Due to the suppression of testosterone, there will be significant changes occurring to your testes. Your testes are the main source of testosterone production, and while taking androgen suppression hormones, the need for their activity declines, resulting in testicular atrophy. Testicular atrophy results in about a 25% size reduction of the testicles over the first year, and may continue to atrophy beyond that.
Testicular Atrophy is the wasting away of testicular tissues.
These changes typically begin over the first 3-6 months of therapy and plateau over 3+ years.
Testicular Changes due to Androgen Suppression Therapy
Ghosted Testicular Anatomy with surrounding Blood Vessels
Typical anatomy of the testes. The cord that suspends the testes was opened to see the internal structures. Within the cord, you can see the blood vessels that supply the testes, the vas deferens, and the epididymis.
After 2-3 years of therapy, the testes may shrink 25% of its normal size and can continue to shrink beyond that. Notice how the blood vessels have thinned out as a result of the atrophy. This is because the testes no longer need as much blood supply.
The severity of testicular atrophy is dependent on genetics and differs on an individualized basis.
Not only does androgen suppression affect the size of the testes, but also in your rate of spermatogenesis. Spermatogenesis tends to cease over time while undergoing therapy, so if you would like to have biological children of your own, freezing your sperm prior to starting therapy is something to consider.
The reason you stop producing sperm is because androgen suppression therapy affects the way your testes produce testosterone. Leydig cells will produce less testosterone with androgen suppression therapy. When testosterone is no longer produced from your leydig cells, your germ cells stop making sperm, and in fact, these germ cells may die off. Without the cells that make sperm, your sperm count will decline.
However, some individuals have maintained a sperm count throughout therapy, so it’s important to take this information on an individualized basis.
Leydig Cells are the cells in your testes responsible for producing testosterone. Leydig cells are affected by androgen suppression therapy.
The vas deferens is the duct that supplies sperm from the testes to the penis.
The edidymis is the convoluted duct that wraps around the testes. It conveys sperm from the testes to the vas deferens.
Spermatogenesis is the scientific term for sperm production.
If you are sexually active with someone with a uterus, it is still recommended to include a method of birth control.
Anatomy of the Vas Deferens with Sperm
Although there is evidence that this will reverse if therapy is stopped, you should approach androgen suppression therapy in the mindset that these changes may cause you to become permanently sterile. Freezing your sperm may cost around $1000 initially and several hundred a year for storage. If you would like to have children of your own, be strongly considered prior to initiating hormone therapy.
LIBIDO & SEXUALITY
Your libido, or your “sex drive”, will also have noticeable changes throughout therapy. Androgens play a significant role in sex drive, and thus, your sex drive will become less active throughout androgen suppression therapy. You may have changes in your erections as well, typically having less erections that last for shorter amounts of time. Your erections may also feel less firm and you may have drier accounts of ejaculation. Although these seem like negative changes, keep in mind that your overall satisfaction may improve because you may experience less dysphoria during sex.
The experience of sexual arousal and orgasms may change as well. You may notice a difference in the areas of your body that cause arousal, and orgasms may feel less directed towards your genitals and involve more of a “whole body” experience. Since this is different for everyone, it is encouraged to explore these changes on your own or with your partner to see how hormone therapy 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) illustrating this concept, which can be found here.
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 testing for sexually transmitted infections, especially with a new person.