Severe pain at orgasm: effect of testosterone on the female body

Agonising pain during orgasm is a little-known effect of testosterone on the female body which seems to be a common experience for FtM transitioners. Are young women made aware before embarking on hormone treatment that atrophy of the uterus will necessitate a hysterectomy? The following post is a copy of a Twitter thread published at the end of last year from @ystriyahysteria, who documented the responses to a video by Aydian Dowling on this subject.

The author must post anonymously due to her profession. She is the mother of two grown-up daughters who is alarmed by the severe consequences of taking testosterone and the lack of knowledge in this area. We agree with her that Aydian Dowling has provided a courageous and important public service by being honest about this very personal experience.

What we see here is a devastating and potentially dangerous side effect of testosterone on the female body. We share it because young people have a right to be fully-informed before making decisions about medical treatment.

The testimonies here expose an arrogance within a medical profession which seems to think it can simply change a female body into a male body and that there will be no problems. Many of the responses reveal that doctors were not asking questions. Many people, especially young people, feel embarrassed revealing to a GP any problems to do with sex, but some doctors have clearly not thought it important to ask simple questions about pain which would have informed them of potentially serious problems.

Is this just another case of the male body being the default in medicine, and because male transitioners haven’t had this problem it’s assumed that females won’t either? Or is it because of doctors’ reluctance to refer to anything which may offend the patient through drawing attention to their femaleness? Either way, young female transitioners deserve the same level of care as any other patient. The lack of awareness among doctors is unacceptable for a medical treatment which is experimental on bodies so young. 

This is a very long post because we felt it was important to document the sheer number of responses to Aydian’s video. We thank Aydian and Buck Angel for sharing this information in order to help others and we thank @ystriahysteria for allowing us to share her Twitter thread here.

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A lengthy thread on a hitherto little known medical consequence of young women being prescribed testosterone, namely severe long-lasting pain during and after orgasm that can apparently only be alleviated by a hysterectomy.

Aydian Dowling is a female-to-male trans person with a male appearance but female body. In this youtube episode, Aydian takes up a topic that has hitherto been taboo or unknown amongst FTM women, and it appears to be a moment of discovery for many.

“8 out of 10 transmasculine people that I talk to do suffer from some form of this, and we don’t talk about it enough.” In other words, according to Dowling, 80% of FTM females experience testosterone-induced uterine pain. That is A LOT.

This is by the way an excellent and courageous public service video for which Aydian Dowling should be thanked. Dowling and a friend, Buck Angel, decided it was necessary to open up a discussion to inform other FTM people that this potentially dangerous effect exists.

So here’s Buck Angel, an extremely masculine-looking FTM with a female body. Angel works in the sex industry, and therefore has many contacts with whom sex is a topic of discussion. So Dowling and Angel together seem to be good sources of information.

Back to Aydian: “The No.1 reason I’m getting a hysterectomy is: At the very peak, when I orgasm, I experience an extreme cramping feeling. More than just when I used to get menstrual cramping. So I’m orgasming, and I’m at what’s supposed to be nature’s beautiful pleasure…”

“…and it literally feels like someone takes two knives and shoves them into here, and twists and turns them. And that goes on from between one minute to seven minutes.”

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“It’s very disruptive to the sexual experience; it makes me feel like I don’t want to engage sexually, because it’s extremely painful. And it just makes me feel uncomfortable, as well as my partner, because she’s trying to give me pleasure, and that always leads to pain.”

“In 2011, 2012, I was suffering from these pains, but at that time it was just random cramping. As the years have gone on, my pain has elevated and dipped, and elevated and dipped, and it’s gone like this for these 5, 6 years now.”

“In the last 2 years, I could know exactly when I would have cramps, and that was at the peak of my orgasm. At first it wasn’t that bad. It was just a little bit of pain, a little discomfort. But in the last two years, it’s gotten more and more drastically painful.”

