urethra- not your clitoris. 

Your urethra  stays the same unless you get surgery to have a urethral lengthening as part of lower/bottom surgery. 

You will still need a device to stand to pee if you want to use the urinals in the men’s bathroom. 

“Can I get my clitoris pierced?”

You can get a piercing in your clitoral hood/”foreskin” if you want to. You can see some of those pics here (tw for nsfw): 1, 2, 3, 4. 

Avoid one of the well-known piercers, Elayne Angel, the ex-wife of Buck Angel, since she’s transphobic.

Getting a genital piercing pre-T is also possible, so you don’t need to wait for clitoral growth if you don’t want to.

“Do you have any info on pumping?”

Some people believe that pumping can cause small increases in clitoral size over time, but other people say that the effect is temporary and limited to a short time after pumping.

Pumping information:

Shopping for a pump:

“Why DHT if I’m already on T?”

DHT is short for dihydrotestosterone, and it can cause growth in the clitoris after you’ve been on testosterone for 2 years and gotten all the growth you’ll get without intervention. 

While the clitoris does grow on testosterone, it doesn’t always reach the maximum size possible for it because the androgen receptors aren’t filled. 

DHT can sometimes add a few centimeters or even an inch of growth, which is really a significant difference with a surgery like meta where every centimeter matters.

People getting a meta are sometimes recommended to take DHT for 3 months before the operation to maximize lower growth, but there’s currently no easy legal way to access DHT in the USA. 

It used to be available online through the All Saint’s Clinic and other vendors, and some folks have gotten it locally through compounding pharmacies.

“Will my clitoris go back to its original size if I stop testosterone?”

No. If you stop testosterone, your clitoris will keep around the same growth it had reached on T, and shouldn’t increase or decrease much in size.

I have heard anecdotally from a few people who took my informal survey that stopping testosterone changed their clitoral size a little bit, so it’s possible that topical estrogen may impact size a small amount too.

Here are their responses on this question:

As you can see, the majority (60%) said they didn’t experience any changes in clitoral size after stopping testosterone, but of course this is a hella small sample size and an informal survey and you’d still be on T so the situation isn’t quite the same, so take that with a grain of salt.

A de-transitioned person who stopped T told me that in their experience, their clitoris didn’t get as hard/erect in the same way as it did when they were on T so it doesn’t look as large as it did before, so a few people I’ve heard of take Cialis or a similar erectile dysfunction medication when they want to have sex if that difference bothers them.

“Wait, I can take erectile dysfunction medications?”

You need to talk to your doctor about it, but yes, you can. 

When you have a certain amount of clitoral growth, you can have erections. These erections aren’t typically noticeable if you’re wearing pants, and honestly you usually can’t even tell if someone is wearing underpants. 

But when you get to be familiar with your own body, you’ll be able to tell the difference between when it’s “hard” and sticking out a little versus “soft” and not as prominent. I can tell the difference on my own body and I can see the difference on my partner (who is also on testosterone).

Erectile dysfunction medication typically won’t make your clitoris any longer, but it will make it a little firmer.

Most folks on T don’t do this because it isn’t necessary, but it’s more common for people who stopped T (as mentioned above) and for post-metoidioplasty folks who have been advised to try it earlier on post-op to prevent retraction, or who want to maximize their “firmness” for sex to make penetration easier.

Some erectile dysfunction medication can interact with HIV medications, so if you’re HIV-positive make sure you talk to your doctor about possible mediation interactions.

Erectile dysfunction medication can also affect your blood pressure, so again, if you have high blood pressure or low blood pressure make sure you talk to your doctor about the best way to make sure you’re healthy while taking the medication. (In my EMT training, we are instructed not to assist with administering nitroglycerin for chest pain if someone has taken erectile dysfunction medication).

I know ordering the meds online can seem tempting, but like the Mayo Clinic website says, “Check to see if an online pharmacy is legitimate. Never order medications from an online pharmacy if there’s no way to contact the pharmacy by phone, if prices seem too good to be true or if you’re told no prescription is necessary. Some illegal businesses sell counterfeit versions of legitimate medications, which can be ineffective or dangerous. In the U.S., the National Association of Boards of Pharmacy can tell you whether an online pharmacy is licensed and in good standing.”

Do not order any medication that does not require a prescription from a doctor- this is illegal and the medication is probably fake or dangerous. Similarly, herbs and “natural” ED treatments are a scam and also possibly dangerous, and they will not work or be effective at all. 

