Despite the increased visibility and knowledge in the area of transgender health, the sexual health and experiences of transgender women undergoing Gender-Affirming Hormone Therapy (GAHT) are still under-researched; often, the effects of GAHT on trans women’s sexuality are broadly miscategorised as ‘erectile dysfunction’. This study aimed to provide an exploration of trans women’s negotiation of the psycho- and physiosexual shifts which result from GAHT. Twelve participants (including one pilot) took part in hour-long semi-structured interviews, with two providing a secondary interview for further data triangulation. These interviews were manually transcribed, coded, and final themes were identified and titled from participants’ own words. The interviewer also maintained a journal that was used to provide further depth, reflection, and insight to the emerging themes. The final analysis identified four themes: overall experiences, physiological changes, psychological changes, and shifts in experiences of orgasm. Most participants had positive and/or affirming experiences of sexuality while medically transitioning. One important, and significantly under-researched, experience described by participants was the development of new erogenous zones; for many, their source of sexual pleasure and climax had shifted partially if not entirely away from their genitals and towards nipples, legs, backs, or other body parts. These findings highlight the dearth of medical knowledge in the area of sexual function and pleasure for trans women undergoing GAHT and provide an impetus for a systematic reimagining of how clinical practitioners might negotiate their treatment of a transgender client.