“And in the beginning of this year, it’s been excruciatingly painful, and it hasn’t just lasted a couple of seconds to a minute or two, it’s extended. It’s extremely painful for about five minutes, and then it tapers down very slowly.”

“So at least 2 to 3 hours after orgasm, I could still be in pain. So this leads to me only wanting to be sexually active at night, because then I fall asleep and I don’t feel the pain.” (…) “I’m a little more hesitant to initiate, because I know I’ll end up in pain.”

“So we as a family have decided it’s about time I get a hysterectomy to solve this issue.”

“Buck Angel was having the exact same problems. So he went and got all types of tests, nobody said that anything was wrong with him, all of his tests would come back great, and then one time, he was in a different country, and I don’t want to say for sure but…”

“…I believe he had some type of eruption in his uterus and he had to be rushed to the hospital and get an emergency hysterectomy. When I heard that story from him, I feel like that was my message from the universe that I should get this.”

“When I expressed to him that I was experiencing the exact same pain, he got an overwhelmed feeling and he even got teary-eyed as he was talking to me that I NEED to get my hysterectomy, I need to take care of my body.”

“He started talking to me about how many other men he’s talked to about this issue. I had only opened up to 3, 4 trans friends and they all told me they had their own versions, some just random pain, some cramping hours or a day after an orgasm.”

“Since Buck & I have opened up about this, a lot more people have shared that they also suffer, from bleeding, from just not feeling well in their reproductive area.”

“A lot of transmen don’t want to talk about this, because talking about reproductive health means you’re not talking about a penis, you’re talking about ovaries, a uterus, fallopian tubes, a cervix, a vaginal cavity. You’re talking about female reproductive organs.”

“And so to talk about that and also be confident in your masculinity and your identity as a male person or as a male-identified person can be really hard.” (…) “I want to be proud about my masculinity and still be proud and OK with me being born into a female body.”

“That’s been a hard thing to do. (…) When I first started transitioning, I wanted to change a lot of things. And as I changed my secondary characteristics, that are male, my top surgery, I feel a lot more comfortable in my body and who I am.”

“Just like Buck, I’ve gone to gynecologists, I’ve gotten ultrasounds and Pap smears, pelvic exams, I’ve gotten every test, and everything always comes back normal.”

“But then I talk about this pain I have, which is at the very peak of my orgasm, then the doctor says, well, my muscle is atrophying, it’s cramping down. And because it’s not really fed right, it doesn’t really have what it needs to cramp and release, cramp and release.”

“So it just cramps and cramps and cramps harder, and then sloooooowwwwly releases. And I talked to some transmen about this, and they said they had a hysterectomy, and then everything was better.”

“Granted, there is a small percentage of people who get a hysterectomy and could STILL experience cramping, but a majority of people I’ve spoken to have had their issues solved with a hysterectomy. So that’s my story.”

“I’m getting a lot of questions why I’m leaving my ovaries in. I don’t really know any 75, 80-year-old transmen who’ve been taking hormones for 50, 60 years. I started hormones when I was 22. So when I’m 70, I’ll be taking hormones for almost 50 years. That’s a lot of years.”

“I don’t know what my body’s going to be when I’m 70. I don’t know what type of health I’m going to be in. I don’t know if I’ll be able to continue my hormone therapy throughout my older age.”

/end of Aydian’s video. Next, the responses.

“I feel like this is something guys should know about before they start T and it should be written on the consent form”

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“Dude, I know this pain. It’s agony.”

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“It took me about 2 years to get the courage to let my doc know what was going on because it is the one part of my body that constantly reminds me that I’ll never be seen as the man I am.”

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“I’m still only fifteen, but this video will be useful when I’m older.”

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“I’ve been wondering whether anyone had this problem”

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“I’ve been having a lot of pain lately and I’ve definitely been too embarrassed to talk about it. I was really scared of what it could be caused by.”

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“I would get pain for hours on end.”

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“This is something I experienced after a couple years on testosterone and later led to a hysterectomy.”

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“I suffer with severe pain after this also.”