If you have any health issues or disabilities at all, make sure you’re talking with your doctor about the safety of erectile dysfunction medication given your particular conditions.

“What’s vaginal atrophy?”

T can cause atrophy of the vagina and and uterus, and vaginal atrophy is symptomized as irritation, itchiness, dryness, and bleeding when penetrated.

It sounds scary, but it isn’t! Vaginal atrophy is treatable if you go to your doctor and get a topical estrogen cream or pill for the area. 

From the Mayo Clinic: Vaginal estrogen therapy comes in several forms. Because they all seem to work equally well, you and your doctor can decide which one is best for you.

I also have talked to a trans guy who took topical estrogen and still continued to experience more clitoral growth, so if you start topical estrogen while you’re still experiencing clitoral growth (which can often continue for 2 years), likely it won’t matter in your ultimate size.

I was briefly on topical estrogen for atrophy myself (more info on that is here), and it did not impact my clitoral size, and I also continued to take testosterone during that period and did not “detransition”.

Right now, there haven’t been any studies on how topical estrogen impacts clitoral growth in transgender people, but I would personally hypothesize that it wouldn’t prevent growth.

Using extra lube during sex can help when you have mild atrophy, so don’t let lube slip your mind! Check out All About Lube for more info on how to choose one.

“Do I still need to go to the gynecologist? When should I start seeing one?”

Yes, when on T you still need to get gynecologist appointments if you still have your uterus, ovaries, and cervix.

The New York Times article “When to Start With a Gynecologist?” says:

“A screening visit concerning reproductive preventive health care is recommended between the ages of 13 and 15, but the appointment doesn’t necessarily have to be with a gynecologist. Many pediatricians and family physicians are comfortable with this, so whom a teenager should see will vary depending on the circumstances.

A first gynecologist visit should happen at the age of 21 for cervical cancer screening, however, anyone who is younger than 21 and is sexually active should be seeing a provider who is comfortable with gynecologic care for annual chlamydia screening.

Other reasons to see an OB/GYN before the age of 21 include irregular periods, heavy periods (soaking onto clothes is a good proxy for being heavy), or period pain that is interfering with daily activities despite the use of over the counter pain medications, such as acetaminophen or ibuprofen.”

We have a post on gynecologist appointments here!

“Will I need a hysterectomy?”

No, it used to be recommended that everyone on testosterone get a hysterectomy but now it turns out that hysterectomies aren’t automatically medically necessary for everyone on T.

There are possible but as of yet unproven links between cervical and ovarian cancer and testosterone treatment, but no, you don’t need one just because you’re on T. 

More info on that is in this post, and our hysterectomy and oophorectomy page is here. 

“What does this mean for lower surgery?”

Metoidioplasty is the only type of lower surgery that relies on clitoral growth because phalloplasty isn’t influenced by clitoral size.

Our Bottom surgery (genital surgery) page has more info on this, so I’ll copy the metoidioplasty-related links below:

There are many other questions on the Bottom surgery (genital surgery) page so the links above are just a sample of questions you might be interested in!

“How will this affect my sex life?”

You can still masturbate and have all kinds of sex while on T, and you can still orgasm. Some people say that they orgasm quicker after being on T, some say it takes longer- but I’ve never heard of someone losing the ability. You may have to relearn your body and technique now that your clitoris is bigger, but hey- it’s more of a good thing!

However, your vagina may not self-lubricate as much anymore so you might want to use more lubricant for anything that involves vaginal penetration.

You may also be able to shallowly penetrate a partner a little bit with your clitoris, but this is typically difficult for folks unless they gained a lot of growth. But it is possible for some people, and using prosthetics that attach to the clitoris like the Hot Rod can be an aid for people as well.

More info: Transmasculine masturbation and sex and Packing and standing to pee.

More info:

T and your Genitals: A summary is a good place for more info on genital changes.

If you want to see the range of clitoral sizes possible, take the anonymous clitoral size survey and you can see everyone else’s responses at the end including the responses from people on T. You can take the survey with or without being on T.

Fun fact: it turns out I can see what Google searches brought people to this page:

Lee says:

If anyone is willing to help me out, I’m looking to reboot the anonymous survey measuring clitoral growth on testosterone!

Since people have been asking how much clitoral growth people get on testosterone, I’m looking to collect some informal data on people’s personal experiences.

I’ve put a question at the end to ask for feedback on what y’all think of the survey and how I can make it better.

This survey only applies to people who were assigned female at birth; however, you don’t need to be on testosterone to respond.

