Many factors go into the decision to start taking daily PrEP 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.
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).
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.
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!
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.
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.
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!
This year, Freddie awarded $2,000 to one student from the LGBTQ2S+ community pursuing their education. After reviewing nearly 100 applications, our selection committee chose Rakhshan Kamran as the winner. Check out our interview with him!
COVID has resulted in many changes in social habits and safety practices, so patients have had questions about PrEP and COVID. Our team has compiled some answers for you below. Have a read!