Sexual functioning in transsexuals following hormone therapy and genital surgery: a review

J Sex Med. 2009 Nov;6(11):2922-39; quiz 2940-1. doi: 10.1111/j.1743-6109.2009.01370.x.


Introduction: Sexual function following genital sexual reassignment surgery (SRS) is an important outcome for many transsexuals, affecting the choice of surgical technique, satisfaction with surgery, and quality of life. However, compared to other outcome measures, little clinical and research attention has been given to sexual functioning following SRS.

Aim: To discuss the potential impact of cross-sex hormone therapy and SRS on sexual function and to summarize the published empirical research on postsurgical sexual functioning in male-to-female (MtF) and female-to-male (FtM) transsexuals.

Methods: Cross-sex hormone therapy and SRS techniques are outlined, the potential roles of cross-sex hormone therapy and SRS on sexual function are discussed, and peer-reviewed literature published in English on postoperative sexual functioning in MtF and FtM transsexuals is reviewed.

Main outcome measures: Sexual desire, sexual arousal, and ability to achieve orgasm following SRS.

Results: Contrary to early views, transsexualism does not appear to be associated with a hyposexual condition. In MtF transsexuals, rates of hypoactive sexual desire disorder (HSDD) are similar to those found in the general female population. In FtM transsexuals, sexual desire appears unequivocally to increase following SRS. Studies with MtF transsexuals have revealed not only vasocongestion, but also the secretion of fluid during sexual arousal. Research on sexual arousal in FtM transsexuals is sorely lacking, but at least one study indicates increased arousal following SRS. The most substantial literature on sexual functioning in postoperative transsexuals pertains to orgasm, with most reports indicating moderate to high rates of orgasmic functioning in both MtF and FtM transsexuals.

Conclusions: Based on the available literature, transsexuals appear to have adequate sexual functioning and/or high rates of sexual satisfaction following SRS. Further research is required to understand fully the effects of varying types and dosages of cross-sex hormone therapies and particular SRS techniques on sexual functioning.

Publication types

  • Review

MeSH terms

  • Female
  • Gonadal Steroid Hormones / physiology
  • Gonadal Steroid Hormones / therapeutic use
  • Humans
  • Male
  • Masturbation / physiopathology
  • Orgasm / physiology
  • Sexual Behavior / physiology*
  • Sexuality / physiology
  • Transsexualism / physiopathology*
  • Transsexualism / surgery
  • Transsexualism / therapy


  • Gonadal Steroid Hormones