Please boost and share this link:

Can you give more info on what happens to my downstairs bits on T?

—

“Bottom growth? Huh?”

People sometimes say “bottom growth” as a euphemism for what doctors call “clitoromegaly” and what we’ll call “clitoral growth”. Trans folks may use “lower growth” or similar terms because they may not want to refer to their genitals with certain words because of dysphoria.

“What is the clitoris?”

The clitoris is the nerve center of the genital area for AFAB people. It’s an organ that exists for sexual pleasure, and it’s very sensitive. It’s located in front of your urethra and vagina. @whoneedssexed is a good resource if you want to learn more about sex or your body and how it works.

Here is a diagram of where it is if you’re a visual person, but know that it’s a diagram of genitals.

Some folks call it a “t-dick” or refer to it as their junk or their penis, and you can call it whatever makes you the most comfortable, but we’ll use the word clitoris here just for clarity.

“Wait, the clitoris grows? How much?”

Your clitoris will grow on testosterone! The average size it ends up seems to be around 1.2 inches give or take. Some folks have even ended up with a 3-inch length, but this is pretty rare!

I started testosterone on low-dose T and I still experienced clitoral growth within the first few months. Genital growth isn’t something you can opt out of if you take testosterone; again, if you take T, you can’t prevent your clitoris from growing because it’s one of the first changes you get. 

Clitoral growth from testosterone comes from the stimulation of the androgen receptors in your clitoris. 

It is possible that you will have a larger growth if you have a rather large clit already, but it isn’t guaranteed.

If you’re pre-T and already have a larger clitoris, then there’s a chance that you won’t experience as much growth because your androgen receptors have already maxed out, so there’s not as much room left for change so you’ll end up with an average size. 

There’s also the chance that you’ll end up a larger clitoral size than average if you start with a larger size and continue to have a normal growth, so you might not have more growth than usual but you’d still end up bigger. 

So basically pre-T clitoral size isn’t necessarily going to indicate what size you’ll end up on after testosterone.

“Does it hurt?”

Sometimes. You don’t usually feel pain from it growing or feel it grow, and it doesn’t grow long enough to affect your sitting. Once you get used to it, it doesn’t really feel like anything unusual. It became normal pretty quickly, and I only really notice the difference when I shower and during sex.

Some people do experience some pain from the new growth rubbing on their underwear when it first starts to happen, but wearing wearing tighter underwear (made of soft fabric, without seams) so that your body isn’t brushing against loose fabric and it’s more “contained”/held closer to your body can help. 

To prevent chafing, you can also use something body-safe on your glans as a protectant/barrier. Some people apply a little cocoa butter (the raw kind that you have to melt a little in your hands, not Palmer’s), coconut oil, or silicone lube so it doesn’t rub.

And not everyone experiences pain from chafing- I didn’t experience any pain or irritation from clitoral growth at all besides one incident when I went swimming after a month or two on T and the chlorine in the pool hurt a bit.

“Do I need to clean it?”

Yes, every time you shower you should carefully clean your clitoris gently with warm water, just like cis men are supposed to clean their penises if they’re uncircumsized. 

Pull back the foreskin/hood and make sure you rinse and (gently!) rub off any smegma around your glans and corona. And just to be clear, it’s only your external genitals you want to clean - your internal genital area is self-cleaning and will not appreciate water or (especially!) soap interfering with it. Soap isn’t necessary and can make hygiene problems worse by throwing off the PH balance in the area, but if you really want to, get something gentle and unperfumed.

“What does it look like?”

Right now, I don’t have many good non-sexual lower growth links to share because of Tumblr’s adult content purge.

There’s one Imgur post here showing lower growth standing and sitting, which only represents one person’s body but it’s a good non-sexual clitoris picture which sounds like an oxymoron but isn’t.

You can see some bottom growth pictures on Reddit’s FtMPorn forum too, which is explicitly trans-centric. But most of those pictures are sexual pictures, so you will see what lower growth looks like, but they have sexual captions and sometimes the person in the picture is wet/aroused and occasionally a toy/penis penetration is involved so you get a little more than what you’re looking for on that forum and you really need to be prepared to See Some Things.

There’s another Reddit group here but it isn’t a group moderated by and for transgender people, it’s mostly targeted towards cis women who want clitoral growth, so the mod’s intentions might be a little more kink/fetish-y than education for the trans population. But it does have pictures.

This is someone’s drawing reference guide on clitoral growth changes, for any artists out there/folks who don’t want to see actual genitals.

