Some transgender men, including those who have sex with non-transgender men, may have an increased risk of HIV. Understanding this risk, taking precautions, and receiving medical care are key. HIV treatment is highly effective.

Transgender men who have condomless sex with non-transgender men (trans MSM) may have an increased risk of HIV. Having sex with a barrier method of protection, such as a condom, having regular testing, and receiving medication promptly can help prevent and treat HIV.

People with a high risk of exposure or recent exposure might consider medication to prevent HIV.

This article discusses the prevalence and risk of HIV for transgender men, as well as treatment and prevention methods and tips for accessing suitable healthcare.

A transgender man playing chess.Share on Pinterest
NicolasMcComber/Getty Images

Most scientific studies relating to HIV and transgender people focus on transgender women — research about HIV and transgender men is limited.

According to research from 2018, this is because HIV prevalence is thought to be higher among transgender women: approximately 25–31%, compared with 0–3% among transgender men.

Other research, from the University of California San Francisco, suggests that trans MSM have an increased risk of contracting HIV, including those who do sex work.

This research states that in one study, most trans MSM reported not consistently using a condom during receptive anal and frontal sex with non-trans male partners. Participants also reported low rates of HIV testing and a low perception of the risk.

Research suggests that the prevalence of HIV among transgender men is 0–3%, based on self-reported data.

The same research reports an HIV prevalence among non-trans MSM in urban areas of roughly 17–40%, with increasing rates of sexually transmitted infections (STIs).

This means that in these areas, trans MSM who have condomless, receptive anal or frontal sex with non-trans MSM may have an increased risk of contracting HIV and other STIs.

However, there is still too little data to accurately assess HIV rates among transgender men. This may be due to:

  • a lack of accurate data collection at testing sites
  • a lack of understanding and research into the experiences and sexual behaviors of transgender men
  • assumptions about the sexual orientations of transgender men, such as the assumption that most transgender men are having sex with non-trans women

The Centers for Disease Control and Prevention (CDC) say that the following factors may affect the prevalence and health outcomes of HIV in transgender men:

  • Discrimination and racism: This can limit access to housing, employment, and healthcare, which may lead to increased risk-taking behavior and negatively affect access to HIV care and treatment.
  • Cissexism: Oppression, abuse, and harassment due to a gender identity or expression may prevent transgender people from accessing appropriate HIV care and treatment.
  • HIV stigma: Social stigma around HIV may prevent transgender people from seeking regular testing.
  • A lack of gender recognition: Research from 2017 suggests that transgender or gender minority youth may be less likely to engage with HIV treatment and prevention services due to a lack of recognition and support of their gender identities. The study notes that stigma in HIV care and medical gender affirmation in health settings were associated with a higher likelihood of missed appointments.
  • A lack of multilevel interventions: Multiple interventions that focus on the structural, behavioral, and biomedical risks of HIV among transgender people may be effective in addressing HIV disparities.
  • A lack of knowledge: If healthcare providers lack knowledge or training in serving transgender people and understanding their needs, it can be a barrier to transgender people seeking HIV care.
  • An unmet need for gender affirmation: If transgender people feel that they are not receiving healthcare related to gender affirmation, including hormone and surgical needs, they may be less likely to engage in HIV treatment and prevention services.

Transgender men may also engage in risk-taking sexual behavior due to:

  • high rates of depression, substance abuse, and low self-esteem
  • alcohol and drug use
  • an increased sex drive as a result of taking testosterone

Additionally, some trans MSM may find validation in having sex with non-trans gay male partners, which may affect how they communicate about barrier methods of protection, such as condoms.

The Terrence Higgins Trust notes that taking testosterone and having reduced estrogen levels can change front hole lubrication and decrease the thickness of the walls of the front hole.

This can increase the chance of tearing during frontal sex, increasing the opportunities for HIV and other STI pathogens to enter the body.

HIV prevention strategies can include:

  • using condoms and other barrier methods of protection
  • regularly testing for HIV and other STIs
  • taking pre-exposure prophylaxis (PrEP), which is medication to prevent HIV
  • taking post-exposure prophylaxis, or PEP, which is medication to prevent HIV after a possible exposure

For HIV-positive people, treatments can effectively manage HIV and prevent the virus from passing to others.

PrEP is medication to prevent HIV. Currently, two PrEP drugs have received approval from the Food and Drug Administration (FDA): Truvada and Descovy.

Truvada is approved for use by all people. Descovy is only approved for non-trans males and transgender females. Researchers are currently investigating whether it is safe for transgender males and non-trans females.

Any transgender man with a high risk of contracting HIV might consider taking PrEP.

PrEP and testosterone

There has been limited research into the effect of PrEP on testosterone. A 2020 study involving 24 transgender men found that Truvada was safe and effective for people taking testosterone.

Transgender males in the study had been taking testosterone for at least 6 months, were over the age of 18, and tested negative for HIV.

Participants took PrEP, a combination of emtricitabine and tenofovir disoproxil fumarate, every day for 4 weeks. After 4 weeks, the researchers found no cases of HIV and no changes to concentrations of free or total testosterone levels among the transgender male participants.

None of the participants stopped taking PrEP due to negative effects, although side effects did include nausea, an upset stomach, and fatigue. Reports of side effects decreased as the study went on.

PrEP is only effective in protecting against HIV. It is still important to use a barrier method of protection, such as condoms, to prevent other STIs.

It is safe for transgender men to take PrEP and use:

  • contraceptive methods, including hormonal birth control
  • conceive and have a pregnancy that is safe for themselves and their baby
  • chestfeed

For transgender men who test positive for HIV, antiretroviral medication is an effective treatment.

This medication can reduce the amount of HIV in the bloodstream, known as the viral load, until it is undetectable. An undetectable viral load allows HIV-positive people to live long, healthy lives and prevents the virus from passing to a sexual partner.

To find trans-friendly clinics and healthcare services, including local HIV prevention and treatment services, a person can search in various databases, including the CDC’s Get Tested search tool.

People in the United States can also search for local PrEP providers here.

A variety of organizations and support groups provide HIV support to transgender men.

People can search for trans-friendly healthcare professionals here, including those that specialize in HIV, sexual health, and mental health.

GLAAD also have a resources page, with transgender support and advocacy groups, as well as resources for legal advice.

Trans MSM may have an increased risk of contracting HIV.

Using barrier methods during sex, having regular testing, and taking any necessary medication for preventing or treating HIV can help reduce the risk and effectively prevent or treat HIV.

Read this article in Spanish.