Throughout the course of human history the only truly free source of pleasure & happiness has been sex.  You didn’t have to plant it, water it, grow, or even catch it.  

Sexuality & the trans-woman; taboos & triumphs

Sexuality has been universally a taboo subject for thousands of years.  Religions of all kinds promote prudishness while idealizing celibacy as if abstinence were a great virtue & sexuality was intrinsically evil, to be sanctioned only within the bounds of matrimony where its primary purpose should be to procreate.  How odd is this, this demonization of an urge as natural as eating food or drinking water, this insistence on making it dirty. 

Free sex

The vast majority of people throughout the world are fascinated about sex, although their interest is often prurient.  When it comes to sexual activity taking place between consenting adults in the privacy of their own homes however, this prurient interest has no place, whether publically or officially.  Despite the free availability of sex, the powers that be, both temporal & religious have consistently interfered with human sexuality, licensing it, regulating it, moralizing about it, allowing tort lawyers to exploit it at great cost to both of the participants & in the case of people like Alan Turing, ruining their lives over it, perhaps even killing them.  And all of this over a set of behaviors which, whether gay or straight, cross-dressed or otherwise, is nobody else’s business. 

The history of the erection

Credible scientific research in the area of sexuality has been limited and less than objective because of our social hang-ups and squeamish avoidance about the subject.  If the general area of sex is so publicly taboo just imagine how much more phobic people must feel about transgendered sexuality. Our ignorance on this particular topic is immense but central to the entire area is the nature of the penile erection.

Castration

Prior to the advent of modern medical/surgical gender transitioning, castration was the only avenue toward feminization.  Castration can be performed either before or after puberty.  The pre-pubertal castrato, a popular feature in church choirs up until as recently as the 18th century, was asexual.   The male who is castrated after puberty is quite a different matter and is called a scopt. Scopts can adequately perform sexually although s0me provocative stimulation is usually needed to bring them to a state of tumescent arousal, in contrast to the intact male who is a self-starter.  The scopt is usually more detached, rational & in voluntary control of his sexuality than is the intact male who may be whipped into action by the tides of his own testosterone, even when this is inconvenient.   

Scopts have played prominent roles in history, being involved in three major attempts to overthrow imperial dynasties.  The Eastern Roman Empire of the Byzantines, the Ottoman Empire & the Tang dynasty of imperial China all experienced attempted power grabs by imperial eunuchs.  The reason for this lay with their capacity to function sexually without fear of pregnancy.  Their sterility meant that scopts might freely enter and leave the imperial harems. But this gave them access to some very powerful women whose children were competing for the imperial succession, women whose power was potential rather than real, for want of representation in the outer world.  And this is where the scopts came in.  

Thanks to their sterility, scopts were being allowed easy access to the harems from which intact males were strictly prohibited. In consequence they could access the imperial mothers, many of whom had been discarded in favor of younger women, despite the fact that these older women were the likely mothers of future kings and emperors, rather than the new wives.  What gave the scopts their edge however was that while they might not be fertile, they could still function sexually, which allowed them to satisfy these women & become their agents. 

How can this be?

It happens that sexual function requires far less testosterone than is needed for the overall masculinization of the male body.  And even after the removal of the testes, the scopt’s body possesses a pair of adrenal glands capable of generating the far lower amounts of androgens that are required for sexual function.  To sum up, the scopt’s adrenal glands produce androgens at a level more than sufficient to maintain sexual function and to keep depression at bay. He possesses enough androgen to support provoked-sexuality but not so much androgen as to make him spontaneously sexual, a testosterone-driven fool subject to the whims of his own sexual follies. That makes the scopt a potentially dangerous man.

Trans Sexuality

So how does all this translate to the transgender situation?  That depends on who we are talking to.  Sexual function in humans is a complicated process compared to the perfunctory sexuality of the lower animals because of the human mind’s unique capacity for over-riding or modifying the body’s natural drives.   However before we get into the variations of sexuality practiced by trans-women, I want to clarify my terms.  I personally find that socially-based wordage such as homosexuality & heterosexuality just gets in the way here.  I prefer to think of the dichotomy of giver & receiver, or as many trans-women like to put it, of tops & bottoms. 

Variations on a theme

Trans-sexuality is complex because it may involve each sexual partner penetrating or being penetrated, or both or neither.   Thus many trans-women wish they never had a penis or that it would simply go away.  And moving a step more distant from sexuality, some of them even desire to be totally asexual and feel that the penis and the sexual urges they sometimes experience are a distraction that just gets in the way.  But wait a minute; surely not all of these sex-rejecting women want to live like robots existing in a social vacuum, totally devoid of feelings such as friendship, caring or compassion.  Surely even for the trans-woman who wishes to dispense with sexual activity altogether, she might still wish to have friends and to connect with people in a warm, non-sexual way.  After all her sexual hormones are the drivers that act upon the brain to endow her with the vibes, personality, communication skills  & the energy to for example flirt with other people or even just to feel warm-heartedly comfortable with them, activities that run far short of overt sexual action. 

Subtle sexuality

In my opinion we are far too dualistically extreme about sexuality, too black or white about its nature.  Sexuality is not limited to the extremity of full-blown, at times domineering, even abusive tumescence & copulation.  It also plays a role in more subtle social interplays.   There is an element of the sexual gestalt built into even some of the most innocent social interactions, but this is a clean, innocuous kind of sexual element, rather than the tawdry, embarrassing kind of concept dreamt up by our dirty minds in response to the thou-shalt-nots of controlling, guilt-ridden religiosity.   
Shifting to a grayer approach we can begin to appreciate the more submerged influences of sex as they contribute to many of the little elements in our daily life, & the way we interact with others.  From this more holistic sexual viewpoint it all begins with brain & mind, critical targets for the sexual hormones, whose influences there are a prominent part of what ultimately defines not only feminine sexuality & sexual function, but offers a real window into the mysterious feminine state of mind.  We are talking here about feminine insight & even feminine identity in and of itself.  And let me remind both of us that for the trans-woman, that is what it is really all about, identity, feminine identity!

