Pre-exposure prophylaxis, orPrEP,involves taking medication to reduce your risk of acquiring HIV. It’s calledpre-exposurebecause people ideally take it before they are exposed to the virus. While not a perfect form ofHIV prevention, PrEP can substantially reduce your risk of becoming infected during sex with an infected partner, as well as reduce the risk of becoming infected through shared needles. Unfortunately, to date, most of the research on PrEP has been inserodiscordantheterosexual couples,cisgendermen who have sex with men, andtransgender womenwho have sex with men. This has left out another risk group—transgender men and other transmasculine people.
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Transmasculine individuals are those who were assigned female at birth but who have a more masculine gender identity. They may identify as men or transgender men, but they may also identify as transmasculine, genderqueer, non-binary, etc. Binary- and non-binary transmasculine individuals have a diverse range of sexual orientations and behaviors. They may identify as straight, gay, pansexual, bisexual, or another sexual orientation. They may use their vagina for sex, or they may not. They may have had aphalloplastyand/ormetoidioplasty. All of these factors can affectHIV risk.
Transgender Men and HIV
Despite that, the HIV-positive transmasculine individuals examined in the study experienced numerous difficulties in getting adequate HIV care. Almost half were living in poverty, a quarter were depressed, and 69% had at least one unmet health care need. In addition, only 60% were treated effectively enough for their viral load to remain suppressed over the entire 12 months before the survey.
So what are the sources of transmasculine HIV risk? They are as varied as the transgender men themselves. Studies have suggested that as many as 63% of transgender men may identify as gay, bisexual, and/or have sex with men.That means they may experience some of the same elevatedHIV riskas cisgender gay and bisexual men.
PrEP for Transgender Men
Another study looked at PrEP use among 857 transgender men who had had receptive anal or vaginal intercourse with a cisgender man within the last six months. More than half of them talked about behaviors that would make them eligible for PrEP, but only around a third had ever taken it. Importantly, that study pointed out some of the issues with using CDC guidelines to determine PrEP eligibility for transgender men. Depending on whether the researchers used the guidelines for men who have sex with men, heterosexual women, or injection drug users, the PrEP eligibility varied from 6% to 55%.
PrEP Efficacy for Transgender Men
How effective is PrEP for transgender men? We don’t entirely know. There is no efficacy data specifically for the transmasculine population.
There is no evidence that PrEP interacts withgender-affirming hormone therapy.However, if you’re concerned about this and want to start PrEP, talk to your healthcare provider about checking your hormone levels more often. That way your dose can be changed as needed.
Should Transgender Men Consider PrEP?
Whether PrEP is a good idea for transgender men and other transmasculine people depends on the person. Individuals who are at higher risk of HIV should definitely discuss PrEP with their healthcare provider. Factors that constitute a higher risk include:
If you fall into one of those categories, talk to your healthcare provider. That way you can weigh your options about whether PrEP is right for you. Just don’t forget that PrEP only reduces your risk of HIV, not of otherSTDs. Therefore,safer sexis still a good idea.
7 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Lemons A, Beer L, Finlayson T, et al.Characteristics of HIV-positive transgender men receiving medical care: United States, 2009-2014.Am J Public Health. 2018;108(1):128-130. doi:10.2105/AJPH.2017.304153
Bauer GR, Redman N, Bradley K, Scheim AI.Sexual health of trans men who are gay, bisexual, or who have sex with men: results from Ontario, Canada.Int J Transgend. 2013;14(2):66-74. doi:10.1080/15532739.2013.791650
Golub SA, Fikslin RA, Starbuck L, Klein A.High rates of PrEP eligibility but low rates of PrEP access among a national sample of transmasculine individuals.J Acquir Immune Defic Syndr.2019;82(1):e1-e7. doi:10.1097/QAI.0000000000002116
Reisner SL, Moore CS, Asquith A, et al.High risk and low uptake of pre-exposure prophylaxis to prevent HIV acquisition in a national online sample of transgender men who have sex with men in the United States.J Int AIDS Soc.2019;22(9):e25391. doi:10.1002/jia2.25391
Centers for Disease Control and Prevention.PrEP effectiveness.
Chou R, Evans C, Hoverman A, et al.Preexposure prophylaxis for the prevention of HIV infection: evidence report and systematic review for the US Preventive Services Task Force.JAMA.2019;321(22):2214-2230. doi:10.1001/jama.2019.2591
Feldman J, Romine RS, Bockting WO.HIV risk behaviors in the U.S. transgender population: Prevalence and predictors in a large internet sample.J Homosex. 2014;61(11):1558-88. doi:10.1080/00918369.2014.944048Poteat T, Malik M, Scheim A, Elliott A.HIV prevention among transgender populations: Knowledge gaps and evidence for action.Curr HIV/AIDS Rep. 2017;14(4):141-152. doi:10.1007/s11904-017-0360-1Vaitses fontanari AM, Zanella GI, Feijó M, Churchill S, Rodrigues lobato MI, Costa AB.HIV-related care for transgender people: A systematic review of studies from around the world.Soc Sci Med. 2019;230:280-294. doi:10.1016/j.socscimed.2019.03.016
Feldman J, Romine RS, Bockting WO.HIV risk behaviors in the U.S. transgender population: Prevalence and predictors in a large internet sample.J Homosex. 2014;61(11):1558-88. doi:10.1080/00918369.2014.944048
Poteat T, Malik M, Scheim A, Elliott A.HIV prevention among transgender populations: Knowledge gaps and evidence for action.Curr HIV/AIDS Rep. 2017;14(4):141-152. doi:10.1007/s11904-017-0360-1
Vaitses fontanari AM, Zanella GI, Feijó M, Churchill S, Rodrigues lobato MI, Costa AB.HIV-related care for transgender people: A systematic review of studies from around the world.Soc Sci Med. 2019;230:280-294. doi:10.1016/j.socscimed.2019.03.016
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