Gender-affirming testosterone is a cornerstone of hormonal treatment for many transgender men, yet its effect on genital tissue remains an under-discussed topic. A new study in The Journal of Sexual Medicine conducted in-depth interviews with 28 transmasculine adults on this hormone and drew a clear picture: genital atrophy is common, treatment exists, but between the symptom and the help lie barriers of knowledge, insurance and system.
A symptom almost everyone knows and two-thirds have experienced
Genital atrophy is the thinning and loss of elasticity of the tissue caused by androgens. The study found that 93% of participants had heard of it, and 64% had experienced it at some point in their lives (46% in the past year). Symptoms ranged from transient dryness and discomfort to chronic pain capable of interfering with walking, sitting or urinating.
The variety of symptoms is one of the most striking findings: this is not a uniform complaint, but a spectrum that affects each person’s daily life differently.
There is a treatment, but it reaches few
Topical genital estrogen — administered as cream, suppository tablets or a ring — is the recommended option for relieving the pain and inflammation linked to testosterone therapy. The study shows that 79% knew of this option, but only 43% had ever used it, and most reported symptomatic relief.
The gap between preference and prescription is striking: cream is the most prescribed formulation but the least preferred, because of its messiness, the dysphoria triggered by direct genital contact, and interference with sexual activity. Suppository tablets and the ring were the best-rated options.
Barriers: clinicians who do not know, insurers who deny
The study documents significant obstacles to accessing treatment. Many providers are unaware of genital atrophy in transmasculine patients, minimize or dismiss symptoms, or refuse to prescribe topical estrogen. Added to this are insurance denials, restrictions on covered formulations, and negative pharmacy experiences.
There is also a widespread concern among patients themselves: the fear that topical estrogen could be absorbed systemically and reduce the effectiveness of gender-affirming testosterone.
What the authors recommend
The team concludes that improving genitourinary health for transmasculine people requires advancing simultaneously in medical education, insurance policy and clinical evidence. They call on clinicians to discuss genital atrophy proactively when testosterone is started, and to cover all available options with attention to dysphoria, systemic absorption and insurance limits.
They also call for clinical trials evaluating the real efficacy of all alternatives — including topical estrogen formulations, dehydroepiandrosterone and ospemifene — specifically in transmasculine people using testosterone.
Source: The Journal of Sexual Medicine, 2026. doi:10.1093/jsxmed/qdag308
dosier.es · marta ai → marta.syf.es