Retaining or restoring functionality

Many trans-women desire continued phallic function & fear that feminizing hormone therapy might reduce or eliminate it along with their customary sexual feelings & sexual desires.  This group of people may normally function either as versatiles or as tops only, and their partners may be members of either gender.   While erectile function is terribly important for those in this group, it would be pointless to retain it unless it was accompanied by a matching level of sexual drive or libido.  In addition the genital skin needs to be sexually sensitive along with other erogenous zones.  For example nipple sensitivity is greatly increased by virtue of feminizing hormone therapy, creating a novel, highly gratifying source of sexual satisfaction in trans-women. 

Teflon sexuality

Many young trans-patients, whether tops or bottoms, pre-operative or post-op, frequently tolerate highly effective doses of feminizing hormones, both estrogens & progestins without any loss of sexual desire or function.  Indeed we at our center have seen many uber-feminized, strikingly attractive trans-women who could still achieve full erectile function.   Even when retained however, the quality and nature of sexuality in the trans-woman does tend to have a slightly different quality. Many trans-women describe a climactic experience that is more complex than it was before hormones. They describe their climax as being better, more drawn out, sustained, widespread and transcendental.

When sexuality has been compromised

For others, erectile function may be blunted or even lost.  At this point hormonal intervention is urgently required and when applied at the hands of an enlightened, non-judgmental, experienced medical practitioner, it can be highly effective.  As the need arises, hormonal therapies and medical treatments can restore sexual function without too much difficulty.   We believe that restoration and maintenance of sexual function should be available to all trans-women who desire it, regardless of the prevailing social attitudes of the community at large. This brings up the most important feature of trans-care, which is attitude.  

The attitude at our hormone center is neither anti-transgender nor is it anti-sexual.  Our first step toward sexual restoration is the elimination of anti-androgenic drugs.  Our patients generally tend to use far lower doses of anti-androgens than other practitioners because our feminizing hormone methods are so highly effective.  Spironolactone is an anti-androgenic progestin which antagonizes all androgens indiscriminately, no matter what their source may be, whether testicular, adrenal or therapeutic, and it may thus fuel erectile dysfunction, fatigue, low blood pressure and even depression.  Needless to say, depression itself has a lethal impact on all aspects of sexuality and needs to be addressed in those suffering from inherited, hormonally-induced or psychogenic mood disorders.

Not a top?

It is usually the ‘top’ who comes seeking sexual restoration but let us not forget those trans-women who are not tops. The knee-jerk reaction is to ignore their needs since surely they do not require tumescence.   This attitude is simplistic & invalid. There is more to sexuality than tumescence. Other critical factors include sexual drive or libido and climax or orgasm.  First of all even in the receiving patient, tumescence may still be desirable because it makes the partner feel appreciated and wanted or it may become stimulated by the partner in other, non-penetrative ways.  Furthermore, even in those bottom patients who are disinterested in erectile function, they still usually desire to retain a sexual drive in the same manner as does a genetic female.

Orgasm

Over and beyond libido & tumescence there is that wonderful culmination of the sexual act, the orgasmic climax.  Even in the individual who lacks a partner, self-stimulation to orgasm is often a desired, remarkably safe & satisfactory source of sexual pleasure, and the firmer the organ, the better the orgasmic quality.  What could be more harmless & victimless than solo-sexuality?  

Some of my trans-women tell me that orgasm as they especially experience it is absolutely amazing.  In the bottom patient this is particularly the case.  Her prostate gland, when stimulated during penetration, greatly increases orgasmic intensity.  What people forget however is that the testosterone-deprived prostate gland loses its sexual sensitivity, a loss that can be restored through hormone therapy.  In contrast to these bottom patients who need to be amped up there is a particular group of trans-women who appear to be phenomenally hypersexual.  They may climax as many times as 8 or 10 times a day, as if they had an unscratchable itch.  They often describe a history of fetishism, sexual addiction & OCD-like features.  For them a reduction in sexual drive is often desired.  

The post-GRS & post orchiectomy patients

This brings us finally to the post-operative trans-woman, the forgotten child of trans-care.  She is hormonally no different from the post-orchiectomy patient.  When these two groups of trans-women are administered feminizing hormones they tend to develop testosterone levels that lie well below even the normal female range.  A quiet, atypical depression often surfaces in them & sexual drive, vaginal lubrication & orgasm vanish rapidly, all of this needlessly I might add.  These features of the post-operative trans-woman who avoids hormone therapy are also accompanied by premature heart disease, dementia & physical premature aging.  In these women, hormonal therapy is essential, yet sadly the majority of post-operative patients obtain no hormone therapy whatsoever!

The good news

The excellent news for each group of women belonging under the broad cloak of transsexuality is that sexual desire & sexual function can be modulated & tailored to the level that each individual desires, through the use of precision hormone therapy.  All in all & despite at times negative mainstream attitudes against it, transsexuality is a biologically-driven human variant worthy of our attention & respect.  A wide variety of treatments are available that can effectively correct not only erectile dysfunction but also optimize the entire panorama of sexual functions & idiosyncrasies including the sexual drive, prostatic pleasure & genital sensitivity that transsexuals seek without sacrificing the underpinnings of femininity that they have worked so hard & long to achieve.  To attain this kind of balance all one has to do is visit a physician who is truly an expert in the field.