(content warning - brief mention of suicidal ideation)
(also, sorry, this is really long, but the context matters, and a lot of detail is included to fend off FAQs)
I'm a transgender woman, in my late 40s. I had my trans awakening about 3 years ago, and I've been on HRT for about 2.5 years, and had an orchiectomy 1.5 years ago. My current HRT regimen, which has remained pretty stable for 6-12 months, includes a moderate dose of estrogen and progesterone. My estrogen blood level is pretty normal for an adult woman.
My sexual history has been very active, but complicated. Well, for the first 40-something years of my life I thought I was a guy. I was pretty miserable and depressed most of the time, but sex was one thing that kept me going. No matter how confusing and frustrating the social world was, no matter how awkward I was with my "maleness," sex was one thing that worked for me, both single-player, and partnered sex.
I've been with my wife for almost 15 years, and our sex life has been pretty good. She has her own health challenges, and sometimes it's difficult for us to connect, but we manage. My transition has been a non-issue for her -- she realized some time ago that she's pansexual, and, well ... we've been able to confirm that as we've been intimate throughout my gender transition.
I've been on antidepressants for a good chunk of my adult life, usually an SSRI (fluoxetine/prozac for a while, then I switched to sertraline 10-15 years ago). The sexual side effects have been noticeable, but usually manageable. After an initial increase in dose, I'd have trouble "functioning" (eg, maintaining arousal, reaching orgasm), but then I'd more or less get used to it.
Since starting HRT, my body's sexual response has changed pretty significantly, as expected. My penis doesn't really care for being stroked or used to penetrate, but I've learned that it *does* like vibration. For the last couple years, that's the only way I've been able to orgasm is through vibration on the glans.
After my orchiectomy, my emotional state cratered. The working theory was that my hormones were going wacky from the sudden offlining of my natal T-producing gonads (it's a thing, apparently). Unfortunately, this led to a hospitalization for suicidal ideation (my mood was getting that low and unmanageable), and another increase in dose of sertraline.
Since then, my overall sexual response has become pretty muted, and orgasm has gotten harder and harder to achieve. I don't think I've had a decent orgasm in almost a year. I sometimes have little crappy pseudo-orgasms, where I feel the nice buildup, and maybe a little bit of typical ejaculate dribble, but no real "climax" or "release." Just, the "don't touch" sensitivity afterwards, and then .. I guess I'm done? Sometimes, I can't even get to the build-up portion ... it just ... doesn't respond.
This happens when I'm by myself or with my wife. When we have playtime, it feels amazing .. her touch, how she kisses me, how she makes me feel sexy and desired and loved and wanted . . my body delighting in her playing with my breasts, touching me gently, etc. I'm on fire with desire. Then I reach for my vibrator, and .... *crickets*. It doesn't matter if I try to have a "quickie" or if I take my time with a nice steady buildup. Once I / we get to the fun part .... *crickets*.
It's not that I *need* orgasm every time we have sex, but it's like ..,. can I get one at least once in a while? And I know there's more to life than orgasmic sex, but ... when I've been enjoying something regularly for most of my life, and then suddenly it's *gone* ... it's frustrating. It's sad. It's scary. I'm not ready to be done with my sex life. I wanna feel *good*, ya know?
I've sought out some resources, but they've been little help. A lot of it is generalities like "you gotta take it slow and communicate and learn what you like" (eg, "Girl Sex 101") or in the case of the "F---ing Trans Women" zine, a lot of "not for me" stuff (muffing? really?). How do I communicate what I like when *I* don't even know what I like, or if I even like *anything* anymore.
I've tried different technical things -- vibrators, butt toys, prostate stimulation ... Nothing.Dysphoria doesn't help any, either. I've come to realize that I *really don't want to have a penis anymore*. I don't like it, I never asked for it, and I *can't wait* for a month from now when I finally get vaginoplasty surgery. It's possible that a lot of this will resolve itself after I'm healed from that, and if/when I ever get to reduce my SSRI dose. But *geez*. It's really frustrating when I feel desire, when I want to feel good, I want to be a sexual person ... but I just can't.