HIV & trans women — hormones, ART, and the care you deserve.

There is a question that comes up in almost every conversation between a trans woman and an HIV clinic, and it is almost never asked out loud: if I start this medication, will I lose my hormones? It sits under the silence in the exam room. It shapes whether prescriptions get filled. And for a long time nobody bothered to answer it with data, which is its own kind of answer about who research was designed for.

The federal HIV treatment guidelines now put a number on the cost of that silence. Roughly 40% of trans women living with HIV reported not taking their antiretrovirals as directed because they were worried about interactions with their gender-affirming hormones — and fewer than half had ever raised that worry with a provider.5 That is not a story about anyone being careless. That is a story about a health system that made people choose between two things they needed and then never explained whether the choice was real.

Mostly, it is not real. The pharmacokinetic studies that finally got done — in Bangkok, in Toronto, inside the DISCOVER and HPTN 083 trials — point in a consistent direction: modern integrase-based HIV treatment and modern PrEP can sit alongside feminizing hormone therapy without either one being sacrificed. This page walks through what those studies found, what genuinely does need watching, and the far larger set of things that actually drive HIV among trans women: housing, income, criminalization, violence, and clinics that never learned to use your name.

The numbers — and what they are actually measuring

Start with the honest version of the epidemiology. In a CDC meta-analysis pooling 88 U.S. studies conducted between 2006 and 2017, laboratory-confirmed HIV prevalence was 14.1% among trans women, 3.2% among trans men, and 9.2% among all trans people studied — against an adult U.S. prevalence of well under half a percent. Among Black participants, prevalence reached 44.2%, compared with 6.7% among white participants.1

Then CDC went and asked. The National HIV Behavioral Surveillance among Transgender Women interviewed 1,608 trans women across seven urban areas between June 2019 and February 2020. Thirty-eight percent had previously received a positive HIV test result, and another 4% tested positive during the study — 42% combined.2 City-level prevalence ranged from 21% in Seattle to 58% in Atlanta.2

The numbers in the same survey that nobody quotes are the ones that explain them. Forty-four percent of the trans women interviewed had earned less than $10,000 in the previous year. Thirty-nine percent had experienced homelessness in the past 12 months. Forty percent reported severe food insecurity.2 Nearly two-thirds were living at or below the federal poverty level.1

Poverty is not context. It is the mechanism.

The survey did not just describe hardship — it linked hardship directly to clinical outcomes. Trans women who had experienced homelessness in the past year were significantly less likely to have a suppressed viral load (adjusted prevalence ratio 0.88). So were those with severe food insecurity (aPR 0.84). The most striking finding was about the clinic itself: trans women who felt comfortable discussing gender-related health needs with their provider were more likely to be virally suppressed (aPR 1.17) and dramatically more likely to be using PrEP (aPR 1.79).2 Comfort was measurable as viral suppression. Across the seven cities, that comfort ranged from 66% to 91%.2

Nationally, trans people accounted for about 2% of new HIV diagnoses in the United States, and roughly 93% of diagnoses among trans people were among trans women.1 By the end of 2022, 83% of trans people with diagnosed HIV had received some HIV care, but only 67% were virally suppressed — well short of the 95% national target. HIV-related deaths among trans women rose 20% between 2018 and 2022.5

The global picture: an epidemic that is not shrinking

Worldwide, the trend line has gone the wrong way. UNAIDS reported that new HIV infections among trans women rose 3% between 2010 and 2022, and that trans women's risk of acquiring HIV relative to the general adult population climbed from 11 times higher in 2010 to 20 times higher in 2022. Median HIV prevalence across 34 reporting countries was 9.2%, ranging as high as 58% in South Africa.3 Prevention service coverage sat at a median of 39% against a 95% target, and antiretroviral coverage at a median of 55%.3 As of June 2024, at least 16 countries criminalized gender identity or expression outright.3

The framing that best fits this data comes from Tonia Poteat, Andrea Radix, and colleagues, whose 2015 Lancet analysis calculated an odds ratio of 48.8 for HIV among trans women compared with other adults of reproductive age, with global prevalence around 19.1%.4 An updated 2021 meta-analysis of 98 studies covering 48,604 trans feminine people put standardized prevalence at 19.9%, with an odds ratio of 66.0.4 Poteat's team described trans feminine communities as carrying "some of the highest concentrated HIV epidemics in the world" — language that deliberately locates the problem in structural exclusion rather than in individual behavior.

