Yes! You can safely take hormone replacement therapy (HRT) and HIV medications without affecting how either drug works!

What’s HRT? And what is HIV medication?

HRT is a gender-affirming treatment which blocks certain hormones while increasing others. Some trans people might take HRT to manage dysphoria and/or to feel gender euphoria.

HIV medications are medications that treat HIV, and help manage someone’s risk for giving or getting HIV. These include anti-retroviral therapies (ART) or Pre-Exposure Prophylaxis (PrEP). People with HIV take ART to reduce the amount of virus in the blood. This helps to keep their immune system healthy, and lowers the risk of them giving HIV to someone else. Someone who takes ART can have what’s called an undetectable viral load, which means they can’t give HIV to someone else — even through sex without a condom!

People who don’t have HIV, but might be at a higher risk for it, can take PrEP. PrEP is kind of like birth control but for HIV prevention! When someone takes it regularly, it lowers the risk of them getting HIV. Different types of PrEP may be taken daily, on-demand, or as a long-term injectable.

Post-exposure prophylaxis, or PEP, is kind of like Plan B for but HIV prevention. Someone can take it after something happens that could put them at risk for getting HIV in order to lower their risk.

I’m on PrEP and want to start HRT, or vice versa

If you’re already taking daily, on-demand, or long-term injectable PrEP, you can keep taking it as usual when you start taking HRT. If you’re already taking HRT, you can keep taking it as usually when you start taking PrEP. PrEP doesn’t affect how HRT works.

In the past, some studies have shown that estradiol and cytoproterone might lower the effectiveness of daily PrEP by 12-25%. But since then, other studies have contracticted these findings, showing no significant difference in effectiveness of daily prep for people on these hormones. And, there are a lot of things that can lower the effectiveness of daily PrEP! It’s important to know that daily PrEP can still prevent HIV for people who take these hormones.

There’s no evidence that other hormones someone might take, like testosterone, lower the effectiveness of daily PrEP. And the effects of HRT on other types of PrEP, like on-demand PrEP and long-term injectable PrEP, don’t have that much research on them. But, most experts agree that people taking HRT can still benefit from PrEP. For more on getting PrEP in Montreal, you can check out our other FAQ article!

I’m on ART and want to start HRT, or vice versa

You can take ART and HRT at the same time without affecting how well either drug works! Estrogen and testosterone levels are unaffected by ART, which means you don’t need to change your HRT dosage. Similarly, there’s no need to change your ART schedule when starting HRT.

There’s evidence that, for trans people living with HIV, taking HRT can help with staying on ART and taking it every day. That means taking HRT can ultimately help lower someone’s viral load!

If you’re on ART and want to start HRT or vice versa, you can talk to a doctor about it. If they’re not familiar with gender-affirming care protocols, you can ask them to refer you to someone who is. You can also check ASTT(E)Q’s list of trans-friendly healthcare and service providers in Montreal! And, you can reach out to Zack at ACCM’S Queer and Trans Outreach program for one-on-one support and help finding trans-friendly resources for people living with or affected by HIV.

I’m taking HRT and I think I might need PEP

If you’re taking HRT and you think you might need PEP, you can talk to a doctor to get a prescription and start taking it as soon as possible. PEP is most effective if you start it within 72 hours of whatever put you at risk.

To get PEP, you’ll need to see a doctor or a nurse. They may you some questions about your level of risk for HIV, and give you a rapid test for HIV. That’s because PEP should only be taken by people who don’t already have HIV. While there’s no known risk for interactions between PEP and HRT, you can tell the doctor or nurse about any other medications you’re on, including HRT.

Some people worry that PEP might change someone’s weight, or the fat distribution in their body. But, there’s no evidence that PEP does this at all! For more on getting PEP in Montreal, you can check out our other FAQ article.

If you have more medical questions regarding HRT or if you’re thinking of transitioning in Quebec, you can get more information at transitionner.info. While in French, the website can be translated by your browser and has information about professional standards for gender-affirming care and transitioning.