A Proposed Treatment Framework for Orgasmic Disorder in Transgender Men: Integrating Contributions from Affirmative and Intersystemic Sex Therapy

This paper proposes a treatment framework for orgasmic disorder in transgender men, integrating principles from affirmative and intersystemic sex therapy. Inspired by the clinical case of a 23-year-old neurodivergent Brazilian trans man, the framework addresses persistent orgasmic difficulties often overlooked in cisnormative sex therapy models. The manuscript begins with a critical review of literature on the impact of testosterone therapy, surgical interventions, and psychosocial factors on orgasmic functioning in transmasculine individuals. It then outlines a biopsychosocial assessment strategy and presents long- and short-term therapeutic goals designed to support embodiment, sexual satisfaction, and relational wellbeing. By centering client experience and identity, the proposed model offers a culturally responsive and pleasure-based approach to a complex clinical issue often neglected in research and training. The case study highlights the importance of moving beyond pathologizing frameworks and underscores the need for future research that includes intersectional variables such as neurodivergence and minority stress.