I don’t feel very good right now. I’m one year and some change on HRT. It’s been a wonderful experience so far and I love being a girl. I know that I’m trans, and I’m reminded by “why” every time I go home and I’m forced to boymode.
Unfortunately that’s little comfort to the complex feelings of starting to feel erectile dysfunction (ED). I just had sex with my trans girlfriend and she didn’t have much left. I can’t ignore this feeling I’m on that same path eventually.
I want some sort of function either male or female. Even though I still wish I was born with a vagina. It pains me to even think about going off HRT though. I love being a girl too much and I don’t think I could present fem without HRT. I still have most all of its function but it doesn’t stay up for as long.
It’s a completely irrational feeling that I hope will be solved eventually with SRS, but that’s probably 10 years away and I just learned how to be sexual 2 years ago.
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Are we talking fertility here, or sexual function? If it’s the former: consider opening an account at the sperm bank. (Their interest rates kinda suck, though.) That way, you won’t have to really worry about becoming infertile.
I used fertility in the title but it’s about sexual function.
You won’t regain penile erectile function after you go off HRT, afaik; the way to retain what erectile function you still have is to ensure you have sustained, full erections every day.
You have to replace the erections that testosterone causes your body to have naturally when you would be asleep. Without testosterone, you lose those involuntary night-time erections and thus lose capacity to hold as much blood and thus to be as erect, so the way to reduce loss of function is to manually give yourself those erections you otherwise would have had.
But yes, SRS is amazing and I highly recommend it - once I transitioned and lived as a woman it was very bad for my mental health to use my genitals like they were male, I actually wanted atrophy as much as possible and learned to wear underwear and use a vibrator to treat it like a clit. That worked much better for me. But SRS was much, much better for my sexual health.
You’ll have to pay attention and notice what causes you to dissociate or lose connection with your body, dysphoria can be tricky to notice or catch (or at least it has been for me, esp. because I lived so long in denial, I learned to dismiss, ignore, and rationalize it away).
If you are gatekept in your country’s medical system, you might also consider making a goal of earning and saving money so you can get SRS in Thailand, which is the go-to option for most people in the world who don’t have access through their country’s healthcare system. That might be easier and faster to make happen than waiting over a decade for potentially worse outcomes (and at this rate who knows whether that healthcare will still be offered that far in the future).
EDIT: oh, and your headline says losing fertility, but “fertility” is particularly about the ability to impregnate and your sperm’s viability, which after a year on HRT has probably been already significantly reduced. Rather than fertility, maybe you meant penile atrophy and erectile dysfunction? Personally, I feel like penile atrophy gave me better sexual function, because it made my penis more like a clit. It’s only if you think of the penis as serving a role as erect and penetrating (in a traditionally “male” kind of sexual role) that we think of atrophy as a “dysfunction” - and I just reject that, I think a female penis doesn’t need to be penetrating, and functions well just the way it is (if not better).
I hope you don’t mind me asking, but on the topic of MTF SRS, are the “consequences” as bad as they’re made out to be? I’ve heard stories about having to dilate daily for years, surgeons not being able to agree on how to take care of it in the long run, leading to infections, and so on. It made me pretty cautious of it, even though I think it sounds pretty cool in theory.
You need to dilate for the rest of your life yes. The frequency will become less with many trans femme people dilating only once a week after a couple of years. Also, penetrative sex counts ;)
For people that aren’t interested in being penetrated (at least vaginally) and that don’t want to dilate there is also Zero Depth Vulvoplasty (also called Minimal Depth Vulvoplasty) where no vaginal canal is created and it’s “just” the vulva (the visible parts on the outside) that is sculpted.
As for infections: there is a trial and error period that is highly personal. For some people it involves douching regularly, especially in the beginning and inserting lacto-acid pills to encourage a sour-ish millieu that is close to a natal vagina’s.
