HRT and Trans, Non-Binary and Intersex Experiences in Relation to Body Piercing
Lars: Before I get into all of the details that this article has to offer, I think it’s important to acknowledge my experience, privileges, and perspective. I am a white, skinny, working class, post-top surgery, on-and-off testosterone-taking, professional piercer of two years, and I am in my early twenties. I identify as a trans nonbinary queer femme, and my pronouns are (currently) they/she/he. I was raised in the south and started getting pierced when I was 15 years old, years before I knew I was trans; receiving piercings was the catalyst for discovering myself through gender euphoria and realizing I could play a bigger part in taking control of my appearance. Piercing plays a large role in my identity and the way that I have a relationship with my body.
Lynn: Much like Lars, I come from a place of great privilege. I am a white passing mixed person, who is skinny, working class, and physically disabled. I identify as non binary, and while I’ve gotten some gender affirming surgeries I currently do not take HRT. My pronouns are they/she. Piercings and body modification have been a huge element of my experience with gender, and have empowered me to explore my relationship with my body as it relates to gender. I am proud to be a piercer of a decade, and I have spent extensive time educating myself on HRT and piercings and working on many clients on HRT. While HRT is not currently a part of my gender experience, I want to offer safe and informed piercing services for those who do choose HRT. I wanted to include Lars in this blog as I feel its important to amplify voices of trans and non-binary folks who choose HRT, and incorporate lived experiences of a piercer on HRT.
This article is written for those curious or enthusiastic about piercing who are on or may be starting Hormone Replacement Therapy, as well as for those considering any variety of gender affirming procedures. While the focus of this article is to reach trans, nonbinary, and/or intersex folks – lots of people take HRT for a variety of reasons! That being said, while not the focal point, there may be helpful info in here for cis folks on HRT as well.
It’s impossible to cover every possible configuration of identity, anatomy, genitals, experiences, etc. in this article. If you find yourself not represented and have a question in regards to the relationship between piercing and transition/gender affirmation/HRT that’s not answered here, please contact us so we can answer your question or direct you to someone that can!
General Experiences on HRT
HRT for trans, nonbinary, and/or intersex patients is a form of hormone therapy in which sex hormones (Testosterone or Estrogen) are administered to the patient for the purpose of gender expression and/or affirmation. While those of you who choose to engage with HRT are familiar with the experiences or stories of the notorious second puberty, many of you may be unaware of how these changes can affect your current or prospective body piercings.
There’s a variety of ways to take hormones, such as through topical methods including creams, gels or patches. These topical methods should not be applied directly to the site of any body piercing. If you wear your patches or apply your topical to an area near a piercing, be mindful of how close to the piercing the medication is applied, and how your piercings respond throughout treatment. If a piercing starts to get irritated, you may want to try applying the medication in a different area, talk to your doctor about HRT and skin issues, and/or consult your piercer about how viable maintaining the piercing through HRT may be for you.
Taking HRT can result in a change in skin type, such as becoming more dry or oily, and it may also cause acne. Muscle and fat redistribution, as well as weight loss or gain, are also not uncommon. These changes may lead you to need different sizes, lengths, shapes, or styles of jewelry for some of your existing piercings; commonly navels, cheeks, oral, or nipple piercings. If you notice your piercings feeling tender, or the skin surrounding them seems irritated or breaks out in acne, pop in for a visit with your piercer to have them take a look. Acne in particular is often treated with topical creams and ointments which can irritate the skin around piercings. Larger jewelry can cause oils and debris to build up under them, so some clients choose to swap to smaller or smiler pieces while they are going through these changes, for easier cleaning and easier skincare.
