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PrEP & Gender Affirming Care

PrEP & Gender Affirming Care

Updated on:
April 25, 2022
In this library section

Many factors go into the decision to start taking daily PrEP medication such as the HIV status of your partner(s), how often you’re having sex, the type of sex you’re having, being a sex worker, and other medical factors. It can be a big decision that brings up many thoughts and discussions.

There are three PrEP pill options that all offer the same amount of protection against HIV: Truvada, generic Truvada, & the Descovy prescription.

One key group of people that has generally been left out of PrEP conversation (especially advertising) is transgender, non-binary, and gender non-conforming folks (Freddie is a great example of inclusive advertising!). This exclusion leads to questions and concerns about how PrEP may or may not affect one’s transition related goals.

Trans folks have often neglected to pursue PrEP out of fear of the drug interacting with their gender affirming hormone therapy. However, recent studies have proven that PrEP does not chemically interfere with testosterone and estrogen! Hooray! The iBrEATHe study (published August 2020) showed that there was no change in sex hormone levels in both trans women and trans men who were taking daily oral PrEP and hormone replacement therapy (HRT).

How does PrEP affect gender affirming hormone therapies?

PrEP does NOT affect the absorption or function of testosterone and estrogen therapies! In sciencey terms: HRT and PrEP go through different metabolic pathways, therefore drug-drug interactions are not expected. Additionally, the iBrEATHe study showed that blood concentrations of testosterone and estradiol were not affected by daily PrEP adherence, nor was the PrEP concentration affected by either hormone therapy. This is great news for trans folks who may be at higher risk of HIV transmission or looking to take a proactive hold on their sexual health.

I’ve been taking PrEP for a while and want to start HRT. Do I need to stop or change my PrEP prescription?

Since PrEP does not interact with HRT, there’s no need for you to stop taking your daily PrEP. You may find that taking testosterone or estrogen increases your sex drive, in which case being on PrEP will most certainly come in handy!

I’ve been on HRT for a while and want to start PrEP. Do I need to change my HRT schedule?

Because there are no drug-drug interactions expected, you should be fine to take PrEP and your HRT dose at the same time. More research is still needed in this area overall, but recent studies have shown that daily oral PrEP does not affect sex hormone absorption rates in your body for both testosterone and estrogen therapies.

Considerations for trans men/masculine/non-binary folks taking testosterone:

For front (vaginal) insertive sex, maximum protection begins 21 days after starting daily PrEP. Receptive anal sex protection begins after 7 days of daily PrEP.

Considerations for trans women/feminine/non-binary folks taking estrogen:

Receptive anal sex protection begins after 7 days of daily PrEP.


PrEP does not interact with estrogen or testosterone absorption rates or overall efficacy, meaning trans folks of all genders can benefit from PrEP without it affecting their HRT. In other words, gender affirming hormone therapy and daily oral PrEP can be part of your life at the same time without issue.

Still have questions? Unsure if PrEP is the right fit for you? Our medical team at Freddie is inclusive and informed on LGBTQ2S+ medical care; they’ll be able to help you understand your options. Get started with our quick and easy One-Minute PrEP Assessment to get personalized and instant feedback!

Reviewed by:
Dr. Caley Shukalek

Caley is passionate about evidence-based, patient-centred care, including telemedicine that can provide high quality care from wherever a patient may choose.

He helped create Alberta's PrEP guidelines and works as a specialist in General Internal Medicine with additional training in sexual health, including HIV and sexually transmitted infections.

He holds an Masters of Public Health from Johns Hopkins University, an MD from the University of Calgary and an MSc from the University of Alberta.