You can see pics of people’s before/after pics of clitoral growth then metoidioplasty surgery on the TransBucket website as well, but you won’t look like this unless you get surgery- some people see meta results and assume that just testosterone will give them testicles which isn’t the case.

“Does it affect peeing?”

No, clitoris growth does not affect how you use the bathroom. Your clitoris grows larger, but you pee through your urethra- not your clitoris. 

Your urethra  stays the same unless you get surgery to have a urethral lengthening as part of lower/bottom surgery. 

You will still need a device to stand to pee if you want to use the urinals in the men’s bathroom. 

“Can I get my clitoris pierced?”

You can get a piercing in your clitoral hood/”foreskin” if you want to. You can see some of those pics here (tw for nsfw): 1, 2, 3, 4. 

Avoid one of the well-known piercers, Elayne Angel, the ex-wife of Buck Angel, since she’s transphobic.

Getting a genital piercing pre-T is also possible, so you don’t need to wait for clitoral growth if you don’t want to.

“Do you have any info on pumping?”

Some people believe that pumping can cause small increases in clitoral size over time, but other people say that the effect is temporary and limited to a short time after pumping.

Pumping information:

Shopping for a pump:

“Why DHT if I’m already on T?”

DHT is short for dihydrotestosterone, and it can cause growth in the clitoris after you’ve been on testosterone for 2 years and gotten all the growth you’ll get without intervention. 

While the clitoris does grow on testosterone, it doesn’t always reach the maximum size possible for it because the androgen receptors aren’t filled. 

DHT can sometimes add a few centimeters or even an inch of growth, which is really a significant difference with a surgery like meta where every centimeter matters.

People getting a meta are sometimes recommended to take DHT for 3 months before the operation to maximize lower growth, but there’s currently no easy legal way to access DHT in the USA. 

It used to be available online through the All Saint’s Clinic and other vendors, and some folks have gotten it locally through compounding pharmacies.

“Will my clitoris go back to its original size if I stop testosterone?”

No. If you stop testosterone, your clitoris will keep around the same growth it had reached on T, and shouldn’t increase or decrease much in size.

I have heard anecdotally from a few people who took my informal survey that stopping testosterone changed their clitoral size a little bit, so it’s possible that topical estrogen may impact size a small amount too.

Here are their responses on this question:

As you can see, the majority (60%) said they didn’t experience any changes in clitoral size after stopping testosterone, but of course this is a hella small sample size and an informal survey and you’d still be on T so the situation isn’t quite the same, so take that with a grain of salt.

A de-transitioned person who stopped T told me that in their experience, their clitoris didn’t get as hard/erect in the same way as it did when they were on T so it doesn’t look as large as it did before, so a few people I’ve heard of take Cialis or a similar erectile dysfunction medication when they want to have sex if that difference bothers them.

“Wait, I can take erectile dysfunction medications?”

You need to talk to your doctor about it, but yes, you can. 

When you have a certain amount of clitoral growth, you can have erections. These erections aren’t typically noticeable if you’re wearing pants, and honestly you usually can’t even tell if someone is wearing underpants. 

But when you get to be familiar with your own body, you’ll be able to tell the difference between when it’s “hard” and sticking out a little versus “soft” and not as prominent. I can tell the difference on my own body and I can see the difference on my partner (who is also on testosterone).

Erectile dysfunction medication typically won’t make your clitoris any longer, but it will make it a little firmer.

Most folks on T don’t do this because it isn’t necessary, but it’s more common for people who stopped T (as mentioned above) and for post-metoidioplasty folks who have been advised to try it earlier on post-op to prevent retraction, or who want to maximize their “firmness” for sex to make penetration easier.

Some erectile dysfunction medication can interact with HIV medications, so if you’re HIV-positive make sure you talk to your doctor about possible mediation interactions.

Erectile dysfunction medication can also affect your blood pressure, so again, if you have high blood pressure or low blood pressure make sure you talk to your doctor about the best way to make sure you’re healthy while taking the medication. (In my EMT training, we are instructed not to assist with administering nitroglycerin for chest pain if someone has taken erectile dysfunction medication).

I know ordering the meds online can seem tempting, but like the Mayo Clinic website says, “Check to see if an online pharmacy is legitimate. Never order medications from an online pharmacy if there’s no way to contact the pharmacy by phone, if prices seem too good to be true or if you’re told no prescription is necessary. Some illegal businesses sell counterfeit versions of legitimate medications, which can be ineffective or dangerous. In the U.S., the National Association of Boards of Pharmacy can tell you whether an online pharmacy is licensed and in good standing.”