Hair loss/removal and new hair growth can also affect your existing piercings; commonly nipples, navels, genital, surface, and facial/oral piercings. Having a hair start to grow inside a philtrum or labret piercing is no pleasant experience. Be mindful as hair changes start to occur, and check in with your piercer if anything feels uncomfortable or off. Likewise, electrolysis (laser hair removal) and piercings don’t always play nice together. If you are planning on having laser treatment in an area you want to get pierced, it’s not a bad idea to wait until you’ve had the treatment and give your skin time to recover before getting pierced, otherwise you may have to retire your piercing for the duration of treatment. If you already have piercings in an area that you’d like to get laser treatment, talk with your technician about what they advise and what materials are safe to wear if they allow you to keep the piercings in for treatment. Some technicians will laser right over piercings without question, some may ask to remove jewelry due to the material or practitioner’s insurance policy, and some may be fairly unaware of the nuances surrounding piercings and laser treatment. Laser treatment may darken your anodized jewelry, and can create soreness and swelling at the sight of the piercing. Some patients have had success with wearing glass retainers during their laser treatment, but it’s recommended to have your piercer reinsert jewelry in the days following treatment as retainers aren’t very viable for long term wear. Some doctors may not allow you to wear any jewelry/retainers during laser removal; seeing your piercer in the days following to have piercings tapered open and jewelry reinserted may help you maintain the piercings you love without having to get them redone!
Nipple Piercings
Nipple piercings can boost confidence, increase sensation, and induce gender euphoria. Some people may bind their chest or wear breast forms to alleviate dysphoria or to help achieve gender euphoria. It can be difficult to heal fresh nipple piercings if you bind or wear breast forms, and it’s recommended to wait till they are fully healed before wearing these items. Nipple piercings can take anywhere from six months to one year to be fully healed, and some folks’ piercings may not be compatible with binding/breast forms even after healing. However, everyone’s body is different and capable of healing/maintaining piercings under varying conditions. Understand that binding/breast forms can increase the risks of migration and rejection, and if you choose to do these after healing, monitor the piercings and remove them if migration begins to become an issue.
Testosterone can cause some changes in breast tissue (shrinkage, muscle redistribution, etc.) and estrogen can cause breast and nipple tissue growth. If you plan on taking HRT long-term, it’s recommended to wait 1-2 years for tissue to fully develop before getting your nipples pierced. However, chest development can be a very slow process. If you choose to get your nipples pierced earlier on in your HRT journey, pay close attention to them and look out for irritation or signs of migration. With estrogen, you may find yourself needing longer barbells during the healing process as the area grows. Binding, wearing breast forms, and experiencing breast/nipple tissue changes with an existing or healing piercing can result in permanent “hammerhead” scarring or migration. If this starts to happen, retiring the piercings sooner rather than later will give you a better change of having them repierced in the future. A good method to avoid the pressure of migration is to take hard vented eyepatches and place them inside the binder over the nipples. This can distribute the pressure of the binder off the the nipple and help maintain the piercings. If the tissue completely rejects the piercing, it’s often not viable to have it redone, as a path of scarring will exist that future piercings may want to follow.
“I started binding and right away my piercings were angry and gross all the time. I tried a few binders but nothing was really helping, until we tried the eyepatches. They worked great, although they moved around in my binder a bit. I ended up sewing some into the liner of a tank top I wear under my binder and that works great- my piercings are happy and I can still bind!” Bryce, 19
Disclaimer Part Two:
The following sections on genital piercings will be referred to as their “traditional” well-known piercing industry names. That being said, many trans/non-binary/intersex folks may refer to their anatomy with alternative terminology. If you are someone who refers to your anatomy outside of “medical terminology”, and want to refer to your piercings’ name with different terminology, talk about this with your piercer during your consultation.
Personally, what I’ve loved most about collecting genital piercings is that my genitals feel very ambiguous and outside of the “traditional” binary genitalia that one would see represented in their school sex-ed class. Body mods have helped my anatomy take on an aesthetic that doesn’t feel gendered. At the same time, many clients love using genital piercings to help achieve a more feminine or masculine aesthetic, to accentuate the parts of their anatomy that they do enjoy, or to distract from the parts of their anatomy that may cause dysphoria. Piercing with these kinds of intentions is subjective, and that’s part of what makes it so beautiful.
