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Understanding Vaginal Atrophy in Gender-Affirming Care: A Guide for Transmasculine Individuals on Testosterone Treatment


Gender-affirming care plays a crucial role in the health and well-being of transgender individuals. For transmasculine individuals undergoing testosterone treatment as part of their transition journey, it’s essential to be informed about potential health considerations, including vaginal atrophy. Vaginal atrophy, although not frequently discussed, can impact the comfort and sexual health of transmasculine individuals. In this article, we’ll delve into why it occurs, strategies for prevention, treatment options, and other important points to consider.

Understanding Vaginal Atrophy:

Vaginal atrophy, also known as atrophic vaginitis, is a condition characterized by the thinning, drying, and inflammation of the vaginal walls. It occurs primarily due to decreased levels of estrogen, which can happen during menopause, but also in individuals undergoing testosterone therapy. Estrogen plays a crucial role in maintaining the health and elasticity of vaginal tissues. When testosterone is introduced into the body, it can lead to a decrease in estrogen levels, resulting in vaginal atrophy.

Why it Appears:

Testosterone treatment suppresses estrogen production, leading to changes in the vaginal environment. These changes include decreased vaginal lubrication, thinning of vaginal walls, and increased susceptibility to irritation and infection. Additionally, the lack of estrogen can contribute to discomfort during sexual activity and may lead to issues such as vaginal dryness and pain.

Prevention Strategies:

While vaginal atrophy may be an inevitable side effect of testosterone treatment, there are strategies to help mitigate its impact:

Moisturise the vaginal area: To prevent dryness and keep vaginal tissues hydrated, it’s recommended to use a water-based and unscented lubricant or a vaginal moisturiser. Follow the instructions provided by the product for proper application.

Regular sexual activity or stimulation: Engaging in sexual activity, including masturbation or using sex toys, can help maintain vaginal health by promoting blood flow, lubrication, and maintaining elasticity. If penetration is uncomfortable, using a lubricant can be helpful.

Regular pelvic floor exercises: Strengthening your muscles through pelvic floor exercises can help improve blood flow and maintain vaginal tone.

Consider local oestrogen therapy: If vaginal atrophy becomes an issue of discomfort, we can then prescribe topical oestrogen creams and emollients, such as Ovestin® (oestriol cream 0.1 % intravaginal cream).

Stay hydrated: Adequate hydration helps keep the body hydrated, including the vaginal tissues.

Other Considerations:

It’s important for transmasculine individuals undergoing testosterone treatment to have open and honest discussions with their healthcare providers about any concerns or symptoms they may experience related to vaginal atrophy. Additionally, maintaining overall vaginal health through regular check-ups, screenings, and preventative care is essential for overall well-being.


Vaginal atrophy is a common concern for transmasculine individuals undergoing testosterone treatment, but it’s not insurmountable. By understanding why it occurs, implementing prevention strategies, and seeking appropriate treatment when needed, individuals can effectively manage symptoms and maintain their sexual health and well-being. Open communication with healthcare providers and a proactive approach to self-care are key in navigating this aspect of gender-affirming care.

Updated on February 12, 2024

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