Clitoromegaly is a typical change that occurs while under testosterone therapy. This begins in the first six months and maximizes over a two year period. During development, while hormones are acting on a fetus, the presence of testosterone affects the underlying erectile tissues, creating the formation of a penis as opposed to a clitoris. While undergoing hormone therapy, testosterone plays a similar role in changes to erectile tissues. Although you will not grow a penis from therapy, your erectile tissues will enlarge, creating noticeable changes to your clitoris and surrounding labia.


Erectile tissues are the tissues that lie beneath the surface of your genitalia that become engorged during sexual arousal.

When discussing development in this case, we are referring to growth during fetal life.

Clitoromegaly is the medical term for clitoral enlargement.

Clitoromegaly is an irreversible change that may or may not occur with hormone therapy. 

Anatomy & Orientation

Surface Clitoral Anatomy & Underlying Erectile Tissues 

Labia Majora
Labia Minora
Vaginal Orifice
Vestibular Bulb
Greater Vestibular Glands

Surface Anatomy

Erectile Tissues

The illustrations above depict surface anatomy of the clitoris and the surrounding structures (right). To the left, you can find the erectile tissues that lie underneath. These tissues are responsible for clitoral engorgement and pleasure during sex.

The clitoris will develop a phallic shape and will grow to an average of 1.5 inches over the two year period. The surrounding labia majora, minora and mons pubis will enlarge as well due to effects on the underlying tissues. When aroused, the clitoris will also protrude more noticeably than before.

Click through the gallery below to witness clitoral changes on the surface and tissue layers.

Other Vaginal Changes & Reproductive Risks

The use of testosterone commonly affects other changes to vaginal tissues that may increase dryness and pain during vaginal sex. These symptoms are often due to changes in the dynamics of vaginal tissue, as they may lose their elasticity and become more friable. Because of these changes, these tissues are susceptible to an increased risk of bacterial vaginosis and become more sensitive to irritation with sex and frictional contact. Vaginal lubricants and moisturizers are one approach to counteracting these effects. However, if symptoms persist, it’s important to discuss them with your physician.

Changes to your ovaries and uterus may also occur that may make it more difficult to produce eggs and achieve pregnancy. Testosterone therapy increases the risks for uterine fibroids, ovarian cysts, and uterine or ovarian cancer. 

It is important to note that many of these risks are uncertain and there are reports of patients achieving pregnancy despite their course of hormone therapy. 


Sex Drive

You’ll find that your libido, or “sex drive”, will become more active during therapy. Across all body types, androgens (such as testosterone) play an important role in libido. Since biological women primarily receive less doses of androgens from their adrenal glands and ovaries, their sex drive is less active. As your testosterone intake will rise to match the normal levels of people who have testes, you will notice a dramatic increase in drive.



Not only will your libido increase, but you may also have changes with orgasms and areas that you find arousable. While under the influence of estrogen, orgasms produce a “full body” experience. This may or may not change in the presence of testosterone.

Orgasms may reach a higher peak intensity along with a more sensitive clitoris and pleasure from penetration. Testosterone may also refocus your heightened desire for sex towards the genitals and less arousal from other parts of your body. Since this is different for everyone, it is encouraged to explore these changes on your own or with your partner to see how testosterone has impacted your sexual experience.

Changes in sexual identity may also occur while undergoing affirmation therapy. This is not uncommon, and could be a result of hormones. It is important to note that this, like all other changes, are entirely based on an individual basis, and may or may not be a part of your transitioning experience.



The National LGBT Health Education Center released a powerpoint (intended for physicians) discussing this concept, which can be found here.


Libido is another term for your sex drive.

Androgens are hormones that are responsible for male sex characteristics. Testosterone is an androgen.

Orgasms are the peak of sexual climax and arousal, resulting in rhythmic involuntary muscle contractions in the pelvic region.



Always remember to approach sex safely, using multiple forms of protection to best suit yourself and your partner(s).


Along with using protection, be sure to undergo regular sexually transmitted infection testing as well, especially with new partners.

© 2019 Sam Nigro, Augusta University

Hormone therapy is not required for any transition or queer experience. Changes from hormone therapy that are outlined in this website are not guaranteed. All changes from hormone therapy are dependent on genetic makeup and can be different for everyone. 

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