Disclosure: This article contains no affiliate links or product recommendations. It is provided for educational purposes only.
This article discusses erectile function in the context of gender-affirming hormone therapy (GAHT). It is written for informational purposes and is not a substitute for care from a qualified clinician — particularly a specialist experienced in transgender health, such as an endocrinologist or urologist affiliated with a gender-affirming care program.
Why This Topic Needs Its Own Page
Most articles about erectile function are built on research involving cisgender men. That research doesn’t transfer cleanly to people undergoing gender-affirming hormone therapy, because the hormonal mechanisms involved — particularly estrogen and antiandrogen use in transgender women, and testosterone therapy in transgender men — work differently than the age- or cardiovascular-related causes most erectile dysfunction research is built around.
This page exists because readers searching for information on erectile function during gender transition deserve research drawn from people actually undergoing GAHT, not general-population data relabeled to fit. Where that transgender-specific research is thin — and in some areas, it is — this article says so directly rather than filling the gap with extrapolation.
This is also not a review of any supplement, device, or treatment product. It is a starting point for understanding what current clinical research does and doesn’t show, and for organizing your own questions before a specialist appointment.
What the Research Shows So Far
A 2021 systematic review in Urologic Clinics of North America examined the available literature on sexual function in transgender people before, during, and after transition. The reviewers found that sexual dysfunction — including changes in desire, arousal, and erectile function — is common in both transgender men and transgender women, and that gender-affirming hormone therapy and surgery can help improve overall sexual satisfaction even when specific function changes occur. The authors were clear that the research base is still limited and called for more dedicated study of sexual health in transgender populations.
More specific data comes from a study led by researchers at the Cedars-Sinai Transgender Surgery and Health Program, published in the Journal of Sexual Medicine in 2024 and presented at the American Urological Association’s 2025 meeting. The study surveyed 50 transgender women on GAHT, with and without prior orchiectomy, who were awaiting vaginoplasty. It found that:
- GAHT reduces erectile function scores on standardized measures, particularly among those not using the penis for sexual activity
- Orchiectomy further reduces spontaneous erections, but does not significantly change erections during active sexual arousal
- Most participants reported some distress related to continued erections, and expressed interest in options to reduce or eliminate them
At the conference presentation, the study’s authors noted that these findings may not change clinical management for most patients, since preserving erectile function was not the goal for most people in that particular cohort. That’s worth sitting with: for many transgender women, reduced erectile function during GAHT isn’t a side effect to manage — it’s an expected and often welcome part of treatment. Whether that’s true for you is a conversation for your own care plan, not something this article can determine.
Separately, a 2023 pilot study presented at the European Congress of Endocrinology looked at whether adjusting a GAHT regimen could influence outcomes like this. Researchers compared sublingual estradiol alone against a combined oral estradiol and antiandrogen regimen in transgender women, after patients had been requesting the sublingual approach based on an unproven belief that avoiding strong antiandrogen suppression might preserve erectile function and testosterone levels. The study was designed to test that belief; the published material available describes the study’s design and rationale but not its final results, so this article can’t tell you what the study found — only that the question is being actively studied, and that going into it, the idea was unproven. Any regimen adjustment is a decision to make with a prescribing specialist, not something to self-direct based on patient reports.
Research specific to transgender men on testosterone therapy is sparser in this exact area. A 2021 study out of a university-based transgender clinic in Thailand followed 39 transgender men on testosterone therapy for roughly two years and found it effective and safe, with the expected masculinizing effects developing in all participants. The available summary of that study covers physical changes, lab results, and safety outcomes like cardiovascular events — it does not address erectile or genital sexual function specifically. That’s not this article drawing a conclusion about the study; it’s a description of what the published summary does and doesn’t cover.
What Isn’t Settled
Being direct about the limits of current research matters as much as reporting what it does show:
- Sample sizes in transgender-specific sexual function research are small — the Cedars-Sinai study, for example, surveyed 50 people
- Most available studies don’t track outcomes over many years, so long-term patterns aren’t well established
- Published research doesn’t consistently separate results by partner status, sexual orientation, or how someone personally defines sexual activity — all of which affect what “erectile function” means to an individual
- There’s no standardized clinical guidance yet for adjusting a GAHT regimen specifically to preserve erectile function, though it’s an area of active study
- Erectile or genital sexual function specifically in transgender men on testosterone therapy is not well represented in the research found for this article
If a source — including this one — states something about erectile function and GAHT as settled fact, that’s worth checking against your specialist’s own read of the current literature, since this field is moving quickly.
Preparing for a Specialist Conversation
Erectile function changes during GAHT can mean very different things depending on the person — a change you’re not concerned about, one you’d like to understand better, or one that’s affecting your wellbeing enough to want options. None of those reactions needs justifying to a clinician, and a specialist experienced in transgender health can only help you effectively if they have a clear, specific picture of what you’re experiencing.
The following is a private worksheet you can fill out for yourself — not something to submit anywhere — to bring structure to that conversation:
Appointment Preparation Sheet
Symptom pattern
- What specifically have you noticed changing (frequency, firmness, spontaneous vs. responsive erections, duration)?
- Is this something you want addressed, something you’re neutral about, or something you’re glad to see change?
Timeline
- When did you start GAHT, and when did you first notice this change?
- Has it been gradual or sudden? Stable, or still changing?
- Did you have orchiectomy or other gender-affirming surgery, and if so, when relative to the change?
Current medicines or substances
- Your current GAHT regimen (medication, dose, route, how long on current dose)
- Any antiandrogens specifically
- Other prescription medications, supplements, alcohol, tobacco, or recreational substance use that could independently affect sexual function or interact with hormone therapy
Relevant health context
- Cardiovascular, diabetes, or circulatory conditions in your history
- Mental health factors that may be relevant (stress, depression, anxiety, body image or dysphoria-related factors)
- Any prior pelvic, genital, or urologic surgery or injury
Questions for your clinician
- Is what I’m experiencing consistent with what’s expected on my current regimen?
- Are there regimen adjustments worth discussing, and what would the trade-offs be?
- If I want to reduce erectile function further, what are my options?
- If I want to preserve or support it, what does the current evidence actually support — and what’s still unproven?
- Are there vascular, medication-interaction, or other medical reasons to be cautious about any option we discuss?
Bring this list — or your own version of it — to your endocrinologist, urologist, or gender-affirming care specialist. A clinician who treats transgender patients regularly will be familiar with this territory and can weigh your specific hormone regimen, surgical history, and goals in a way that no article can.
A Note on What This Article Isn’t
This page doesn’t assume anything about your sexual orientation, your partners, or how you use or don’t use your anatomy. “Erectile function” means different things to different readers, and whether a change in it matters to you is entirely your call, not a medical default. The research cited here reflects transgender women on feminizing GAHT more heavily than transgender men on masculinizing therapy, simply because that’s where more of the current published data sits — not because the question matters less for transgender men. If you don’t see your situation reflected clearly above, that’s a gap in the research, not a sign you should extrapolate from someone else’s physiology.
For readers who found this page through our article on pelvic floor exercise and erectile circulation — that piece discusses general approaches to erectile and pelvic health and was not written with GAHT in mind. The physiology discussed there isn’t invalidated by hormone therapy, but how relevant it is to you depends on the specifics above, which is why this page exists as a separate, standalone resource rather than a rewrite of that one. You can also browse our full Men’s Sexual Health coverage for related topics.