Many people taking testosterone do benefit from localised oestrogen treatment for genital health. Research shows that testosterone suppresses overall oestrogen production in the body, but the tissues of the vagina, vulva, and urethra require some oestrogen to maintain their health and thickness.
Evidence indicates that without adequate localised oestrogen, these tissues can become very thin and fragile, which may lead to serious health complications including increased risk of infection and injury. This is particularly important for people who have undergone testosterone therapy, as the systemic reduction in oestrogen affects the integrity of genital tissues over time.
Guidelines demonstrate that localised oestrogen treatment does not interfere with the masculinising effects of testosterone when used appropriately for genital health. This targeted approach allows people to maintain tissue health whilst continuing their hormone therapy. Medical professionals often recommend topical oestrogen creams or pessaries that work locally rather than systemically.
This aspect of hormone management is sometimes overlooked, particularly for people managing their own therapy. Understanding the need for localised oestrogen alongside testosterone helps ensure comprehensive care that addresses both gender-affirming goals and long-term genital health, supporting overall wellbeing throughout the transition process.