Do not order any medication that does not require a prescription from a doctor- this is illegal and the medication is probably fake or dangerous. Similarly, herbs and “natural” ED treatments are a scam and also possibly dangerous, and they will not work or be effective at all. 

If you have any health issues or disabilities at all, make sure you’re talking with your doctor about the safety of erectile dysfunction medication given your particular conditions.

“What’s vaginal atrophy?”

T can cause atrophy of the vagina and and uterus, and vaginal atrophy is symptomized as irritation, itchiness, dryness, and bleeding when penetrated.

It sounds scary, but it isn’t! Vaginal atrophy is treatable if you go to your doctor and get a topical estrogen cream or pill for the area. 

From the Mayo Clinic: Vaginal estrogen therapy comes in several forms. Because they all seem to work equally well, you and your doctor can decide which one is best for you.

I also have talked to a trans guy who took topical estrogen and still continued to experience more clitoral growth, so if you start topical estrogen while you’re still experiencing clitoral growth (which can often continue for 2 years), likely it won’t matter in your ultimate size.

I was briefly on topical estrogen for atrophy myself (more info on that is here), and it did not impact my clitoral size, and I also continued to take testosterone during that period and did not “detransition”.

Right now, there haven’t been any studies on how topical estrogen impacts clitoral growth in transgender people, but I would personally hypothesize that it wouldn’t prevent growth.

Using extra lube during sex can help when you have mild atrophy, so don’t let lube slip your mind! Check out All About Lube for more info on how to choose one.

“Do I still need to go to the gynecologist? When should I start seeing one?”

Yes, when on T you still need to get gynecologist appointments if you still have your uterus, ovaries, and cervix.

The New York Times article “When to Start With a Gynecologist?” says:

“A screening visit concerning reproductive preventive health care is recommended between the ages of 13 and 15, but the appointment doesn’t necessarily have to be with a gynecologist. Many pediatricians and family physicians are comfortable with this, so whom a teenager should see will vary depending on the circumstances.

A first gynecologist visit should happen at the age of 21 for cervical cancer screening, however, anyone who is younger than 21 and is sexually active should be seeing a provider who is comfortable with gynecologic care for annual chlamydia screening.

Other reasons to see an OB/GYN before the age of 21 include irregular periods, heavy periods (soaking onto clothes is a good proxy for being heavy), or period pain that is interfering with daily activities despite the use of over the counter pain medications, such as acetaminophen or ibuprofen.”

We have a post on gynecologist appointments here!

“Will I need a hysterectomy?”

No, it used to be recommended that everyone on testosterone get a hysterectomy but now it turns out that hysterectomies aren’t automatically medically necessary for everyone on T.

There are possible but as of yet unproven links between cervical and ovarian cancer and testosterone treatment, but no, you don’t need one just because you’re on T. 

More info on that is in this post, and our hysterectomy and oophorectomy page is here. 

“What does this mean for lower surgery?”

Metoidioplasty is the only type of lower surgery that relies on clitoral growth because phalloplasty isn’t influenced by clitoral size.

Our Bottom surgery (genital surgery) page has more info on this, so I’ll copy the metoidioplasty-related links below:

There are many other questions on the Bottom surgery (genital surgery) page so the links above are just a sample of questions you might be interested in!

“How will this affect my sex life?”

You can still masturbate and have all kinds of sex while on T, and you can still orgasm. Some people say that they orgasm quicker after being on T, some say it takes longer- but I’ve never heard of someone losing the ability. You may have to relearn your body and technique now that your clitoris is bigger, but hey- it’s more of a good thing!

However, your vagina may not self-lubricate as much anymore so you might want to use more lubricant for anything that involves vaginal penetration.

You may also be able to shallowly penetrate a partner a little bit with your clitoris, but this is typically difficult for folks unless they gained a lot of growth. But it is possible for some people, and using prosthetics that attach to the clitoris like the Hot Rod can be an aid for people as well.

More info: Transmasculine masturbation and sex and Packing and standing to pee.

More info:

T and your Genitals: A summary is a good place for more info on genital changes.

If you want to see the range of clitoral sizes possible, take the anonymous clitoral size survey and you can see everyone else’s responses at the end including the responses from people on T. You can take the survey with or without being on T.

Fun fact: it turns out I can see what Google searches brought people to this page:

Can you give more info on what happens to my downstairs bits on T?

