Cover illustration & animation by Leo Mateus. Anatomical diagrams by Katja Tetzlaff. This article was updated by the FOLX Clinical Copywriter and Editorial Team on 9/6/23.
Bottom growth is a phrase that many transgender people use to describe the process of clitoral hypertrophy, or the clitoris growing in length and width while taking testosterone. Almost all folks will have some bottom growth as a side effect of T hormone replacement therapy. People experience genital changes differently, which can depend on their doses of testosterone and testosterone levels.
Here's the hard truth. We don't have much clinical info about bottom growth for transgender and nonbinary folks on T.
We know how important it is for people in our LGBTQ community to have viable information on hormone therapy. When it comes to "FTM" transitioning for transgender folks, our clinicians have received lots of feedback on how gender-affirming hormone therapy affects trans men and nonbinary people. Our clinicians have gathered key information on the effects of testosterone from anecdotal experience working with and providing care to trans folks.
"Bottom growth" typically means the clitoris and clitoral hood will get longer and/or wider.
Typical bottom growth on testosterone therapy is approximately 1 to 4 cm. One small study about bottom surgery reported the average length of bottom growth measured from 2.5 cm to 4 cm in the study participants who eventually underwent surgery. Another study found that at one year, average growth was 4.6 cm.
Bottom growth varies widely from person to person.
For some, bottom growth is one of the first changes noticed while on T for their gender transition. Among increased sex drive and muscle mass, clitoral lengthening is extremely common. Masculinizing changes can be noticed within the first year of T gender-affirming hormone replacement therapy. Clinical resources generally say changes start around three to six months, but this is only sometimes the case throughout the community. Typical guidance is that maximum growth is reached in the first year to three years, but this depends heavily on the individual and their T route and dosage.
Bottom growth sensitivity also varies from person to person.
Initially, the sensation of the growth can feel very sensitive. Some words we have heard describing the feelings from these physical changes are pressure, slightly painful, itchy, hot-feeling, and hard all the time. One study found that the discomfort some people experienced with bottom growth resolved after six months of treatment.
Hypersensitive growth can be uncomfortable when brushing against underwear. Some people try different underwear cuts (like boxers instead of briefs). Underwear made of softer fabrics can also decrease discomfort around your genitals. Or, try going underwear-free! Some folks also use lube or moisturizer to help.
In terms of sex drive, many describe changes in their orgasms and in the kind of touch that feels gratifying or pleasurable. Some people describe feeling a more erection-like sensation when aroused.
There are options for those looking for more bottom growth, but there is no sure-fire way to guarantee it will happen.
However, there are a few strategies that people have told us that work for them to enhance bottom growth. You can use a clitoral pump to increase the size of bottom growth. Pumps can be used before starting T or while on T. Some folks find using lube while pumping helpful.
Many use DHT cream (dihydrotestosterone cream). DHT cream is applied directly to the genital area. This treatment uses a testosterone-based substance to induce growth. DHT cream is NOT the same as testosterone gels prescribed for HRT (hormone replacement therapy). DHT creams are compounded (specifically mixed) by specialty pharmacies. Testosterone gels contain alcohol, which can cause irritation and pain when used on genital tissues. FOLX can send a prescription for T cream to a compounding pharmacy.
Some considerations exist for people who don't necessarily want bottom growth with T.
First and foremost, each person has a unique response to hormones. However, there are options for those who want to start T but aren't so keen on bottom growth. If someone is experiencing bottom growth that feels excessive or rapid, they can adjust to a lower T dosage to manage these side effects.
Some people on T will also take finasteride (or dutasteride) to keep bottom growth minimal. Finasteride blocks the conversion of testosterone into a more potent androgen called DHT -- it is commonly used to prevent hair loss on the head (balding). Still, people have also used it to minimize bottom growth. It's important to note that finasteride has other side effects - it may decrease body hair or facial hair growth and potentially restart menstruation, which may or may not be ideal for your other gender transition goals on testosterone.
Whether or not bottom growth reverses after stopping testosterone depends on the person.
The standard advice is that bottom growth is not reversible once it starts. However, anecdotally, we have heard from people who weren't on T for a long time, were on low doses, or didn't have a large amount of growth, that bottom growth reverted completely (or almost entirely) after stopping T.
For those ready to get started with FOLX for testosterone, sign up for a membership. For existing FOLX members with questions about what they're currently experiencing with T, don't hesitate to message or schedule time with a clinician. And for those who've just got some more questions, read up on testosterone in the Library.
FOLX Health is the first digital healthcare company designed by and for the LGBTQIA+ community. Our services include virtual primary care, gender-affirming hormone therapy including estrogen and testosterone (HRT), mental health care, sexual and reproductive health care, preventive care, and fertility consultations. FOLX memberships give you access to LGBTQIA+ expert clinicians, peer support, thousands of LGBTQIA+ resources, and more. Whether you’re lesbian, gay, bisexual, transgender, queer, gender non-conforming, or nonbinary, you can find LGBTQIA+-specialized health care that helps you meet your wellness goals. FOLX Health is health care that's queer all year. Get all the benefits of becoming a FOLX member and sign up today!