Testosterone and Genital Piercings
Testosterone can be administered through injection, patches, creams, or gels. The method that you choose to take testosterone can affect how quickly changes occur. The most notable change for those with vulva based anatomy who take testosterone is growth of the clitoral glans. Growth of the clitoral glans and changes in its surrounding anatomy often open the door to genital piercings options that may have not been possible before. It’s a good idea to wait till clitoral growth has fully developed before getting any piercings on or around the glans, but if you choose to do this earlier on, be sure to keep a close eye on these piercings for potential signs of irritation or migration. If you wear a packer, it’s a good idea to cease packing while your genital piercings heal to prevent irritation from rubbing/pressure. You can also pierce your packer for a fun aesthetic! If you are someone who plans on getting any kind of bottom surgery, you will probably have to retire your genital piercings for your procedure(s). If you plan on getting repierced after surgery, it’s a good idea to talk with your doctor and your piercer about nuances, such where stitches/scars will sit, so you can plan to have the most affirming results and aesthetics moving forward. Depending on where stitches are placed and how tissue heals/scars, some piercings may not be viable on your post op genitals.
VCH (Vertical Clitoral Hood): (Similar in aesthetic to a foreskin piercing or a penile PA piercing). These piercings are notoriously easy to get, and heal in about four to eight weeks. Larger jewelry choices can create a great visual effect and can provide additional stimulation. While a VCH doesn’t directly increase sensitivity to the glans, it does allow for more direct contact and increased stimulation. These can take 3-5 months to fully heal
HCH (Horizontal Clitoral Hood): (Similar in aesthetic to a frenum piercing). If your glans protrudes from the hood, the jewelry in this piercing may offer stimulation. These piercings tend to be less common than the VCH for that reason along with viable anatomy being less common. With bottom growth from Testosterone, many folks that are on or have used HRT are a candidate for this. Just like the VCH, they heal in about 3-5 months.
Clitoral Glans: (Similar in aesthetic to an Apadravya or Ampallang – Lars lovingly calls their glans piercing a Transpallang.) Many clients have too small of a glans to receive this piercing, but bottom growth often opens the door to being a candidate. Some folks experience a decrease in their glans sensitivity on HRT, and getting this piercing can help bring sensation back and adds a great visual effect accentuating the “head” of the glans. These typically heal in around 3-6 months.
Labia: (Similar in aesthetic to Hafada/Scrotal piercings.) Whether it be inner or outer labia, these piercings don’t offer much in regards to stimulation on the client, but they can potentially provide stimulation for sexual partners and create a great aesthetic. Some clients really love the weight of heavy captive bead rings or other jewelry styles in this piercing; emulating the feeling of having a scrotum or other “atypical” genitalia. Inner Labia are typically a quick heal at around four to eight weeks, while Outer Labia tend to take three to five months. This anatomy is not commonly affected by HRT.
“I decided to get outer labia piercings after seeing Lynn mention them in a tiktok video as a gender affirming piercing. We did a 6g initial piercing, and I wear larger diameter rings now that they are fully healed. They are the most annoying, difficult, in the way piercings. I have to be aware of how I place my legs when I sit, of how my underwear hangs, of them getting tangled and pinched and caught. I’m often adjusting them to sit correctly, and when they snag its unpleasant- and I couldn’t be happier! To me, this must be what having a scrotum is like. And since healing these I feel they have masculinized my body motions- I’m sitting and walking and moving differently to avoid the rings catching, and I move more like a cis man with a scrotum to avoid. This single piercing has done more for masculinizing my body movements then anything else, and I feel so much gender euphoria every time I adjust them or work around them. I would suggest this to any trans masculine person who wants the struggles and euphoria of a scrotum.” -Trevor, 23
Christina: (Similar in aesthetic to a pubic mound piercing). These piercings are visually appealing in trailing down the pubic mound towards the hood of the glans, though they don’t offer much of anything for stimulation. These take around six to nine months to heal, and this anatomy is not commonly affected by HRT.
