The Feeld guide to testosterone: your sex drive on gender-affirming care

When I started testosterone as part of my gender-affirming healthcare in 2017, I was vaguely aware that my sex drive could increase. Honestly, it was one of the last things on my mind—I was just desperate to finally begin hormone therapy and the medical aspect of my transition. I also wasn’t sexually active, due to a mixture of dysphoria and general discomfort with my body, so an increased sex drive was quite far down my list of priorities.

That was, until a few months after my first dose. I began to feel a new kind of hunger. It crept in at first, like a gnawing desire at the back of my mind, but it soon progressed into a ravenous wanting. My sex drive had awoken, and soon I was horny nearly all the time. I barely focused at work, spent most of my time distracted by sexual fantasy, and soon began having regular casual sex for the first time in my life. 

Over time, testosterone transformed my relationship with my own sexuality: I became more sexually confident, explored different kinds of sex, and was generally happier. Conversations with others on testosterone showed that I wasn’t alone—many people’s libido changed, but there was a lack of information about what to expect, why it changed, and how to handle it.

This guide focuses on the experiences of people assigned female at birth who are undergoing (or considering undergoing) testosterone therapy, but it’s also for anyone interested in how testosterone affects sexual drive and desire. 

The science of testosterone

First of all, what does testosterone therapy actually do to your body? “Your testosterone levels rise and your estrogen is downregulated, but ovaries will continue to produce a little estrogen,” explains Dr. Corinne McLeod, Regional Medical Director for Planned Parenthood of Greater New York, and Program Director of their Gender Affirming Hormone Therapy Program. “This is normal—everybody needs a balance of testosterone and estrogen to be healthy, but you produce far less estrogen when your testosterone levels rise.”

This shift from an estrogen-dominant to a testosterone-dominant hormone profile may cause a lot of the physical changes that people seek out from testosterone therapy. These can include “increases in facial and body hair growth, redistribution of muscle and fat, a lower voice, bigger muscles and, sometimes, acne,” says McLeod.

She also explains that, for most people, increased testosterone means their periods stop. The speed of these physical changes can differ from person to person, even if they’re on the same dose of testosterone. 

“There’s definitely something genetic that we don’t yet understand about how people’s bodies process hormones differently,” she adds. “It’s really important to work closely with a clinician, if you can, to find the right dose and schedule for you.”

The impact of testosterone also depends on the dosage—low dose testosterone will typically result in slower physical changes, while those on a higher dose may notice differences much faster. However, as McLeod says: everyone is different. 

In my case, it took around six months for my periods to stop, and much longer to see noticeable physical changes. What did change quickly, though, was my sex drive.

How can testosterone change your sex drive?

Short-term changes

My sudden high sex drive after going on testosterone isn’t unusual. When I spoke to other people who had been on testosterone, they shared similar stories. 

Waithera, who used a low dose, told me they “noticed an increase in sex drive almost immediately.” For them, this manifested as a “significantly increased interest in cisgender men.” Elsewhere, Eliott said he noticed a significant change after switching from gel-based testosterone to injections, when he went from “being horny maybe once or twice a week to multiple times a day.”

While not everyone’s sex drive increases, it is a common experience. Kate Nambiar, Gender Clinician and Endocrinologist at the Welsh Gender Clinic, says that many people have  “increased libido over the first few months, which then tends to plateau as people readjust to their new normal.” 

Research backs this up—one study published in the American Journal of Obstetrics & Gynecology on sexual function and testosterone found that testosterone use was linked with higher interest in sexual activity in people assigned female at birth.

This increase in sex drive is accompanied by what’s generally known as “bottom growth”—enlargement of the clitoris, which can also make it more sensitive. “Bottom growth happens as a relatively early change, especially for people on higher doses of testosterone,” explains Nambiar. “For people on these higher doses, it can even be a bit uncomfortable as it can happen so quickly.”

Long-term changes

While testosterone can cause a sudden spike in horniness that evens out over time, there are longer term changes too. Nambiar notes that as feelings of gender dysphoria, if present, may lessen, people can become more confident and sexually adventurous. This was certainly my experience—after being on testosterone for a few years and having top surgery, I felt more at ease being intimate with new partners, and more confident seeking them out through apps like Feeld.