Also, penetrative sex counts ;)
would just add that the width & hardness of what you are penetrated with matters here - you can lose width / have stenosis from no longer dilating with a hard dilator and just relying on penetrative sex, if the width & hardness of your partner or your toys are not comparable or don’t make up for what a dilator would have provided
in practice, plenty of women are happy with the width maintained from just penetrative sex, and there is no obligation to keep a wider canal than what you are happy living with.
Excellent addition/clarification, thanks!
I’ve had bottom surgery and I never needed to dilate even once, since I don’t have a vagina. I had nullification surgery. I’ve got nothing down there but a uritty.
Nulloplasty isn’t for everyone, but it’s the absolute lowest maintenance bottom surgery and I love the results. I wear leggings all the time now. No bulge, no camel toe, no nothing.
I’d really like to go streaking at a protest and get arrested for exposing nothing. I want to go to cout and establish some precedent!
to be honest I haven’t heard what the “consequences” are that you’re referring to (other than debunked lies from TERFs about a vagina remaining as a permanent, open-wound, etc. - but I’m not even sure how widely those lies are believed at this point).
What kinds of infections did you have in mind?
A vaginoplasty fully heals and absolutely is not a long term risk for infection; the only way I could think it might increase infection risk is by not managing your microbiome through douching or other means, which does leave potential for increased UTI risk (this can happen in cis women as well), but I can’t tell if that’s what you are talking about or not. Either way, I would just say that no, vaginoplasty does not result in long-term risks of infection.
Vaginoplasties are very safe with low rates of complications and extremely low rates of regret, but it is true you have to dilate the rest of your life if you want to retain the canal at a particular width.
Dilation may not be as big of a deal as it sounds, e.g. eventually (at least >1 year after surgery) you can dilate once a week, and it’s up to you how thick you want your canal or what to prioritize, lots of women stop dilating many years after their surgery and continue to have a canal and are able to enjoy penetrative sex. If you stop dilating much later in life, it can also be possible to regain some width by going back to dilating with larger and larger sizes - you can stretch the canal back open (but there are limits to this, and in the first years of healing there can be stenosis that you can’t overcome).
I see, thanks for the response! The problems/consequences I was referring to were based on a post, I think even in this exact community, about someone who had bottom surgery and was having lots of trouble with it, from the hospital staff during the initial recovery being absolutely unfamiliar with it, to having to concoct their own cleaning solution to avoid infections and bad smells. It made me pretty concerned.
lol, that was probably me?
The “concoting their own cleaning solution” might have been making a lactic acid douche instead of using a vinegar douche?
But for context, that’s so I can cultivate a microbiome that is friendly to lactobacillus - not to prevent infection. It did improve the smell, but tbh there was a stable microbiome (not lactobacillus dominant) that stabilized over time without my regimen which was maybe not as good-smelling as the lactobacilli, but was also not an overtly bad smell like it could get when there was something going wonky down there. Also, none of it is relevant if you just follow the doctor’s orders: douche every other day with vinegar solution during recovery (eventually I think you can reduce frequency to “as is”).
The hospital staff issues I had were particular to the hospital I had my surgery in, and because that wing was short-staffed and had to pull staff from other wings. I only had one truly bad nurse, and one mediocre nurse, but almost everyone I worked with was great even if they needed more training on dealing with vaginoplasty patients and the role that sitting can play in creating wound separation in that first week.
But those issues were in the end inconsequential and I recovered fully without issue. I don’t know how typical my experience was, and since my surgery that hospital no longer provides gender-affirming surgeries, so even that specific hospital’s problems aren’t relevant to future trans patients there.
Either way, none of this really bears on how safe and successful vaginoplasties are - I am very thankful I went through with mine despite the hardships I endured before and after the surgery.
the way to retain function (particularly erections) is to ensure you have sustained, full erections every day.
From what I’ve heard (but no proper sources) about once a week is enough, but that’s all I have to add
I lost function / had penile atrophy despite multiple erections per week. Once a week absolutely will not replace the multiple, long erections that happen every night on testosterone - I’m not even sure once a day is sufficient to prevent atrophy, to be honest. (That certainly doesn’t mimic or replace the amount of time the penis spends erect at night.)
