Preexposure prophylaxis (PrEP) is a medication to help prevent contracting HIV. People who have a high risk of HIV exposure may choose to take PrEP. It is also safe for transgender people.
PrEP is highly effective in preventing HIV-negative people from contracting HIV. People who are at high risk of HIV exposure can take PrEP before exposure to protect against HIV.
PrEP is safe for transgender people and safe to take alongside gender-affirming hormones and other gender-affirming procedures.
This article discusses taking PrEP alongside hormones, as well as how to take it, what it costs, and how to access it.
Truvada and Descovy are both PrEP medications. The type of hormone a person is taking will affect which PrEP medication they can take.
According to PleasePrEPMe, Truvada does not reduce hormone levels. Although Descovy is also unlikely to affect hormone levels, researchers still need to study it further.
Testosterone is safe to take with PrEP. Truvada is safe for people of all gender identities. However, there is currently limited research on Descovy, which does not currently have approval for those taking testosterone.
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.
The same 2020 study mentioned above looked at the effects of Truvada on 24 HIV-negative, transgender women who 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.
Taking PrEP alongside feminizing hormones will not cause fat redistribution in the face or body.
Interactions between PrEP and gender-affirming hormone therapy
However, the World Professional Association for Transgender Health (WPATH) suggests that doctors can safely prescribe PrEP and gender-affirming hormone therapy together.
WPATH notes that researchers have not extensively studied the interactions between PrEP and gender-affirming hormone therapy. However, recent studies suggest there are minimal interactions between the two treatments.
Although PrEP protects against HIV, it does not protect against any other STIs.
Using protection correctly, such as condoms or dental dams, and undergoing regular testing is important in protecting against STIs.
While using PrEP, people can get regular testing for HIV and other STIs every 3 months.
According to a
If a person is concerned about how PrEP will affect their choice of hormonal contraception, they can speak with a healthcare professional.
If a person has not undergone an orchidectomy or vasectomy, they will need to use contraceptives for 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:
- gonadotropin-releasing hormone (GnRH)
- cyproterone acetate (not available in the United States)
According to the Terrence Higgins Trust (THT), PrEP is safe to take:
- when trying to conceive
- during the pregnancy
- while chestfeeding or breastfeeding
People may want to consider PrEP if they are HIV-negative and at risk of HIV exposure. This includes people who:
- have a sexual partner who is HIV-positive
- do not consistently use condoms and are unsure of the HIV status of any sexual partners
- engage in sex work
- have recently had a bacterial STI
- use injection drugs and share drug equipment or have an injecting partner who is HIV-positive
In some cases, PrEP may not be suitable for people to take. This includes people who:
- have an unknown HIV status, as PrEP is only suitable for HIV-negative people
- have any signs or symptoms of acute HIV infection
- have reduced kidney function
- have an unknown hepatitis B or hepatitis B vaccination status
Before taking PrEP, it is important that people know their HIV status. People can go to a local testing center or sexual health clinic and get a full sexual health screen.
People will need an HIV test and a test to check kidney function to make sure that it is safe for them to take PrEP.
How to take PrEP
There are two ways to take PrEP: daily dosing or on-demand 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, daily PrEP 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.
For daily doses of PrEP, people will need to take the medication for 7 days before it will provide full protection against HIV.
On-demand dosing, or event-based dosing, is for people who are not taking gender-affirming hormones and have a risk of HIV from anal sex.
People take on-demand PrEP before and after they have sex.
The on-demand dosage is as
- 2 tablets 2–24 hours before having sex
- 2 tablets 24 hours after the first dose
- 1 tablet 24 hours after the second dose
It is important for those having sex for an extended period of time, for example, over a few days, to continue taking the pill every 24 hours. A person should do this until they have 2 sex-free days.
If a person assigned male at birth is not taking gender-affirming hormones and is only having anal sex, they can also take PrEP on-demand dosing.
People can talk with a healthcare professional about getting PrEP, or go to a sexual health clinic.
If people are finding it difficult to access PrEP, they may want to use an online resource such as PrEP Daily to talk with a PrEP navigator who can help connect people to a professional who can provide PrEP.
People can also find HIV testing and PrEP through the
If people want to stop taking daily PrEP, they will need to continue taking the medication for 7 days after they last had sex without a protective barrier.
If people are taking on-demand PrEP, they will need to continue taking the medication for 2 days after they last had sex without a condom or other barrier method.
If people want to restart PrEP, they will require a HIV test beforehand.
If people have a hepatitis B infection, they will need to speak with a healthcare professional before stopping PrEP.
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.
If people do not have health insurance and have an annual income of less than $63,000, they may be eligible for free PrEP. People can find out more about applying for financial assistance for PrEP from the San Francisco Aids Foundation or via the Please PrEP Me website.
The following section answers common questions about PrEP and gender-affirming hormone therapy.
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 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. Descovy is still being researched and does not yet have approval for people taking testosterone.
Does Truvada affect hormones?
Truvada does not reduce or increase hormone levels in transgender individuals. According to the
Can you take PrEP and birth control?
It is safe to take PrEP while on birth control. The
PrEP is a form of medication to help prevent people from contracting HIV.
It 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 may affect which PrEP medication they can have.
It is important to note that PrEP does not reduce the chance of contracting other STIs, and a person should use additional contraceptive measures. A person can discuss their options with a healthcare professional.