—

“Bottom growth? Huh?”

People sometimes say “bottom growth” as a euphemism for what doctors call “clitoromegaly” and what we’ll call “clitoral growth”. Trans folks may use “lower growth” or similar terms because they may not want to refer to their genitals with certain words because of dysphoria.

“What is the clitoris?”

The clitoris is the nerve center of the genital area for AFAB people. It’s an organ that exists for sexual pleasure, and it’s very sensitive. It’s located in front of your urethra and vagina. @whoneedssexed is a good resource if you want to learn more about sex or your body and how it works.

Here is a diagram of where it is if you’re a visual person, but know that it’s a diagram of genitals.

Some folks call it a “t-dick” or refer to it as their junk or their penis, and you can call it whatever makes you the most comfortable, but we’ll use the word clitoris here just for clarity.

“Wait, the clitoris grows? How much?”

Your clitoris will grow on testosterone! The average size it ends up seems to be around 1.2 inches give or take. Some folks have even ended up with a 3-inch length, but this is pretty rare!

I started testosterone on low-dose T and I still experienced clitoral growth within the first few months. Genital growth isn’t something you can opt out of if you take testosterone; again, if you take T, you can’t prevent your clitoris from growing because it’s one of the first changes you get. 

Clitoral growth from testosterone comes from the stimulation of the androgen receptors in your clitoris. 

It is possible that you will have a larger growth if you have a rather large clit already, but it isn’t guaranteed.

If you’re pre-T and already have a larger clitoris, then there’s a chance that you won’t experience as much growth because your androgen receptors have already maxed out, so there’s not as much room left for change so you’ll end up with an average size. 

There’s also the chance that you’ll end up a larger clitoral size than average if you start with a larger size and continue to have a normal growth, so you might not have more growth than usual but you’d still end up bigger. 

So basically pre-T clitoral size isn’t necessarily going to indicate what size you’ll end up on after testosterone.

“Does it hurt?”

Sometimes. You don’t usually feel pain from it growing or feel it grow, and it doesn’t grow long enough to affect your sitting. Once you get used to it, it doesn’t really feel like anything unusual. It became normal pretty quickly, and I only really notice the difference when I shower and during sex.

Some people do experience some pain from the new growth rubbing on their underwear when it first starts to happen, but wearing wearing tighter underwear (made of soft fabric, without seams) so that your body isn’t brushing against loose fabric and it’s more “contained”/held closer to your body can help. 

To prevent chafing, you can also use something body-safe on your glans as a protectant/barrier. Some people apply a little cocoa butter (the raw kind that you have to melt a little in your hands, not Palmer’s), coconut oil, or silicone lube so it doesn’t rub.

And not everyone experiences pain from chafing- I didn’t experience any pain or irritation from clitoral growth at all besides one incident when I went swimming after a month or two on T and the chlorine in the pool hurt a bit.

“Do I need to clean it?”

Yes, every time you shower you should carefully clean your clitoris gently with warm water, just like cis men are supposed to clean their penises if they’re uncircumsized. 

Pull back the foreskin/hood and make sure you rinse and (gently!) rub off any smegma around your glans and corona. And just to be clear, it’s only your external genitals you want to clean - your internal genital area is self-cleaning and will not appreciate water or (especially!) soap interfering with it. Soap isn’t necessary and can make hygiene problems worse by throwing off the PH balance in the area, but if you really want to, get something gentle and unperfumed.

“What does it look like?”

Right now, I don’t have many good non-sexual lower growth links to share because of Tumblr’s adult content purge.

There’s one Imgur post here showing lower growth standing and sitting, which only represents one person’s body but it’s a good non-sexual clitoris picture which sounds like an oxymoron but isn’t.

You can see some bottom growth pictures on Reddit’s FtMPorn forum too, which is explicitly trans-centric. But most of those pictures are sexual pictures, so you will see what lower growth looks like, but they have sexual captions and sometimes the person in the picture is wet/aroused and occasionally a toy/penis penetration is involved so you get a little more than what you’re looking for on that forum and you really need to be prepared to See Some Things.

There’s another Reddit group here but it isn’t a group moderated by and for transgender people, it’s mostly targeted towards cis women who want clitoral growth, so the mod’s intentions might be a little more kink/fetish-y than education for the trans population. But it does have pictures.

This is someone’s drawing reference guide on clitoral growth changes, for any artists out there/folks who don’t want to see actual genitals.

