Preexposure prophylaxis (PrEP) is a medication that people can take to prevent contracting HIV. People who have a high risk of HIV exposure may choose to take PrEP. PrEP is safe for transgender people to take.

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 is safe to take alongside gender-affirming hormones and other gender-affirming procedures.

In this article, we look at taking PrEP alongside hormones, as well as how to take it, what it costs, and how to access it.

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Truvada and Descovy are both PrEP medications. The type of hormone a person is taking will affect which PrEP medication a person can take.

According to PleasePrEPMe.org, Truvada does not reduce hormone levels. Although Descovy is unlikely to affect hormone levels either, researchers still need to study it further.

Alongside testosterone

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 is not currently approved for those taking testosterone.

A 2020 study looked at the interaction between testosterone and PrEP in 24 transgender men who were HIV-negative, 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.

Alongside estrogen

It is safe to take estrogen alongside PrEP. Both Truvada and Descovy are approved for those taking estrogen.

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.

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.

It is safe for transgender people to take PrEP alongside contraception methods such as hormonal birth control.

According to a 2014 clinical trial, PrEP had no negative impact on the efficacy of hormonal contraceptives. Additionally, a 2017 systematic review notes that current data does not support limiting access to hormonal contraceptives for those taking PrEP. The authors state that people taking PrEP should have full access to all forms of hormonal contraception.

If a person is concerned about how PrEP will affect their choice of hormonal contraception, they should 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 hormonal therapy is not effective as a contraceptive. This includes:

  • estradiol
  • gonadotropin-releasing hormone (GnRH)
  • analogues
  • finasteride
  • cyproterone acetate

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, either as 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 follows:

  • two tablets 2–24 hours before having sex
  • one tablet 24 hours after the first dose
  • one 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.

Finding PrEP

If people do not know the nearest place to find PrEP, they can use this search tool to find someone local who can provide PrEP. People may also want to find PrEP through an online prescriber.

People can also find HIV testing and PrEP through the Centers for Disease Control and Prevention.

If people want to stop taking daily PrEP, they will need to continue taking the medication for 7 days after they last had unprotected sex.

If people are taking on-demand PrEP, they will need to continue taking the medication for 2 days after they last had unprotected sex.

If people want to restart PrEP, they will need to test for HIV before taking PrEP again.

If people have a hepatitis B infection, they will need to speak to 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 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 Sans Francisco Aids Foundation or through the Please PrEP Me website.

PrEP is a form of medication to help prevent people from contracting HIV.

It is safe for transgender individuals to take regardless of the hormones they are taking and whether or not they have undergone gender-affirming procedures. However, the type of hormone a person is taking may affect which PrEP medication they are able to take.

It is important to note the 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.