However, experts suggest that people on testosterone long-term ought to be aware of vaginal atrophy—when the vaginal lining becomes drier and thinner due to a prolonged lack of estrogen. According to Nambiar and a guide by the Terrence Higgins Trust, this can make penetration painful and dry, and sometimes leads to bleeding. Luckily, it can be easily treated with topical estrogen cream, which doesn’t impact your testosterone levels.

Navigating a higher sex drive

Increased desire isn’t always a welcome change, especially for people who have a complicated relationship with sex. “Some people have told me the change in libido can be overwhelming,” Nambiar says. “It can feel like being a teenager all over again.” 

This was echoed when I spoke to Louis*, who identified as asexual before starting testosterone. He described how he “went from being pretty comfortable in asexuality, to not knowing how to handle having a sex drive,” and found it difficult to navigate.

What should you do if you’re struggling with changes in your sex drive? Sex and relationship therapist Rafaella Smith-Fiallo recommends being curious and going slow: “Rather than feeling like you need to keep up with your libido, think about how you can be curious about these new feelings without an urgency to act on them.”

“Focus on body literacy, where you can notice new sensations, arousal patterns and emotions without judgment,” she continues. “And be conscious of separating arousal from a sense of obligation to have sex.”

Exploring new sexual desires and preferences can be both fun and nerve-wracking, whether you have a partner or are flying solo. Waithera told me that, despite enjoying the increased libido testosterone gave them, “it did unfortunately have a negative effect on my sexual confidence as I found myself comparing my body to cisgender men in a way I never had before.”

Accepting both the positive and the more challenging elements of testosterone is key. They don’t cancel each other out, but rather create a layered, complex experience of sexuality that’s worth exploring. 

Smith-Fiallo says that “being in a space of curiosity, flexibility, and openness [can] take you a long way. This includes having continuous, open discussions with any partner about what feels good for both of you, without shame or judgment.” For a deeper dive, take a look at our guide to communicating your desires, and opening those conversations with partners.

Safer sex on testosterone

So, if you decide to explore with others, what are some ways you can prioritize safer sex on testosterone? 

Nambiar says that contraception is still an important consideration for anyone who hasn't had a hysterectomy, regardless of how long they’ve been using testosterone: “People on testosterone may still ovulate, even if they’re not having periods, so they can potentially still get pregnant,” she explains. “When someone is on testosterone for a long time, that risk goes down, but it’s never zero.”

Thankfully, as Nambiar adds, there are a range of contraceptives available that don’t impact testosterone levels, including but not limited to condoms, the copper IUD, the progestogen-only pill (also known as the mini pill), the progestogen injection, and a progestogen implant or IUS. The morning after pill, also known as “Plan B,” also works for people on testosterone. 

Similarly, limiting exposure to sexually transmitted infections (STIs) is just as important when you’re using testosterone. Barrier methods like condoms or dental dams are great, but if you have sex without barriers, taking PrEP to prevent the transmission of HIV “is safe and studies show that it doesn’t interfere with testosterone,” says Nambiar. 

Ultimately, what safer sex looks like for you depends on the kind of sex you have. If you can, it’s always best to talk to your clinician or healthcare provider about your options. For more information, take a look at our guides to STI testing and self-testing, plus prevention options for safer sex.

Reconnection through exploration

In my experience, testosterone helped me reconnect with my body after years of discomfort and dysphoria. I had newfound enjoyment when being intimate with my partner—for the first time, I wanted them to touch me and see me naked. We had joyful, frequent, messy, silly sex, and gradually my body began to feel like home.

After we broke up, my sex drive remained high and I began seeking casual connections on Feeld. Through the app, I was able to experiment with different people and kinds of sex to find what worked for me—this was something I’d struggled to do before testosterone enabled me to be more comfortable in my body. I had late-night hook ups, coffee dates, sexting sessions, and even found love while experimenting through Feeld. I felt powerfully, wonderfully desired.

After eight years on testosterone, my sex drive has mellowed from an insatiable hunger to a more manageable appetite. Whatever your relationship with sex is while taking testosterone, it’s important to remember that it’s normal to have highs and lows, conflicting feelings, and nerves about how things might change. As Smith-Fiallo says, “the goal isn’t to suppress how change makes you feel—it’s to approach those feelings with curiosity and compassion, and figure out the right path for you.”

If you’re curious about becoming more connected to your own desires, and meeting others who understand them, you can discover more on Feeld.