PA (Princess Albertina): (PA piercings, whether an “Albertina” or “Albert” are essentially equivalent – both going in and through the urethra). Some folks on HRT experience frequent UTIs due to increased bacteria in the urine, and if so you may want to hold off on getting this piercing. While visually appealing, these should only be pierced on folks interested in urethral stimulation. These piercings go through the urethra and exit inside the entrance to the vaginal canal, and this anatomy is not commonly affected by HRT. These are an advanced piercing that should only be done by an experienced piercer. They heal in about four to six weeks.
Fourchette: (Similar in aesthetic to a Guiche piercing). These piercings are very anatomy dependent and should only be done by a piercer with experience in this area. This anatomy isn’t commonly affected by HRT. A fourchette is typically pierced with a curved barbell through the bottom lip of the vaginal canal, and they take about six to eight weeks to heal. They are often easily irritated from penetration.
Triangle: (similar in aesthetic to a Lorum piercing). This is an anatomy dependant piercing
that passes horizantally behind the clitoral glans. Often clients don’t have enough piercable anatomy for this, and that often changes with HRT and bottom growth. Much like a clitoral glans piercing, the enlargement of the entire glans also means we now have more piercable tissue. This piercing when healed allows for stimulation of the shaft of the clitoral glans, which was previously unable to be contacted. For folks experiencing reduced sensation this piercing is a great way to return sensation and function to the area. These are advanced piercings that should only be attempted by a piercer with experience in this area. Triangles can take up to 4-6 months to fully heal.
“I had always wanted a triangle but didn’t have the anatomy for one until I started T. Since then this has become by favorite piercing, the stimulation it provides is great. Mine naturally stretched on HRT and I wear a 2g now and the thicker jewelry is very masculine and makes me feel very tough.” Charlie, 51
Estrogen and Genital Piercings
PA (Prince Albert): (Directly similar to a princess albertina, visually similar to a VCH). A PA is a piercing that passes through the urethra out the underside of the glans. This is one of the most popular penile genital piercings and great for anyone who enjoys urethral stimulation. Anatomical changes on HRT can sometimes cause you to need smaller or lighter jewelry for comfort. Erectile dysfunction and occur on HRT, and this may also effect how your jewelry wears. UTI’s are not uncommon on HRT, and any piercing that bisects the urethra may cause irritation. These piercings can take 3-5 months to fully heal.
“Early on in HRT I experienced ED, although this was already something I had struggled with in the past. The most incredible thing was my orgasms changed as well, they became full body experiences that felt different. Most notable was the way the sensation and feeling around my PA changed- urethral stimulation I now felt like waves down my spine and stomach, and I was able to achieve orgasm without needing to be erect. I’m getting bottom surgery next year, and I’m honestly going to miss my PA a lot!” M, 49
Reverse PA: (similar in aesthetic to an HCH) A Reverse PA follows a similar path to a PA, simply reversed- this exits on the top of the glans rather and the underside. These piercings can be difficult to heal, and many clients choose to heal an Apadravya instead for an easier heal, and then wear it as a RPA. Much like the PA, jewelry fit and style may change during HRT. RPAs are very anatomy dependent and should only be preformed by a piercer with experience in these piercings. UTI’s are not uncommon on HRT, and any piercing that bisects the urethra may cause irritation. They can take 6-9 months, up to a full year to heal.
Ampallang: (similar in aesthetic to an HCH, directly similar to a clitoral glans) An Appalling is a piercing that passes horizontally through the glans and bisects the urethra. This piercing visually can give a similar effect to an HCH, although this is pierced with a straight barbell. The urethra and internal glans stimulation this can provide can be very functional for folks. Jewelry size and length may need to be modified during HRT, particularly if erectile dysfunction is experienced. UTI’s are not uncommon on HRT, and any piercing that bisects the urethra may cause irritation. These piercings can take 6-9 months sometimes a full year to heal.
