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Dear Aunt Vadge – help!
I am a trans man. I have not started testosterone yet, but am on a progesterone-based medicine to prevent bleeding in the meantime. I have got a cut around 8–10mm long right on my glans, left of midline, which I think was caused by a not-well-trimmed nail while masturbating.
The thing is, the cut seems somehow to have got longer – possibly this is just a visual effect as it heals and dead skin pulls away, hard to say. It is uncomfortable but usually not painful, no blood, but it looks pretty grody with that dead skin and is healing glacially slowly.
I definitely do not have any overt sign of bacterial infection and I am pretty sure not fungal either – I have had thrush before and it sucks worse than this by many orders of magnitude. I am washing with cool water, no soaps or irritants, and do not wear tight-fitting undies.
I am starting to feel pretty fed up – I would expect such a small cut to be gone in less than the week it has been, or at least improving – and more than a little sexually frustrated too. I would be very grateful for any tips to get the blasted thing to heal up. I am dysphoric enough that showing it to someone is pretty much out of the question.
Sincerely,
TDude (early 30s, UK-based)
Dear TDude,
Thanks for writing, and good on you for keeping it clean and simple while it heals. The slow healing is the useful clue here, and it points somewhere you can actually do something about.
Slow wound healing in genital tissue is a classic low-oestrogen sign. A progesterone-based medicine used to stop your cycles will usually be lowering your oestrogen as well, and genital tissue that is not getting much oestrogen goes thinner, drier and slower to knit back together. When a genital cut stays stubbornly open like this with no sign of infection, the first thing I look at is oestrogen – thin, under-oestrogenised tissue heals painfully slowly, and a little topical oestriol often gets it moving again.
The most straightforward fix is a topical oestrogen cream, oestriol (E3) specifically, applied to the tissue. Topical E3 is a good choice here because it works locally and barely enters the bloodstream, so it will not undo your going oestrogen-free or interfere with your other treatment – it just sorts out the local tissue. If low oestrogen is the driver, a cut like this usually clears up quickly once you start.
This is the same underlying problem as atrophic vaginitis, which is what happens to menopausal tissue when oestrogen drops away – the flesh thins, splits easily and then struggles to heal. Your situation is not identical, but the mechanism is. There is a useful parallel in how clinicians manage atrophic vaginitis in breast cancer survivors, where systemic oestrogen is off the table but topical oestriol can still be used because it stays local.
Oestrogen cream is normally prescribed, so you will need a GP or your transition team to write it. You should not have to show anyone the cut if that is not something you can face – if you describe the symptoms and your understanding of the low-oestrogen picture, most prescribers will be happy to help. A trans-friendly GP or sexual health service is worth seeking out for this. Whoever is managing your transition should know anyway, because you do not want the tissue quietly atrophying over the longer term.
In the meantime, a moisturising, genital-friendly cuts cream can encourage a minor cut like this to heal. Keep doing what you are doing otherwise – cool water, no soaps, loose clothing.
If it starts looking infected (hot, swollen, spreading redness, pus) or simply refuses to heal despite the oestriol, please get it seen even though it is hard – a one-off look is worth it to rule out anything else. There is more general guidance on our resources for trans men too.
I would love to know if this sorts it, so please write back.
Warmest regards,
Aunt Vadge
This is general information, not a substitute for personalised medical advice.
