Okay okay, back to HRT discussions! As I am considering and figuring out when and how to get back on testosterone, I want to talk about the changes to our bodies. I’ve been in limbo trying to figure out whether I’m going to start T again now, or if I should postpone so I can potentially breastfeed in the near future (yes, Flo is considering starting a family!).

BTW, there’s really not enough research about T and breastfeeding, so I’m in active conversations with my medical team about it—but we can get to that later.

Anyway, let’s get back to the main topic at hand: What do gender-affirming hormones actually do to our bodies besides what we’ve already talked about?

There’s no way to sugarcoat this: Babe, your genitals are gonna change. Your hormones are gonna flip-flop. Your skin, sweat, and emotions will all be readjusting.

When it comes to our genitals on GAHT, we can go through periods of bottom growth, bottom shrinkage, or atrophy.

Bottom Growth (Testosterone)

When you take testosterone, your clitoris is one of the very first things to react.

Because clitoral tissue is loaded with androgen receptors, T causes it to expand in both length and girth—a process known as bottom growth (or a “T-dick”).

• The Timeline: Growth usually kicks off pretty quickly—often within the first few weeks to months—and can continue developing for 1 to 3 years.
• The Sensation: Early on, it can feel very sensitive. Everything from tight denim to a sudden breeze will get your attention, and you’ll definitely notice changes in how you experience arousal or erections.
• Is it permanent? Yes! Bottom growth is one of the permanent structural changes from T. Even if you pause or stop hormone therapy later on, the physical size you gained stays put, though the tissue might feel a bit less full or behave a little differently off T.

Bottom Shrinkage & Atrophy

“Shrinkage” and tissue changes happen in a couple of different ways depending on which hormones are dominating your system:

• For Feminizing GAHT (Estrogen & Anti-Androgens): Testosterone suppression leads to fewer spontaneous erections (like overnight erections). Over time, without that natural regular stretching, the penile tissue can decrease in size, and the testicles shrink as sperm production drops off.
• For Masculinizing GAHT (Testosterone): While your clitoris grows, testosterone can cause front-hole/vaginal atrophy (also known as Genitourinary Syndrome). Lower estrogen levels cause internal tissues to thin, produce less natural lubrication, and lose elasticity—which can feel like tightness, dryness, or discomfort during sex or friction.

The Good News: Atrophy on T is super common and completely manageable! Topical, localized estrogen creams or inserts can restore tissue moisture and elasticity without messing with your overall systemic T levels.

Also, “use it or lose it” is a very real thing here—scientifically, the more you use and stimulate the tissue, the less severe the atrophy risk tends to be.

How Atrophy & Shrinkage Affect Surgery

If you are considering feminizing surgeries down the line, bottom shrinkage and atrophy can directly impact your options—especially Penile Inversion Vaginoplasty (PIV):

• Skin Availability: PIV uses penile skin to line the new vaginal canal. If atrophy reduces that skin length, surgeons often have to supplement the canal using scrotal skin grafts or skin harvested from the abdomen or thigh to reach full depth (typically 12–16 cm).
• Extra Prep: If scrotal skin is used, it requires thorough hair removal (electrolysis or laser) before surgery to prevent intra-vaginal hair growth later.

How to manage shrinkage pre-surgery:

• Intentional Stretching/Erections: For those comfortable doing so, inducing manual erections 2–3 times a week helps stretch the tissue and preserve skin surface area.
• Topical Testosterone Cream: A low-dose, compounded T cream applied directly to genital skin can preserve skin thickness and elasticity without significantly raising overall blood T levels or reversing systemic feminization.

So, that covers the main genital changes and how they play out! Of course, always do your own research, but your care team will also walk you through all of this during your consults before you start GAHT or schedule any surgeries.