References UK clinical guidance from the NHS, the British HIV Association (BHIVA), and the British Association for Sexual Health and HIV (BASHH). Last updated: April 2026.
PrEP (pre-exposure prophylaxis) and gender-affirming hormone therapy can be taken together safely. There are no significant drug interactions between tenofovir/emtricitabine (the standard PrEP medication) and oestrogen, testosterone, or the other hormones used in gender-affirming care. Both treatments work independently in the body without reducing each other’s effectiveness.
If you’re a trans person considering PrEP or already taking hormones, here’s what you need to know.
Is It Safe to Take PrEP with Hormones?
Yes. Clinical studies and real-world experience show that PrEP and gender-affirming hormone therapy can be safely combined. The drugs work on different systems in the body and don’t interfere with each other’s metabolism in clinically significant ways.
Does PrEP Reduce the Effectiveness of Hormones?
No meaningful reduction. Research has specifically looked at whether tenofovir/emtricitabine affects oestrogen or testosterone levels and found no significant changes. You don’t need to adjust your hormone dose when starting PrEP.
Do Hormones Reduce PrEP Effectiveness?
There was early concern that feminising hormones might lower tenofovir levels in rectal tissue, potentially reducing PrEP protection during receptive anal sex. More recent studies suggest this concern was overstated. For full protection, the key factor is consistent daily PrEP use, which is the most important determinant of effectiveness.
For trans women on feminising hormones, daily PrEP is recommended rather than “on-demand” PrEP, to ensure consistent drug levels.
PrEP Options for Trans People
- Daily oral PrEP (tenofovir/emtricitabine) — the standard option, safe with all hormones
- Event-based PrEP — not recommended for trans women on feminising hormones; daily is safer
- Long-acting injectable PrEP (cabotegravir) — newer option, also compatible with hormones
Practical Considerations
- Take PrEP at a consistent time each day — you can take it alongside your hormones if that helps you remember
- Regular HIV and STI testing is part of PrEP care (every 3 months)
- Tell your HIV clinic about your hormone regimen so they have a complete picture
- Tell your gender clinic you’re on PrEP so they have a complete picture
- PrEP doesn’t affect any gender-affirming surgeries you may have
Read more: What is PrEP? | What is HIV?
Frequently Asked Questions
Will PrEP affect my transition?
No. PrEP has no impact on your transition, hormone levels, or gender-affirming care. It works entirely separately.
Do I need any extra blood tests on PrEP if I’m on hormones?
Standard PrEP monitoring (HIV, kidney function, STI screening every 3 months) is the same for everyone. Your gender clinic will continue their own hormone-level monitoring as usual. No extra tests are needed just because you take both.
Can trans men take PrEP?
Yes. Testosterone has no interaction with PrEP. Trans men at risk of HIV can take PrEP safely alongside testosterone therapy.
Related reading
- Are HIV Tests Accurate If You're on PrEP, PEP or ART?
- Choosing the Right PrEP Drug: Truvada vs Descovy
- Post-Exposure Prophylaxis (PEP) for HIV
- Pre-Exposure Prophylaxis (PrEP) for HIV
- PrEP and Sexually Transmitted Infections
Sources
- NHS — Sexual health conditions
- BASHH — UK clinical guidelines for STI management
- British HIV Association (BHIVA) — HIV treatment guidelines
- Terrence Higgins Trust — sexual health information
- UK Health Security Agency — STI surveillance data
Steve Page is a recognised expert on Sexually Transmitted Diseases (STDs) and STD treatments, having published numerous articles in peer-reviewed journals and presented his research at conferences around the world. He has an in-depth understanding of the latest medical research on STDs, and is an advocate for the development of new treatments and protocols to improve the health of those affected. In addition to his research, he has dedicated his career to understanding the causes and symptoms of STDs, as well as how to best treat those impacted.