Hormones and HIV medication — what the studies actually found

This is the section most people came for, so let us be precise. Feminizing hormone therapy typically means an estrogen — most often estradiol, given orally, transdermally, or by injection — usually combined with an anti-androgen such as spironolactone. The clinical goal in adults is to suppress testosterone below 50 ng/dL while holding serum estradiol in a range of roughly 100–200 pg/mL.5 This is not the same thing as postmenopausal hormone therapy in cisgender women — different doses, different formulations, different targets — and studies of one should never be quietly substituted for the other.

Both estradiol and several antiretrovirals are handled by overlapping liver enzyme systems, mainly CYP3A4, which is why the interaction question is a real pharmacological question and not a myth. But the answer depends enormously on which antiretrovirals.

The Toronto study: no difference at all

Marina Loutfy's team in Toronto ran the study that most directly answers the exam-room question. They compared estradiol concentrations in trans women living with HIV who were virally suppressed on unboosted integrase inhibitor regimens — six on bictegravir/emtricitabine/tenofovir alafenamide, two on dolutegravir/abacavir/lamivudine — against trans women without HIV taking oral estradiol. Median dose in both groups was 4 mg. There was no significant difference in any estradiol measurement between the groups, and 73% of all participants hit the target estradiol range.7 The sample was small — 15 people — and the authors were appropriately cautious. But the direction was unambiguous: low probability of clinically relevant interaction.

The same Canadian research program produced a finding about prescribing that is arguably more consequential than the pharmacology. Across a cohort of 1,495 trans women, only 71.8% of those living with HIV had been prescribed feminizing hormone therapy at all, compared with 88.4% of those without HIV — and among those who were prescribed it, serum estradiol levels were statistically identical between groups.7 Read those two numbers together. The hormones worked fine. The prescriptions were the thing being withheld.

The Bangkok studies: where a real interaction shows up

The iFACT studies out of Thailand tested the older regimens, and they did find something. In 20 trans women starting tenofovir disoproxil fumarate/emtricitabine plus efavirenz, estradiol exposure fell by roughly 28% (geometric mean ratio 0.72 for AUC), with the trough concentration dropping further.8 That is a genuine, measurable reduction — and it is worth knowing that efavirenz is the culprit, not HIV treatment as a category. Two details keep it in proportion: testosterone did not rise despite the estradiol drop, and 90% of participants had a viral load below 40 copies/mL after seven weeks.8 Efavirenz-based therapy is no longer first-line in U.S. guidelines, and the integrase-based regimens that replaced it do not show this effect.

Bone, heart, and clot risk — the other conversation

The guidelines flag a second set of considerations that has nothing to do with hormone levels and everything to do with long-term health. Antiretroviral choice should avoid adding unnecessary cardiovascular or bone risk on top of what hormone therapy may already contribute. Tenofovir disoproxil fumarate should be used with caution in anyone with osteoporosis risk factors, and bone density screening by DEXA is recommended by age 50. Where cardiovascular risk is elevated, transdermal estradiol may be the safer route because it carries a lower thromboembolism risk than oral dosing.5 Separately, ethinyl estradiol and conjugated equine estrogens are not recommended for gender-affirming hormone therapy at all, because of venous thromboembolism risk.6

One practical note the guidelines add: long-acting injectable antiretrovirals given intramuscularly in the buttock should not be injected into areas with gluteal implants or soft-tissue fillers.5 Tell whoever is giving the injection. It is a two-second conversation that prevents a real problem.

Integrated care — why one clinic beats two

The federal guidelines contain a recommendation graded AII, which in that system means a strong recommendation supported by nonrandomized clinical trial or cohort data: HIV care for trans people should be delivered within a gender-affirming care model.5 This is not a comfort measure. It is a clinical intervention with outcome data behind it.

Three findings from that evidence base are worth stating plainly. Providers who use a person's chosen name and pronouns have patients who are more likely to be virally suppressed. Adherence to hormone therapy correlates with adherence to antiretroviral therapy — the two habits reinforce each other rather than compete. And most importantly: making hormone access contingent on HIV treatment adherence is associated with a lower likelihood of viral suppression.5 Some clinics have used hormones as leverage — take your HIV meds and you get your estradiol. The data say it backfires. If a provider has ever framed it that way to you, they were working against your health, and the guidelines say so.

