"At least 1.6 million transgender adults and adolescents live in the United States,1 among whom an estimated 70% of transgender men have used testosterone as gender-affirming hormone therapy (GAHT). A vaginectomy is rare (<3%) in this population, and the majority of transgender men and gender diverse people retain their vagina. Testosterone GAHT likely impacts sexual function via several complex pathways. Testosterone GAHT is associated with vaginal atrophy, which may be associated with decreased lubrication and/or discomfort during sexual activity. At the same time, increased gender affirmation through testosterone use may be associated with improved sexual function."