Without testosterone, you lose those involuntary night-time erections and thus lose capacity to hold as much blood and thus to be as erect
Nobody told My body that! I was on HRT for five years before I had bottom surgery, and I got boners all the time! It was super annoying
And I’m not some high T alpha male, I’ve never been able to grow a beard, thankfully
That sounds like your T levels were too high during that time.
What’s your secret then? I don’t think my testosterone is particularly high, but I actually don’t want to loose function because I get way too much use out of it.
I might be the outlier here but I’m 8 years on hrt, prog and E, and have not had any surgeries. I have zero issue with erectile function.
My only change of note to my erectile function is sometimes, maybe 50% of the times I get hard, the second stimulation stops, I mean literally, count to 10 and I’m flaccid like I just climbed out of a cold pool. 30 -120 seconds of rubbing later and I’m hard as a rock again.
You can absolutely maintain normal erectile function while on HRT, I’m two years in and everything still works just fine thanks to sildenafil and a pump+ring. Most of the time I don’t even need the pill but I’m also on monotherapy so non-zero T levels may be a factor. Also there are much cheaper options available for pumps that I’m told will get comparable results, I just like that specific design.
Talk to your doctor. There are a few options. I used Cialis/Tadalafil for a bit. Also, I was not taking androgen blockers as the estradiol alone lowered my testosterone levels enough which is somewhat common and many doctors are waiting now to prescribe the androgen blockers due to the possible side effects. But I know it’s difficult to remove those if you’ve already started with them. That said I still suffered some ED, but the meds helped though I didn’t like the side effects of getting hot and face flushing. But you can take Cialis regularly in lower doses rather than just in the moment which helped reduce the impact of those side effects.
On the plus side, the orgasms become way, way better without testosterone, and eventually you can have multiple orgasms in a single session, things just take longer to build up. Remember, cis-women require more stimulation to get turned on, too, and to orgasm and you’ll need to get used to that. Even after SRS, my orgasms take a long time, though I did have some complications around the clitoral tissue and am awaiting revision surgery, but they are way more intense and last longer.
So, my advice is be patient. Realize that you will need your partner to give you more attention than a cis-male. Your erection no longer directly expresses how turned on you are. So communication is required instead, again, similar to a cis-woman, though our cultures rarely allow for it even with cis-women. And it’s a reason I like sleeping with women rather than men since they better know what to expect.
I can’t speak to SRS because I’m slightly leaning away from it myself, but ultimately undecided.
That said, I can give a bit of insight into a similar experience with HRT. When I started HRT, I had quite a few issues with ED and I just thought that’s how it was supposed to be. Eventually, I started taking Tadalafil to help with the issue and that was an okay bandaid for a while (honestly, it wasn’t such a big deal, I just kept a little in my sleep over bag and in my bathroom medicine cabinet).
When I swapped doctors, we did a little meetup to talk about how things were going and I brought up the ED situation. My doctor recommended we try changing up the HRT prescription (a very slightly lower dose of Finasteride, a slightly higher dose of Estrogen, and starting Progesterone) and the ED issue basically went away completely.
If you haven’t yet, definitely check with the doctor about seeing if modifying your HRT dosages may help!
Edit: as an after thought, my bloodwork was showing I already had a relatively low testosterone level before HRT, so I was WAY overdoing the blockers (even below the range of CIS women) and similarly, I had an average to slightly below average estrogen levels (as compared to CIS women).
The world is heading into worse climate change, things will get horrible for future generations with potentially billions dying across the globe and society collapsing.
Is that a world you would want to bring a child into? If you want children look into fostering or adopting those who are already in need of love and support.
You can keep your erection with use. You don’t need semen for being sexual, only for reproduction.
they weren’t talking about fertility, btw - just erections … they’re a year on HRT, their fertility has likely long been compromised (not that HRT is fool-proof contraception)
