We don’t have a ton of clinical data on testosterone HRT & bottom growth, but community knowledge offers a lot.
Bottom growth is a phrase that many 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 on T, but it’s widely varied from person-to-person.
We know how important it is for people in our community to have viable information, so we will share what we know based on feedback our clinicians have received in their years of learning through anecdotal experience gathered from working with and providing care to our community.
Typical growth 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.
For some, it’s one of the first changes noticed. Clinical resources generally say changes start around 3-6 months for people, but this is not always the case throughout the community. Typical guidance is that maximum growth is reached in 1-3 years, but this depends heavily on the individual and their route and dosage of testosterone.
Initially, the sensation of the growth can feel very sensitive. Some words we have heard describing the feelings are: pressure, slightly painful, itchy, hot-feeling, hard all the time. One study found that the discomfort that some people experienced with bottom growth resolved around six months of treatment.
Hypersensitive growth can be uncomfortable when brushing against underwear. Some people will try different cuts of underwear (i.e. boxers instead of briefs) or underwear made of softer types of fabrics to decrease discomfort (or none at all!). Others use lube or moisturizer to help.
In terms of sexual function, many describe changes in their orgasms and in the kind of touch that feels gratifying. Some people describe feeling a more erection-like sensation when aroused.
However, there are a few strategies that people have told us that work for them. You can use a clitoral pump to increase the size of bottom growth. Pumps can be used before starting T or while on T; and some find using lube while pumping to be helpful.
Some people also use DHT cream directly applied to bottom growth. This treatment uses a testosterone-based substance to induce growth. DHT cream is NOT the same as testosterone gels that are prescribed for HRT. DHT creams are compounded (specifically mixed) by specialty pharmacies. Testosterone gels contain alcohol, which can cause irritation and pain and when used on genital tissues. FOLX’s pharmacy does not mix medications, but we are actively looking for ways to offer DHT cream.
First and foremost, each person has their own unique response to hormones. However, there are options for those who want to start T, but aren’t so interested in bottom growth. If someone is experiencing bottom growth that feels excessive or rapid, they can potentially adjust to a lower T dosage.
Some people on T will also take finasteride (or dutasteride) to keep bottom growth minimal. Finasteride blocks the conversion of testosterone into a stronger androgen called DHT -- it is commonly used to prevent balding of the hair on the head, but people have also used it to minimize bottom growth. It’s important to note that finasteride comes with other effects - it may decrease the hair that grows on the body and face and potentially restart menstruation, which may or may not be ideal for your other goals on testosterone.
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 (how long varies by individual), were on low doses, or didn’t have a large amount of growth, that growth reverted completely or almost completely after stopping T.
For those ready to get started with FOLX for testosterone, the process begins here. 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 here, and feel free to reach out to us at email@example.com.