Apadravya: (similar in aesthetic to a VCH, directly similar to a clitoral glans) An Apadravya is a piercing that passed vertically through the glans, and bisects the urethera. This piercing visually can give a similar effect to an VCH, although this is pierced with a straight barbell. The urethra and internal glans stimulation this can provide can be very functional for folks. Jewelry size and length may need to be modified during HRT, particularly if erectile dysfunction is experienced. UTI’s are not uncommon on HRT, and any piercing that bisects the urethra may cause irritation. These piercings can take 6-9 months sometimes a full year to heal.
Frenum: (similar in aesthetic to inner or outer labia piercings) A frenum is any piercing along the shaft of the penis, sometimes called a lorum at the base. This tissue is often not effected much by HRT, although some people experience more severe erectile dysfunction which causes things to remain at rest at all times. You may find yourself needing different length or fit jewelry as bottom changes occur. These take 2-4 months to fully heal.
“I had the Jacobs ladder before starting HRT, and I ended up having to remove a few once things settled down. They weren’t comfortable anymore with some of my bottom changes. I still wear 2 and I’m very happy with those!” M, 49
Hafada/Scrotum: (similar in aesthetic to inner and outer labia piercings) Hafada piercings are scrotum piercings off to either side of the scrotum, when placed anywhere else along the scrotum they are typically just called scrotum piercings. During HRT, the testicles often shrink to about half their initial size, although the tissue of the scrotal sac remains. This can cause piercings along the scrotum to shift in placement and require different jewelry to be worn. Given how much this tissue can change during HRT, it’s strongly recommended to wait for bottom changes be done before getting pierced, or if you are already pierced understand placements may shift. These piercings can take 3-5 months to fully heal.
Guiche: (similar in aesthetic to a fourchette) A Guiche is a piercing through the backside of the scrotum, under the anus. Like scrotum piercings, this area is affected the the shrinkage of the testicals during HRT. The tissue of the scrotum remains but may shift in position during the bottom changes experienced. These piercings can allow for greater prostate stimulation and many clients enjoy the sensation of larger, heavier pieces and weights in this area. These take 3-5 months to fully heal.
Foreskin: (similar to VCH/HCH piercings) A foreskin piercing is a piercing through the foreskin. These piercings can be effected by HRT as it can occasionally cause erectile concerns and irritation to the tissue of the foreskin. We suggest discussing with your doctor if they think this would be a good choice for you with any potential HRT and bottom changes. These piercings can take 2-4 months to fully heal.
Dydoe: (similar to a clitoral glans piercing) Dydoe piercings pass through the coronal ridge along the glans. These piercings can be difficult to heal, and should only be preformed by a piercer with experience in this area. This is often not too effected by HRT, bur jeweler size and fit may change with any bottom changes. These can take 6-9 months to fully heal.
Its important to note that the healing timelines suggested here are just suggestions. HRT can effect your healing, and sometimes cause longer healing time frames and extra healing considerations. For example, you may notice piercings becoming irritated or flaring up around the time of your hormone injections if you take injectables. You may also experience changes in skin health around the piercings including oily or dry skin during healing. HRT can change the way your body heals, and particularly piercings directly in the area being effected by HRT. Each persons experience with HRT, and by extension piercings, is going to be unique. An important factor in getting and healing these piercings is finding a piercer who is experienced in working with HRT and who can work with you as these heal to troubleshoot any concerns caused by HRT.
Body Piercing can be an empowering, and transformative way to reclaim your body and stand against social gender norms. Piercings can help with dysphoria, help to heal our relationships with our bodies, and encourage our own agency over out bodies, our sex lives, and our gender. We hope this article can help you with your own experience of gender and your body, and perhaps help you get information about the way piercings can assist in that experience. Happy healing!
To see examples of genital work like this you can check my portfolio on this site. Please follow and support Lars through instagram at @larsmakes