Preexposure prophylaxis (PrEP) is a medication that helps prevent the contraction of HIV. People with a high risk of HIV exposure may choose to take PrEP. It is safe for transgender people.
PrEP is highly effective in preventing people from contracting HIV. It is safe for a person to take alongside gender affirming hormones.
Truvada, Descovy, and Apretude are PrEP medications that are safe to take alongside gender affirming hormone therapy. However, the type of hormone a person is taking will affect which PrEP medication they can take:
- Testosterone-based hormone therapy: Those taking testosterone-based hormone therapy will likely receive Truvada, as this form of PrEP is safe for people of all gender identities. There is limited research on Descovy, which does not currently have approval for use among those taking testosterone.
- Estrogen-based hormone therapy: Truvada and Descovy have approval for use in those taking estrogen-based hormone therapy. Taking PrEP alongside estrogen-based hormone therapy will not cause fat redistribution in the face or body.
Apretude also has approval for transgender individuals. However, there appears to be less research on its effects among transgender males. A person can speak with a doctor about which type of PrEP may best suit them.
According to PleasePrEPMe, Truvada does not reduce hormone levels. Although Descovy is also unlikely to affect hormone levels, researchers still need to study this medication further.
Testosterone-based hormone therapy
A 2020 study looked at the interaction between testosterone and PrEP among 24 trans men who did not have HIV and had been taking testosterone for at least 6 months.
After 4 weeks, there were no changes in concentrations of free and total testosterone, and PrEP remained at a level that would provide a high level of protection against HIV.
Estrogen-based hormone therapy
The same 2020 study also looked at the effects of Truvada on 24 trans women who did not have HIV and had been taking estradiol for at least 6 months.
After 4 weeks of taking PrEP daily, there was no effect on estradiol levels. PrEP also remained at a level that would be highly effective against HIV.
The study notes older research that suggested high doses of estrogen-based hormone therapy may lower the levels of tenofovir, a component of some forms of PrEP. However, the World Professional Association for Transgender Health suggests that doctors can safely prescribe PrEP and gender-affirming hormone therapy together.
While the organization notes that researchers have not extensively studied the interactions between PrEP and gender-affirming hormone therapy, recent studies suggest there are minimal interactions between the two treatments.
According to the Terence Higgins Trust (THT), a British nonprofit organization, it is safe for transgender people to take PrEP alongside contraception methods such as hormonal birth control.
If a person is concerned about how PrEP will affect their choice of hormonal contraception, they can speak with a healthcare professional.
A person who has not undergone an orchidectomy (testical removal) or vasectomy will need to use contraceptives during penetrative vaginal sex with a partner who could become pregnant and is not using contraceptives.
It is important to note that gender affirming hormone therapy is not effective as a contraceptive. This includes:
- estradiol
- gonadotropin-releasing hormone (GnRH)
- analogs
- finasteride
- cyproterone acetate (not available in the United States)
It is important that people know their HIV status before taking PrEP. To find out their status, a person can go to a local testing center or sexual health clinic and get a full sexual health screen.
A healthcare professional will provide specific instructions on how to take PrEP. However, there are typically two ways to take it:
Daily dosing
Daily dosing is suitable for anyone who is taking gender affirming hormones.
According to the THT, daily PrEP may be the best option for people assigned female at birth and people taking testosterone.
If people are taking testosterone, it may decrease natural lubrication and reduce tissue thickness in the vagina. This can make it more likely for those having penetrative sex to have small tears, which increases the risk of exposure to HIV.
Daily dosing is also the only option for anyone receiving penetrative vaginal sex. This is because PrEP levels need to be high enough in vaginal tissues to ensure sufficient protection against HIV.
On-demand or event-based dosing
People take on-demand PrEP before and after they have sex.
The THT states that on-demand dosing, also called event-based dosing, is only suitable for those who are not taking gender affirming hormones and who only have a risk of HIV from anal sex.
People who wish to take PrEP can talk with a healthcare professional or go to a sexual health clinic.
If a person is finding it difficult to access PrEP, they can try the following resources:
- PrEP Daily: A person can speak with a “navigator” who can help connect them to a professional who can provide PrEP.
- PleasePrEPMe: This website has several search tools to help people find PrEP services.
If people have health insurance, it may cover the costs of PrEP.
People may still have to pay part of the cost at a pharmacy, known as the prescription copay. There are copay assistance programs available to help people pay these costs.
A person can find out about applying for financial assistance for PrEP through groups such as the San Francisco Aids Foundation or Please PrEP Me.
Can you take PrEP while on hormone replacement/affirming therapy (HRT)?
It is safe to take PrEP alongside gender affirming hormone therapy. Most forms of PrEP have approval for use in people receiving gender-affirming hormone therapy, with reports of minimal interactions.
Can I take PrEP while on testosterone?
It is safe to take most forms of PrEP while on testosterone. Research into Descovy is ongoing, and it does not yet have approval for use in people taking testosterone.
Does Truvada affect hormones?
Truvada does not reduce or increase hormone levels in transgender individuals. There are no significant interactions between PrEP and hormone therapy or hormone-based birth control.
Can you take PrEP and birth control?
It is safe to take PrEP while on birth control. The
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Preexposure prophylaxis (PrEP) is a form of medication to help prevent people from contracting HIV.
PrEP is safe for transgender individuals, regardless of the hormones they are taking and whether they have undergone gender affirming procedures. However, the type of hormone a person is taking can affect which form of PrEP medication they can have.
It is important to note that PrEP does not reduce the chance of contracting other STIs, which means a person will need to use additional contraceptive measures. People can discuss their options with a healthcare professional.
