For many trans men and non-binary people taking testosterone, changes in the body can bring both positive and challenging effects. While testosterone helps with masculinization, it can also lower estrogen levels. One of the side effects is thinning and dryness of the vaginal tissue, sometimes called vaginal atrophy or genitourinary syndrome of menopause (GSM). 

This is very common, but it’s not often talked about. The good news is that there are safe and effective treatments available—one of the most helpful being vaginal estrogen cream. 

Why does this happen? 

Estrogen keeps the vaginal tissues healthy, flexible, and naturally moist. When you’re on testosterone, your estrogen levels drop, and the vaginal lining can become thinner and more fragile. This may cause: 

• Dryness, irritation, or itching 

• Burning or stinging sensations 

• Pain with penetration (during sex, exams, or inserting tampons/cups) 

• More frequent small tears or infections 

These symptoms can affect daily comfort, make medical check-ups stressful, and sometimes increase gender dysphoria. 

How does vaginal estrogen cream help? 

Vaginal estrogen cream works by delivering a very small amount of estrogen directly to the vaginal tissue. Unlike taking estrogen pills or patches, the cream acts locally, which means: 

• It improves vaginal health and comfort 

• Only a tiny amount enters the bloodstream 

• It does not interfere with the masculinizing effects of testosterone (such as voice deepening, hair growth, or body changes) 

Most people notice improvement within a few weeks, and symptoms usually continue to get better over the first couple of months. 

Common questions 

Will it stop the effects of testosterone? 
No. The dose is very low and stays local to the tissues. Testosterone’s effects remain unchanged. 

Is it safe? 
Yes, for most people. Because the absorption is minimal, it’s considered safe. If you have a history of hormone-sensitive cancers, talk with your healthcare provider before starting. 

What if using the cream feels triggering? 
For some, applying a cream to the vagina can feel uncomfortable or dysphoric. If that’s the case, other options—such as vaginal tablets, a low-dose ring, or even non-hormonal moisturizers—may be better suited. Your clinician can talk you through choices that feel right for you. 

How is it used?

• Usually applied daily for the first couple of weeks, then reduced to a few times a week for maintenance 

• Often easiest to apply at night before bed 

• Your provider wl give you clear instructions and can help adjust the routine to suit your comfort level 

The bottom line 

Vaginal dryness and discomfort are very common for trans men on testosterone, but you don’t need to just “put up with it.” Vaginal estrogen creams are a safe and effective way to restore comfort, improve tissue health, and make both daily life and medical exams less painful—without undoing the effects of testosterone. 

If you think you might benefit from this treatment, talk to your healthcare provider. Together, you can find an option that works best for you and supports both your health and your gender journey.