You can see pics of people’s before/after pics of clitoral growth then metoidioplasty surgery on the TransBucket website as well, but you won’t look like this unless you get surgery- some people see meta results and assume that just testosterone will give them testicles which isn’t the case.

“Does it affect peeing?”

No, clitoris growth does not affect how you use the bathroom. Your clitoris grows larger, but you pee through your urethra- not your clitoris. 

Your urethra  stays the same unless you get surgery to have a urethral lengthening as part of lower/bottom surgery. 

You will still need a device to stand to pee if you want to use the urinals in the men’s bathroom. 

“Can I get my clitoris pierced?”

You can get a piercing in your clitoral hood/”foreskin” if you want to. You can see some of those pics here (tw for nsfw): 1, 2, 3, 4. 

Avoid one of the well-known piercers, Elayne Angel, the ex-wife of Buck Angel, since she’s transphobic.

Getting a genital piercing pre-T is also possible, so you don’t need to wait for clitoral growth if you don’t want to.

“Do you have any info on pumping?”

Some people believe that pumping can cause small increases in clitoral size over time, but other people say that the effect is temporary and limited to a short time after pumping.

Pumping information:

Shopping for a pump:

“Why DHT if I’m already on T?”

DHT is short for dihydrotestosterone, and it can cause growth in the clitoris after you’ve been on testosterone for 2 years and gotten all the growth you’ll get without intervention. 

While the clitoris does grow on testosterone, it doesn’t always reach the maximum size possible for it because the androgen receptors aren’t filled. 

DHT can sometimes add a few centimeters or even an inch of growth, which is really a significant difference with a surgery like meta where every centimeter matters.

People getting a meta are sometimes recommended to take DHT for 3 months before the operation to maximize lower growth, but there’s currently no easy legal way to access DHT in the USA. 

It used to be available online through the All Saint’s Clinic and other vendors, and some folks have gotten it locally through compounding pharmacies.

“Will my clitoris go back to its original size if I stop testosterone?”

No. If you stop testosterone, your clitoris will keep around the same growth it had reached on T, and shouldn’t increase or decrease much in size.

I have heard anecdotally from a few people who took my informal survey that stopping testosterone changed their clitoral size a little bit, so it’s possible that topical estrogen may impact size a small amount too.

Here are their responses on this question:

As you can see, the majority (60%) said they didn’t experience any changes in clitoral size after stopping testosterone, but of course this is a hella small sample size and an informal survey and you’d still be on T so the situation isn’t quite the same, so take that with a grain of salt.

A de-transitioned person who stopped T told me that in their experience, their clitoris didn’t get as hard/erect in the same way as it did when they were on T so it doesn’t look as large as it did before, so a few people I’ve heard of take Cialis or a similar erectile dysfunction medication when they want to have sex if that difference bothers them.

“Wait, I can take erectile dysfunction medications?”

You need to talk to your doctor about it, but yes, you can. 

When you have a certain amount of clitoral growth, you can have erections. These erections aren’t typically noticeable if you’re wearing pants, and honestly you usually can’t even tell if someone is wearing underpants. 

But when you get to be familiar with your own body, you’ll be able to tell the difference between when it’s “hard” and sticking out a little versus “soft” and not as prominent. I can tell the difference on my own body and I can see the difference on my partner (who is also on testosterone).

Erectile dysfunction medication typically won’t make your clitoris any longer, but it will make it a little firmer.

Most folks on T don’t do this because it isn’t necessary, but it’s more common for people who stopped T (as mentioned above) and for post-metoidioplasty folks who have been advised to try it earlier on post-op to prevent retraction, or who want to maximize their “firmness” for sex to make penetration easier.

Some erectile dysfunction medication can interact with HIV medications, so if you’re HIV-positive make sure you talk to your doctor about possible mediation interactions.

Erectile dysfunction medication can also affect your blood pressure, so again, if you have high blood pressure or low blood pressure make sure you talk to your doctor about the best way to make sure you’re healthy while taking the medication. (In my EMT training, we are instructed not to assist with administering nitroglycerin for chest pain if someone has taken erectile dysfunction medication).

I know ordering the meds online can seem tempting, but like the Mayo Clinic website says, “Check to see if an online pharmacy is legitimate. Never order medications from an online pharmacy if there’s no way to contact the pharmacy by phone, if prices seem too good to be true or if you’re told no prescription is necessary. Some illegal businesses sell counterfeit versions of legitimate medications, which can be ineffective or dangerous. In the U.S., the National Association of Boards of Pharmacy can tell you whether an online pharmacy is licensed and in good standing.”