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“My sharp pain will last sometimes a full 24 hours.”

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“When you described the pain upon orgasm, I knew exactly what you were talking about.”

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“I’ve actually been experiencing these kinds of pains randomly at the peak of my orgasms.”

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“I get these cramping pains too, but all tests show everything is normal.”

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“I was seriously considering HRT, but now I’m thinking no because I really don’t want a hysterectomy, too big a surgery for me. I might just do top surgery.”

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“I’m only 3 months on testosterone for this exact reason because I’m terrified of atrophy.”

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“Cramping for me happens more than just when I have an orgasm. It will happen if I sneeze. I know I need to get a hysterectomy.”

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“I suffer from PCOS, but I’ve noticed cramping has been happening more often than usual.”

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“I have had pretty bad pains, but I worry getting a hysterectomy in the long run might affect me more if I am not able to produce any hormones at all.”

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“I have experienced this pain quite a few times and thought I was the only one and never really knew who to talk about it, either.”

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“I haven’t experienced the pain you are speaking about but I do bleed every single time because the walls get thin from testosterone.”

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“Had the hysto/double oophorectomy. I couldn’t orgasm without pain, lasted up to two days after orgasm, now I’m pain free and very happy.”

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“I have had pain for over 6 years. I also get hot/cold flushes, migraines and pain through play.”

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“I’m one year on testosterone and I’ve been having spells of extreme cramps.”

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“I’ve been on hormones for 5 months. Since starting I’ve had some crazy pain. It was just after sex or during, but as time went on it was all the time, especially during any type of physical activity.”

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“I’ve been experiencing the same thing for quite some time now, pre-hormones and more severe once I started.”

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“I have the same problem but mine lasts like all night after it I can’t even lay down because it hurts so bad. But I’ve noticed it only happens after multiple orgasms so I just keep to one and I seem to be ok.”

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“I get the same pain after orgasms and if I take my shot a day late. Maybe it is that time to get a hysterectomy.”

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“The cramping is pain asf. Sometimes it last 1 hour or more n i be taking pain killers back n forth and sometimes they help n sometimes they dont.”

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“I had my hysto partially for this reason. I didn’t realize how much the cramps were affecting the quality of my daily life.”

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“In the last 6 months the cramping has gotten worse for me. After top surgery next month, I’ll be looking into going for a hysterectomy.”

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“This year my pain has been worse and it made me wonder if I should get a hysterectomy and I think this reassured me I should.”

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“I have been googling my butt off but I got no info on this. It’s really been a drag on my sex life, which doesn’t help my relationship.”

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“I am waiting for my hysterectomy for this reason. I’ve decided to keep my ovaries because I am afraid of surgical menopause.”

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“As a mental health counselor to a lot of trans folks, it is really important for me to know so I can discuss it with my clients, and isn’t mentioned in any of the literature on transitioning that I have found so far.”

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“I didn’t even cramp back when I had menstruation really and these were like hella painful, not like how it felt back then.”

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“All my trans friends have this pain. I’m pre-testosterone. I think I’ll just go for the hysterectomy in the future.”

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“Yeah I definitely feel this, sometimes even without sex. I’m in line to do the top surgery and may just get that done also.”

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“I’ve been going through this for about the last year, year and a half. Sometimes I cannot handle the pain. I’m getting my hysterectomy next week.”

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“I experienced the same for 3 years. I was always too afraid to talk to someone.”

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“I also have been experiencing the exact same thing and I couldn’t understand what it was.”

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“Now I know what’s going on cuz the doctor had no idea. I will ask about a hysto.”

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“Been there, same issue – avoided sex until I could get a hysterectomy.”

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“I’ve been experiencing this too and am seriously considering a hysterectomy next year because of it.”

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“I’ve been having that pain for close to three years since being on testosterone and had no idea what was causing it, let alone wanting to speak to a doctor about it.”

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“I never talked about it because I figured it was just me.”

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“I experience the same exact thing you do. This is like a sign for me to also get my hysterectomy done.”

