HRT & PrEP: Ensuring Safe Sex in a Body You Can Call Home

Let’s start here: anyone, any gender, can get HIV (human immunodeficiency virus), but certain folx are more at risk than others.

Navigating HRT and PreP

The three main categories of folx slightly more at risk for 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 may inject recreational drugs and share needles

Fortunately, there’s PrEP, or 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, and for those on Hormone Replacement Therapy (HRT), we can shed a little light here on hormones and PrEP.

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High-level: PrEP does not decrease the effectiveness of HRT.

The first and most important piece of information to know is that PrEP does not decrease the effectiveness of hormone replacement therapy. Folx 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. That’s it, that’s the section.

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. 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 211) since that is not as effective as continual daily PrEP, and given the possible decrease in PrEP with estrogen, may not provide adequate protection against HIV.

Whether on estrogen or testosterone, just be sure to stay consistent with PrEP!

PrEP does not decrease the effectiveness of hormone replacement therapy. Folx can take PrEP and still have the same effects of hormones on their body, so no worries! Protection from HIV and hormones and safety for all! But folx should aim to follow these basic guides, regardless of whether they are 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.

For FOLX members who think they may be at higher risk for HIV, consider scheduling an appointment with a provider. For anyone who isn't a FOLX member, drop us a line at thelibrary@folxhealth.com and we'll do our best to offer some helpful info.