Testosterone therapy in biological women has been found to suppress ovarian estrogen production, creating a hypoestrogenic state that can thin vaginal tissue and cause atrophic changes similar to those experienced after menopause.
The Department of Health and Human Services (HHS) awarded the University of Alabama at Birmingham (UAB) a $316,000 federal grant to study vaginal health in transgender-identifying biological women who use testosterone as part of their so-called gender-affirming treatment.
The grant, which began in August 2024 under the Biden administration, is scheduled to run through July 2029. The funding was awarded to the assistant professor in the UAB Division of Infectious Diseases, Dr. Olivia Van Gerwen. According to federal records, UAB already received over $230,000 of the obligated funds.
According to the grant description, the research will examine the “vaginal health of transgender men (TGM).”
“Despite their significance, vaginal symptoms and infections are poorly characterized in TGM,” the description stated. “This population is underserved and have limited engagement with sexual health services, largely due to discrimination from and mistrust of the medical establishment.”
The grant follows another federally funded study that concluded in October 2024. A report from 1819 News noted how that project received nearly $440,000 to examine the “impact of testosterone use on the vaginal microbiota in transgender men.”
That grant description states, "Unlike postmenopausal CGW (Cisgender Women), TGM on testosterone also experience elevated testosterone levels.”
"The impact of low estrogen/high testosterone on the vaginal microbiota of TGM is unknown and cannot be extrapolated from studies of CGW,” it continued. “Hormonal changes in conjunction with sexual behaviors due to increased sexual desire from use of testosterone could impact the vaginal microbiota of TGM, putting them at risk for bacterial vaginosis and, ultimately, HIV and other STIs.”
Testosterone therapy in biological women has been found to suppress ovarian estrogen production, creating a hypoestrogenic state that can thin vaginal tissue and cause atrophic changes similar to those experienced after menopause. Studies have reported that more than half of transgender men who use testosterone experience genital pain or discomfort during sexual activity. Researchers have also suggested that these changes increase the risk of bacterial vaginosis and STI susceptibility due to a changed microbiome and fragile tissues.
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