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“I suffer badly also.”

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“Hearing that they can explode, that scares me and makes me wanna get mine out as soon as I can which is… after I get my top surgery though.”

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“Half the time, I can’t reach peak. The other half, when I do, recently I seem to be starting to suffer from this problem.”

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“OMG it’s not just me! I thought I was the only person having this really bad pain.”

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“It’s nice knowing I’m not alone.”

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“OMG I didn’t know this was a normal thing! I thought it was just me!”

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“It’s good to know I’m not the only one.”

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“But if you’re not sure whether you will be able to continue hormone therapy for your entire life, isn’t it dangerous to get a hysterectomy? How will your body get the hormones it needs if you can’t inject testosterone and you have no ovaries?”

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And that brings us to the end of this thread, by far the longest I’ve ever done. I thought it was worth documenting in full because this horrendous pain caused by the uterus atrophying due to testosterone seems almost totally unknown.

This Post Has 9 Comments

  1. Sly Fawkes

    Experiences like these gentlemen are describing are part of the reason why people who insist that biology is bigotry make me want to smack my head against the wall. An XX person who is taking hormones to have XY secondary sex characteristics requires different medical treatment than an XY male or an XX female. That is not bigotry, it is fact.

    1. Emmitt

      the real problem is that even though medically transitioning trans people have been around since at least the 1950s, doctors still don’t do enough research on the topic. And yes, it’s true that trans men and trans women need to have proper care for the parts that they do have if they haven’t had certain surgeries.

  2. Chance

    Horrifying.

  3. Alex

    I’ve been on T for coming 8 years this August and it’s been a few days since I started experiencing this. I mean I was only told by my doctor who did the too surgery for me that it is advisable to get hysterectomy about 4 years into T but did not say it was mandatory and I had no problems until now. The cramps are not super painful like some guys here but I need to go for check up. Thanks so much for sharing this. Now I know what I need to prepare myself for. It’s too bad but we don’t even know what will happen to our body with all the changes we are introducing to it. We’ll see. Not like there was another choice. It was either living a possibly shorter but Truthful life or a longer life not being myself.

  4. Wily

    Holy cow. The ignorance of the dire consequences of taking testosterone when biologically female is ridiculous! And the solution to this orgasm pain is more pain – all while trying to appear to be so macho and impress other trans guys… will the madness never cease?? Erasure of your womanhood is insane – it only leads to unhappiness and denial of the authenticity of your true self.
    What isn’t known is how the future will be with a testosterone riddled biologically female body. Oh, well, aside from balding, and who knows, maybe erectile dysfunction?

    1. Emmitt

      The ignorance is because doctors still have not done enough research on trans people bc we essentially don’t have equal rights, so we are less cares for. also, there are far more chromosome combinations than xx and xy. I am a very happy and healthy trans person. I am loving my truest self. And I would do it all over again if I had to. And I can speak for many many other trans folks when I say that. Please leave your judgements and assumptions at home and maybe open your mind a little more.

  5. Emmitt

    Ftm folks are not “transitioning females”. Please do better research on the language before you write your articles on this topic. We were assigned female at birth, yes, and we have particular parts associated with women, but we are not women and we are not females. Hence trans MAN— NOT “ftm women” (which is contradictory). I appreciate that this topic is being discussed as it very important but I find that your language is all over the place and quite frankly wrong. Maybe read closer as to how Aydian uses his language. And btw, buck angel being “super masculine looking” has nothing to do with this issue/topic. Again, thank you for bringing this discussion into the public, but please be better at correct use of language.

    1. Teresa Unger

      People are not “assigned” a sex at birth, they are born a sex at birth. There is no “assigning” done. Humans are born male or female, like other mammals.

  6. Polly MacDavid

    You were not “assigned” female at birth. Nobody is “assigned” female or male. We are biologically female or male. Talk about not knowing how to use language properly. Not only do you need to learn proper English, you also need a course in Biology.

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