The administration of testosterone causes the FTM body to try it’s very best to grow a penis. More specifically, a trans man’s clitoris* typically grows to about the length of a thumb (though size varies with each person.) Genital growth is highly desired by trans men seeking a metoidioplasty. Are there ways to optimize that growth?
While there aren’t any clinical studies proving these techniques are effective in trans men, two of the three surgeon’s I have been consulting with have recommend DHT cream and pumping to maximize growth and improve final surgery outcomes. Dr. Bowers doesn’t discourage these methods, but she doesn’t specifically recommend them. Dr. McGinn concedes that there aren’t studies to prove results, but does recommend DHT cream and pumping. Dr. Miro (aka Dr. Djordjevic) not only recommends DHT cream and pumping, he also thinks these techniques work.
DHT Cream for FTM genital growth
A 10% concentration of dihydrotestosterone cream is what’s recommended. This is not the same thing as testosterone cream or testogel/androgel. These can be applied topically for genital growth but have a lesser effect.
Dihydrotestosterone or DHT is a metabolite of testosterone and is 3-30 times more potent than testosterone. The body converts some testosterone into DHT with contact to the 5a reductase enzyme. It plays a very important role in facial and body hair growth, voice changes, sex drive, and growth of muscle and genital tissue. Unlike other androgens such as testosterone, DHT cannot be converted to estradiol. It is not anabolic, so it doesn’t build up in tissue, muscles and bones.
DHT can be topically applied to the clitoris in a transdermal cream formulation. It should be noted that estrogen is responsible for the growth of labial tissue, so DHT should not be applied to the labia if a scrotoplasty is in your future. One could try a topical estrogen cream for this, but that’s outside the scope of this post. (UPDATE: I’ve since read that labial and scrotal tissue are completely analogous. It’s unclear if it’s testosterone or estrogen that has a greater effect on growth of these tissues.)
Topical DHT shouldn’t drastically affect your testosterone levels, but it is wise to observe your moods and keep an eye your blood work and adjust as required. (Remember, bio-men with T naturally in their systems use DHT cream.) Because it isn’t converted to estriadol though, it shouldn’t cause the feminizing side effects that too much testosterone can. You may want to get your T and DHT levels checked periodically throughout your use of DHT cream.
You can buy DHT cream online without a prescription. You can also ask your doctor for a prescription and take that to a compounding pharmacy. (This is what I’m doing in an hour.) You’ll want to be very clear however that they don’t make it with an alcohol-based gel, which can cause a temporary burning sensation for some people. (UPDATE, July 2009: DHT is no longer being manufactured in North America. You may have a hard time getting a prescription filled at this time.)
Dr. Miro recommends a minimum of three months of usage prior to surgery, and suggested that the longer you’re using DHT cream pre-op, the better. (UPDATE: This may not be true. In a clinical study, the mean increase rate (153%) in the first 4 weeks of treatment was higher than that (118%) of the second 4 weeks.)
Apply the DHT cream in small amounts (20mg) a few times a day.
Pumping for FTM Genital Growth
Pumping is another technique that’s recommended to stimulate genital growth. Basically, we’re talking about application of low pressure vacuum or suction to the clitoris. The immediate effects of pumping are temporary but pumping over time stretches genital tissues and can lead to permanent enlargement in some people. It’s recommended for pre-op trans men as well as 6-12 months of post-op to ward off retraction (shrinkage.)
Pumping is safe when done properly. If overdone however, you can cause nerve damage. The rules of thumb are: never pump dry (always use a lubricant), when starting out don’t pump for more than 15 minutes, use mild pressure, and stop pumping immediately if you experience pain or any bleeding. We’re talking about genitals here—be conservative!
When performed in conjunction over a period of time, DHT cream and pumping can provide extra genital growth that can put metoidioplasty results over the top. While they’re not guaranteed to work for everyone, these techniques seem a small and worthwhile time/money investment that can potentially improve surgery results.
*Note: I realize that some trans men find the term “clitoris” offensive, but I’m using it here for clarity.