Not all sex is the same. That’s one of the many beautiful parts of our diverse community. While it’s possible for anyone of any gender to get HIV, some folks have a higher likelihood of getting HIV (human immunodeficiency virus). Knowing what those bodies and sex acts look like can help you play it safe and remain negative for HIV. 

Some anatomies & behaviors have a higher probability of exposure to HIV:

• Those with a penis who are having anal or vaginal sex with parter(s) with or without a penis
• Those without a penis who are having anal or vaginal sex with partner(s) with a penis
• Those who inject recreational drugs and might share needles

Fortunately, there’s PrEP (pre-exposure prophylaxis): a medication used to prevent HIV or stop HIV from taking hold and spreading throughout the body. With this, people of all genders can be safer in their bodies. For those on Hormone Replacement Therapy (HRT), we are here to shed some light on hormones and PrEP. Daily PrEP is 99% effective at preventing HIV infection through anal or vaginal sexual activity and at least 74% effective when exposed to HIV through injection drug use.

Big picture: PrEP does not decrease the effectiveness of HRT.

The top level takeaway  is that PrEP does not decrease the effectiveness of hormone replacement therapy. You can take PrEP and while still maintaining  the same effects that testosterone or estrogen has on your  body. You can take PrEP and still have the same effects of testosterone or estrogen on their body. A new study published in the journal Clinical Infection Diseases and presented at the AIDS 2020 conference found that, after four weeks of daily PrEP use, estradiol or testosterone levels were not affected.

With estrogen, there are some questions around PrEP levels, but research needs to be expanded.

There aren’t many large-scale, generously-funded studies that look into the impact of hormone replacement therapy and any associated medications. And unfortunately, there aren’t many large-scale studies into trans healthcare, period. However, one study has shown that taking estrogen may decrease the amount of PrEP in the bloodstream, and therefore may decrease how effectively PrEP protects you from acquiring HIV.

We do not recommend anyone who is taking estrogen to use PrEP-on-demand (PrEP 2-1-1) since that medication is not as effective as continual daily PrEP. Given the possible decrease in PrEP with estrogen, PrEP 2-1-1 may not provide adequate protection against HIV.

Whether on E or T, just be sure to stay consistent with PrEP!

The good news is that PrEP does not decrease the effectiveness of HRT. You can continue taking PrEP and not have to worry about whether or not this will impact your journey on hormones. Hormones, protection, and safety for all! But you should aim to follow these basic guides, regardless of whether you’re taking testosterone or estrogen:

• Make sure to take PrEP as consistently as possible--every 24 hours. This will keep a steady supply of PrEP in your bloodstream.
• Continue to use barrier methods, such as condoms, in addition to PrEP as additional protection against HIV.

FOLX is currently able to prescribe daily PrEP with TDF/FTC, and the process begins here. For existing FOLX members interested in adding a PrEP prescription to their plan, reach out to your clinician through your Athena patient portal or reach out to our member advocates at support@folxhealth.com. And for those who want to know more, read up on all things sexual health here, and feel free to reach out to us at support@folxhealth.com.