Antiretroviral therapy (ART) is the treatment for HIV infection. Some people receiving ART may also be having hormone therapy to affirm their gender.
ART involves taking medications each day to help reduce the viral load in the body, which is the amount of the virus circulating in the blood. Regular treatment is the only way to reduce the viral load, keep the body healthy, and help reduce the risk of HIV transmission.
Everyone with HIV can have ART, including people on hormone therapy. People who may receive hormone therapy include transgender, intersex, and gender-nonconforming individuals.
Hormone therapy, in this sense, helps affirm a person’s gender. It eases an individual’s feelings of gender dysphoria by aligning their secondary sex characteristics with their gender.
Although some people may be skeptical about possible interactions between ART and hormone therapy, these concerns seem unfounded. Working closely with a doctor to monitor any changes or side effects that may occur can ensure that a person is able to continue both treatments.
In this article, we examine whether ART interacts with hormone therapy. We also look at how people receive these treatments and the potential risks and barriers.
Some people are wary of taking ART while on hormone therapy, fearing an interaction between the two. However, the
A 2020 study looking at the interactions between ART and transgender hormone therapy found no changes in the effectiveness of hormone treatment after 4 weeks of treatment for HIV. The participants had no changes to hormone dosing and no signs of hormone withdrawals while on ART.
However, there are interactions to consider, such as whether an ART drug will increase the risk of someone on hormone therapy facing other issues. Doctors will analyze these risks in each case as they create a treatment regimen.
Anyone who has concerns about their treatments should talk with a doctor who is comfortable providing gender-affirming care. The doctor can help ensure that both hormone therapy and ART continue to be safe and effective.
ART is highly effective when a person stays on it. It works by reducing the amount of HIV in the blood, keeping the immune system strong and the body healthy. Regular treatment helps prevent the virus from multiplying and sometimes reduces it to undetectable levels in the blood.
According to the
ART is just as effective in transgender individuals as in cisgender individuals. Research from 2019 found that transgender women receiving HIV treatment had viral suppression levels comparable to those of cisgender people on similar treatments.
However, staying consistent is vital with ART, as missing or forgetting treatment allows the virus to multiply rapidly in the blood.
ART has various possible side effects, which do not occur in all people. If side effects do appear, they may include:
The side effects may vary from mild to severe. Some side effects may be severe enough that a person will stop taking their medication.
Inconsistency with ART treatment puts a person at risk of a worsening condition. Without ART, the virus can multiply rapidly in the body, which weakens the immune system and causes levels of the virus to increase quickly in the blood.
Inconsistency with treatment may also promote drug resistance by giving the virus time to adapt to the drug and become resistant.
If the side effects of ART are an issue, a person should talk with a doctor. The doctor may provide other drugs to counteract problematic side effects and help a person stay consistent with treatment.
The Department of Health and Human Services notes that gender-affirming hormone therapies may have risks, including higher blood fats, which raises the risk of cardiovascular problems, and bone deficiencies. Other common concerns include an increased risk of blood clots and mood fluctuations.
Due to this, doctors should recommend an ART regimen that will not also increase the risk of similar adverse effects.
The involvement of healthcare professionals is an essential part of long-term ART treatment. Therefore, anyone with HIV who is looking to start hormone therapy should try to find a doctor who is knowledgeable about and comfortable with gender-affirming hormone therapy. Their knowledge and compassion for the unique issues of a person on hormone therapy will likely facilitate treatment.
A doctor should inform a person about the changes they may experience when first beginning ART, including the possible side effects. It may help to journal any side effects and their severity and then provide this information to the doctor.
Doctors may also order tests to check for hormone levels while on ART. Although hormone levels and dosages should not change during ART treatment, doctors may still monitor them to ensure that a person feels comfortable with their treatment.
Over time, monitoring treatment may evolve into ensuring that a person sticks to their treatment schedule. Doctors may ask for regular checkups to discuss any potential changes in treatment or difficulties staying on the regimen.
Doctors may also recommend tools, such as devices, alarms, or apps, that remind a person about taking their medication to promote treatment adherence. For example,
People receiving hormone therapy may face both physical and mental barriers to ART.
If a doctor is unable to provide compassionate, gender-affirming care, this may sometimes prevent successful treatment. For example,
Working with a doctor whom they are comfortable with is crucial for people on hormone therapy. It may make reporting issues with either treatment easier, reducing or removing one of the possible barriers to treatment.
People who experience side effects from ART may find them challenging to manage.
If they cannot find a way to manage these side effects, people may be less regular with their treatment, which can reduce its effectiveness.
Social stigma may also play a role in preventing effective treatment. Social stigma or beliefs about gender-nonconforming individuals or HIV may make people feel isolated or uncomfortable talking about their treatment. They may look to hide or deny their treatment, which, if it affects adherence, may make the treatment less effective.
Treatment fatigue may also be a barrier to long-term HIV treatment. As there is no cure for HIV, a person will need to maintain a regular treatment regimen throughout their lifetime. Some people may find that keeping to their treatment plan becomes more difficult with time.
Regularly checking in with a doctor or using other tools, such as calendar reminders, may help a person stay on track with their treatment over time.
Other conditions or issues
Other issues that a person may face, such as substance misuse or mental health conditions, may also be a barrier to treatment if they interfere with the person’s ability or desire to keep themself healthy.
Working with a mental health professional may help ease the difficulties that mental health conditions can cause.
The National Institutes of Health (NIH) recommend that all people with HIV start treatment as soon as possible. HIV medicines help reduce HIV transmission and allow people with HIV to live longer and healthier lives.
People with early HIV infections or AIDS-defining conditions — severe and potentially life threatening conditions that indicate stage 3 HIV — must start treatment immediately.
Anyone who thinks that they may have HIV should talk with a doctor immediately. If a person believes that they may have had exposure to the bodily fluid of a person with HIV, they should speak with a doctor about testing for HIV.
Following a diagnosis, doctors will recommend beginning treatment as soon as possible. They will design and prescribe an HIV treatment regimen based on a person’s specific needs. The drug regimen will vary depending on potential drug interactions, possible side effects, and how the drugs work together to treat HIV.
After confirming the most suitable drug regimen, doctors will work with the person to monitor the treatment and make any changes necessary to treat HIV or relieve any side effects that occur.
ART enables people with HIV to stay healthy and live longer, and it reduces the risk of the virus transmitting to others.
Some people on hormone therapy, such as transgender or other gender-nonconforming individuals, may be skeptical about ART and fear that it may interact with their hormones.
However, there do not appear to be any interactions between ART and hormone therapy.
Doctors will monitor a person’s treatment, including their hormone levels. They will help identify any potential changes or side effects and adjust the treatment regimen in response to them to help people on hormone therapy stay consistent with their treatment plan in the long term.