Receiving gender-affirming hormone therapy (GAHT) alongside HIV treatment is both safe and effective and will not affect the outcome of either treatment. However, people who receive GAHT may face unique barriers that could undermine their HIV treatment.
HIV is a virus that attacks the immune system. Medications are available to help prevent HIV in people who are HIV-negative and manage HIV in people who are HIV-positive.
GAHT involves administering controlled amounts of hormones in an effort to help align a transgender or intersex person with their gender identity.
This article describes what GAHT is and provides information on whether people can receive GAHT and HIV treatment simultaneously. We also outline some ways people receiving GAHT can seek treatment for HIV and how they can best manage the condition.
Gender-affirming hormone therapy (GAHT) involves administering sex hormones to a transgender or intersex person to help align them with their gender identity. The therapy can help a person develop secondary sex characteristics associated with their gender identity and may help to alleviate gender dysphoria.
There are two main types of GAHT: testosterone-based and estrogen-based.
Testosterone-based hormone therapy
Testosterone-based hormone therapy involves administering the hormone “testosterone” to help define “masculine” secondary sex characteristics.
Estrogen-based hormone therapy
Estrogen-based hormone therapy involves administering various hormones to help define “feminine” secondary sex characteristics. These hormones may include:
- estrogen
- progestogens
- antiandrogens
- gonadotropin-releasing hormone modulators
GAHT-associated changes
Changes to secondary sex characteristics vary according to a person’s treatment goals. They may include changes in:
- the voice
- breast tissue growth
- patterns of hair growth
- muscle and fat distribution
Hormone therapy impacts the body in many ways. It may also cause changes to the following:
- mood
- personality
- appetite
- energy levels
The
HIV treatments
The primary treatment for HIV is antiretroviral therapy (ART), which uses a combination of drugs to help reduce the amount of HIV in the blood. This therapy effectively suppresses the virus, improving the person’s health while reducing the risk of transmission.
The National Institute of Health (NIH) recommends that all transgender people with HIV receive ART.
A 2019 analysis found that transgender women receiving HIV treatment achieve similar rates of viral suppression to cisgender women and cisgender men receiving the same treatment.
A 2021 study compared rates of viral suppression among transgender women with HIV who were either receiving GAHT or not receiving GAHT. The study found that those receiving GAHT had significantly higher viral suppression rates than those not receiving GAHT.
HIV preventive medication
Pre-exposure prophylaxis (PrEP) is a drug that people who are HIV-negative can take to help reduce their risk of HIV.
A 2020 study investigated possible drug interactions between sex hormone therapy and PrEP. According to the findings, PrEP did not affect concentrations of estrogen or estradiol hormones in blood samples from transgender women. It also did not affect concentrations of testosterone in blood samples from transgender men.
There were no clinical or self-reported incidences of hormone withdrawal during the 4-week study.
Both GAHT and HIV treatment can induce widespread changes in the body.
Gender-affirming hormone therapy may cause changes to the following:
- mood
- personality
- appetite
- energy levels
HIV treatment may cause side effects, including:
Not everyone who takes HIV treatment will experience side effects, but those who do should talk with their doctor. They may be able to prescribe additional medications to help manage the side effects.
The goal of HIV treatment is to achieve high rates of sustained viral suppression using ART. This therapy reduces the viral load in the body. The term “viral load” refers to the amount of HIV in the blood.
High viral suppression means having less than 200 copies of HIV per milliliter of blood. This helps keep the immune system strong and helps prevent HIV transmission.
In some cases, continuous HIV treatment may reduce the viral load to such an extent that the virus is no longer detectable in the blood. Medical professionals refer to this as an “undetectable viral load” (UVL). According to the
A person who is undergoing GAHT while receiving HIV treatment should work with a doctor who is familiar with GAHT. Such doctors will be better able to monitor any changes that occur while a person is receiving both types of therapy.
People receiving HIV treatment should take their medications consistently. They should never forget or skip a dose. Doing so gives the virus a chance to multiply in the blood. It may also allow the virus to build up a resistance to the drug.
People who are gender nonconforming may face unique challenges that can become a barrier to treatment. Examples include:
- Lack of compassion or understanding from care providers: It is important that a person works with a doctor who is familiar with GAHT and will provide a gender-affirming care model throughout HIV treatment. Receiving such care may make it easier for a person to:
- be consistent with treatment
- report any medication side effects
- manage any changes that occur during GAHT or HIV treatments
- Social stigma: Ideas about HIV and attitudes toward gender nonconforming individuals may make it difficult for people to discuss these issues or their treatment. This can affect a person’s mental health and cause them to avoid seeking treatment or hide their treatment from others.
A person who is receiving GAHT and wants to undergo treatment for HIV can talk with the doctor or medical team who oversees their GAHT. These medical professionals should be able to recommend a suitable doctor who understands gender-affirming care. Having such a doctor increases the likelihood that a person will continue with their HIV treatment plan.
HIV treatment should begin as quickly as possible following the initial diagnosis. Delaying treatment gives the virus a chance to multiply rapidly in the blood and start causing damage to the immune system.
Studies show that people receiving gender-affirming hormone therapy (GAHT) can safely take pre-exposure prophylaxis (PrEP) medications to help prevent HIV, as well as antiretroviral (ART) medications to help manage HIV. Experts have not identified any interactions between the different drugs.
Nonetheless, people receiving GAHT may face unique barriers to HIV treatment. They may encounter doctors who are inexperienced with gender-affirming care and may experience social stigma relating to HIV or gender nonconformity. These barriers can make a person less likely to continue with their HIV treatment.
If necessary, a person can have their GAHT medical team recommend a suitable doctor to oversee their HIV treatment. This treatment should begin as soon as possible to help reduce the viral load within the person’s body. Doing so will improve the person’s health and help prevent transmission of the virus.