Integration also reduces the sheer logistical load. Co-locating HIV and gender-affirming services means fewer appointments, fewer waiting rooms where you have to brace yourself, and one blood draw instead of two. Routine HIV monitoring can ride along with the labs already being drawn for hormone titration.5 Peer navigation — support from people with shared experience — improves sustained viral suppression, and visibly trans staff make engagement more likely.5

Models like this exist and have been studied. Callen-Lorde Community Health Center in New York — one of the largest outpatient trans health practices in the country, serving more than 3,000 trans and gender-nonconforming patients — has been documented in the peer-reviewed literature as an integrated model where HIV testing is folded into the routine bloodwork already needed for hormone monitoring.5 Internationally, the Tangerine Clinic in Bangkok, a trans-led integrated gender-affirming and sexual health service, published data on 1,534 trans women showing that only 34.2% had hormone levels within target at baseline — mostly because levels were too low, not too high — and that more than half improved after engagement with the clinic.8 Brazil's response offers a scale example: São Paulo state created 30 new comprehensive services across 26 cities in a single year, and the Trans Amigas peer navigation programme was associated with 40% higher retention in care.3

PrEP — the evidence, the myths, and the new options

PrEP is HIV prevention medication for people who do not have HIV. For trans women it has a complicated history that is worth knowing, because the myths that circulate today are fossils of research decisions made fifteen years ago.

Why the early data looked bad

The iPrEx trial established that daily oral tenofovir/emtricitabine prevents HIV. When researchers went back — at the insistence of trans community advocates — and analyzed the 339 trans women in the study separately, the intention-to-treat result showed no benefit: 11 infections in the PrEP arm versus 10 in placebo.11 That headline traveled for years and did real damage.

The rest of the analysis almost never traveled with it. No trans woman who acquired HIV in the trial had any detectable drug in her blood. And no trans woman with drug levels consistent with four or more doses per week became infected.11 The finding was not that PrEP fails in trans women. The finding was that trans women in that trial were not taking it — plausibly because a study framed around "men who have sex with men" was not built to reach them, and because the hormone-interaction fear had no answers yet.

The pharmacokinetics have now been done

Several studies have since measured directly whether hormones and PrEP interfere with each other, and the pattern is consistent. Feminizing hormone therapy modestly lowers tenofovir in blood plasma — around 12–24% depending on the study — but does not meaningfully reduce the active intracellular forms of the drug, tenofovir diphosphate and emtricitabine triphosphate, which are what actually block HIV.913 A 2024 review of the literature concluded that PrEP efficacy "is expected to be maintained despite this interaction," and found no demonstrated interaction between hormones and either cabotegravir or tenofovir alafenamide.13

Crucially, the traffic runs one way. PrEP does not lower hormone levels. The iFACT PrEP analysis found no change in estradiol or testosterone pharmacokinetics with tenofovir/emtricitabine, and the 2025 iFACT-3 study found no significant bidirectional interaction between hormones and oral emtricitabine/tenofovir alafenamide across blood, cellular, and rectal tissue compartments.9 Inside the DISCOVER trial, intracellular drug levels in trans women taking hormones were comparable to those in cisgender men who were not.12

Long-acting options, and a trial that got enrollment right

HPTN 083 tested injectable cabotegravir every two months against daily oral pills, and it deliberately set a minimum enrollment floor of 10% trans women — a design choice worth naming, because it is why usable data exist. The trial enrolled 570 trans women, 58% of whom reported using gender-affirming hormones. In the trans women specifically, there were 2 infections on cabotegravir versus 7 on oral tenofovir/emtricitabine, and cabotegravir drug concentrations did not differ by hormone use.14 In the overall trial, injectable cabotegravir reduced HIV acquisition by 66% compared with daily pills.14

The newest option is lenacapavir, a twice-yearly injection. PURPOSE 2 enrolled 3,265 people including trans women, trans men, and gender-nonbinary people who have sex with partners assigned male at birth. There were 2 infections in the lenacapavir group compared with 9 on daily oral tenofovir/emtricitabine — a 96% reduction against background incidence and 89% against the daily pill.15 The companion PURPOSE 1 trial in cisgender women in South Africa and Uganda recorded zero infections among 2,134 participants.15 The FDA approved lenacapavir for PrEP in June 2025, and CDC clinical guidance now includes twice-yearly lenacapavir as a strongly recommended PrEP option for people weighing at least 35 kg.15

The actual barriers

Among 902 trans women without HIV surveyed by CDC across seven urban areas, 57% had recently discussed PrEP with a provider and 32% had recently used it. The strongest predictors of PrEP use were not behavioral — they were structural: having a usual source of care (aPR 2.54), having ever received transgender-specific health care, having insurance (aPR 1.54), and feeling comfortable discussing gender-related health with a provider (aPR 1.79).22 Documented barriers included fear of hormone interactions, side-effect concerns, medical mistrust rooted in real experience, and the belief — reinforced by a decade of marketing — that PrEP is "for gay men."2 Every one of those is addressable, and none of them is a reason PrEP will not work in your body.

Gender-affirming surgery when you are living with HIV

Living with HIV is not a barrier to gender-affirming surgery, and any surgeon who says otherwise is out of step with published clinical guidance.