Do not order any medication that does not require a prescription from a doctor- this is illegal and the medication is probably fake or dangerous. Similarly, herbs and “natural” ED treatments are a scam and also possibly dangerous, and they will not work or be effective at all. 

If you have any health issues or disabilities at all, make sure you’re talking with your doctor about the safety of erectile dysfunction medication given your particular conditions.

“What’s vaginal atrophy?”

T can cause atrophy of the vagina and and uterus, and vaginal atrophy is symptomized as irritation, itchiness, dryness, and bleeding when penetrated.

It sounds scary, but it isn’t! Vaginal atrophy is treatable if you go to your doctor and get a topical estrogen cream or pill for the area. 

From the Mayo Clinic: Vaginal estrogen therapy comes in several forms. Because they all seem to work equally well, you and your doctor can decide which one is best for you.

I also have talked to a trans guy who took topical estrogen and still continued to experience more clitoral growth, so if you start topical estrogen while you’re still experiencing clitoral growth (which can often continue for 2 years), likely it won’t matter in your ultimate size.

I was briefly on topical estrogen for atrophy myself (more info on that is here), and it did not impact my clitoral size, and I also continued to take testosterone during that period and did not “detransition”.

Right now, there haven’t been any studies on how topical estrogen impacts clitoral growth in transgender people, but I would personally hypothesize that it wouldn’t prevent growth.

Using extra lube during sex can help when you have mild atrophy, so don’t let lube slip your mind! Check out All About Lube for more info on how to choose one.

“Do I still need to go to the gynecologist? When should I start seeing one?”

Yes, when on T you still need to get gynecologist appointments if you still have your uterus, ovaries, and cervix.

The New York Times article “When to Start With a Gynecologist?” says:

“A screening visit concerning reproductive preventive health care is recommended between the ages of 13 and 15, but the appointment doesn’t necessarily have to be with a gynecologist. Many pediatricians and family physicians are comfortable with this, so whom a teenager should see will vary depending on the circumstances.

A first gynecologist visit should happen at the age of 21 for cervical cancer screening, however, anyone who is younger than 21 and is sexually active should be seeing a provider who is comfortable with gynecologic care for annual chlamydia screening.

Other reasons to see an OB/GYN before the age of 21 include irregular periods, heavy periods (soaking onto clothes is a good proxy for being heavy), or period pain that is interfering with daily activities despite the use of over the counter pain medications, such as acetaminophen or ibuprofen.”

We have a post on gynecologist appointments here!

“Will I need a hysterectomy?”

No, it used to be recommended that everyone on testosterone get a hysterectomy but now it turns out that hysterectomies aren’t automatically medically necessary for everyone on T.

There are possible but as of yet unproven links between cervical and ovarian cancer and testosterone treatment, but no, you don’t need one just because you’re on T. 

More info on that is in this post, and our hysterectomy and oophorectomy page is here. 

“What does this mean for lower surgery?”

Metoidioplasty is the only type of lower surgery that relies on clitoral growth because phalloplasty isn’t influenced by clitoral size.

Our Bottom surgery (genital surgery) page has more info on this, so I’ll copy the metoidioplasty-related links below:

There are many other questions on the Bottom surgery (genital surgery) page so the links above are just a sample of questions you might be interested in!

“How will this affect my sex life?”

You can still masturbate and have all kinds of sex while on T, and you can still orgasm. Some people say that they orgasm quicker after being on T, some say it takes longer- but I’ve never heard of someone losing the ability. You may have to relearn your body and technique now that your clitoris is bigger, but hey- it’s more of a good thing!

However, your vagina may not self-lubricate as much anymore so you might want to use more lubricant for anything that involves vaginal penetration.

You may also be able to shallowly penetrate a partner a little bit with your clitoris, but this is typically difficult for folks unless they gained a lot of growth. But it is possible for some people, and using prosthetics that attach to the clitoris like the Hot Rod can be an aid for people as well.

More info: Transmasculine masturbation and sex and Packing and standing to pee.

More info:

T and your Genitals: A summary is a good place for more info on genital changes.

If you want to see the range of clitoral sizes possible, take the anonymous clitoral size survey and you can see everyone else’s responses at the end including the responses from people on T. You can take the survey with or without being on T.

Fun fact: it turns out I can see what Google searches brought people to this page:

Found this thread on twitter and thought it was a great visual guide!

The Twitter post: