Gender-Affirming Hormone Therapy and Antiretroviral Drugs of Human Immune Deficiency Virus
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Abstract
Transgender healthcare consists of three main components, including social transition, gender-affirming hormone treatment, and gender-affirming surgery. Not all transgender individuals need all available treatment options, they have different ways to select the appropriate and suitable therapeutic options. Gender-affirming hormone therapy should be prescribed individually based on benefits versus potential short- and long-term individual risks. There is a major difference in hormone therapy between transgender women and transgender men. In adult transgender women, estrogen and antiandrogen are used to replace female hormone and suppress endogenous male hormone, respectively. On the other hand, estrogen-only therapy should be used in transgender women who had undergone orchiectomy-based gender affirming surgery. In transgender men, testosterone-only therapy can be prescribed for transgender individuals who had or had not undergone gender affirming surgery. Testosterone therapy simultaneously suppresses endogenous female hormone and replaces exogenous male hormone with a single agent. Antiretroviral therapy for Human Immune Deficiency Virus (HIV) prevention, including pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP) are very interesting options due to its efficacy. Combinations of transgender hormone therapy and HIV prophylaxis in transgender individuals are common in clinical practice. The drug interaction of the concurrent use of gender-affirming hormone therapy and some antiretroviral drugs for HIV should be taken into account. Some types of antiretroviral drugs affect circulating sex hormone levels. However, some serum antiretroviral drug levels are affected by sex hormone treatment. In clinical practice, the concurrent use of both groups of drugs could be considered. The appropriate strategies are to select the right agents, monitor serum sex hormones, and the appropriate adjustment dose of gender-affirming hormone therapy.
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