The New York State Department of Health AIDS Institute guideline on perioperative care states it directly: HIV is not a contraindication to surgery. For a person on antiretroviral therapy with a viral load below 200 copies/mL and a CD4 count above 200, the recommendation — graded A2 — is to proceed exactly as for a patient without HIV. Antiretrovirals should be continued through the perioperative period rather than interrupted.16

The occupational-risk objection does not survive the evidence either. Transmission risk to the surgical team is eliminated when a person is virally suppressed, and the historical record is stark: between 1985 and 1999, only two surgical technicians and no surgeons reported occupational HIV transmission to CDC, and there have been no such reports since 1999.16 If a surgical practice raises "risk to staff" as a reason to decline you, that is not a clinical position. It is a refusal wearing clinical clothing, and it is worth naming as such — to them, to your HIV provider, and if necessary in a written complaint.

The WPATH Standards of Care, Version 8, remains the reference document for gender-affirming surgical and hormonal care, including criteria, informed consent, and coordination between providers.17 Practical coordination matters: your HIV provider and your surgical team should be talking to each other about your regimen, your viral load, bone health if you are on tenofovir disoproxil fumarate, and how hormone dosing will be managed around the procedure. If nobody is convening that conversation, ask your HIV clinic's case manager to start it. That is squarely within their role.

Mental health — naming the cause correctly

The 2022 U.S. Trans Survey, the largest survey of trans people in the United States, found that 78% of respondents reported lifetime suicidal thoughts and 40% reported a lifetime suicide attempt.18 Those figures are devastating, and they are also frequently misread as though distress were an intrinsic feature of being trans. The survey's own data refute that reading.

Among respondents who had experienced no discrimination or harassment, 31% reported suicidal thoughts in the past year. Among those who had been verbally harassed, that rose to 50%. Among those who had been denied equal treatment, 53%. Among those who experienced both, 63%.18 The gradient tracks discrimination, not gender identity. This is the gender minority stress framework in a single table: chronic external stressors — rejection, harassment, denial of care, the daily labor of anticipating all three — accumulate into measurable health outcomes.

The same survey found that trans women bore the highest HIV burden among respondents at 2.4%, more than three times the general U.S. prevalence of 0.3%, and that Black trans women reported the highest prevalence at 15.5%.18 UNAIDS reports a median of 49% of trans people experiencing stigma and discrimination across reporting countries, a median of 24% experiencing violence — reaching 69% in some countries — and a median of 10% avoiding health care altogether because of stigma.3 Avoiding care is a rational response to being mistreated in it. It is also a mechanism by which people go undiagnosed and untreated.

Two things are worth holding together. First, a mental health provider who does not understand trans lives will spend your sessions on the wrong problem — the WPATH and GLMA provider directories referenced in federal guidance are reasonable starting points for finding someone who does.5 Second, unmet basic needs measurably drive HIV outcomes. In Ryan White program data, trans clients with unmet service needs were significantly more likely to have difficulty sticking with antiretroviral therapy (aPR 1.39) and to have a detectable viral load (aPR 1.47).5 Housing, food, and transportation are HIV interventions.

Sex work, survival economies, and criminalization

Many trans women trade sex for money, housing, food, or safety. This page will not treat that as a character flaw or a lapse in judgment, because the evidence does not support that framing.

Poteat and colleagues described sex work among trans women as arising from economic survival and, in many cases, from the need to fund gender-affirming care itself — in a context where trans women are pushed out of formal employment, education, and housing.4 When 44% of trans women in a national U.S. survey earned under $10,000 in a year and 39% experienced homelessness, sex work is not an inexplicable choice.2 HIV prevalence among trans women sex workers was 27.3% in Poteat's Lancet analysis — higher than among trans women overall, and higher than among cisgender female sex workers — which reflects compounded exclusion, not compounded recklessness.4

What changes the numbers is law, and the public health consensus here is unusually clear. WHO's 2022 consolidated guidelines for key populations name decriminalization of sex work — removing all offences criminalizing sex workers, clients, and third parties — as a priority enabling intervention, alongside decriminalizing gender identity and expression and ending the police practice of treating condom possession as evidence of sex work.19 WHO cites modelling indicating that decriminalizing sex work could reduce new HIV infections among sex workers by 46% over ten years, and that eliminating sexual violence against sex workers could reduce them by 20%.19

Practical harm reduction still matters: PrEP, including long-acting options that do not require carrying pills; doxy-PEP where you meet CDC criteria; STI screening every three to six months at all sites of exposure; and knowing where the nearest clinic is that will not ask you to justify yourself.20 But none of that substitutes for the structural fix.

Partners, dating, and what U=U actually means

If you are living with HIV and taking antiretroviral therapy that keeps your viral load undetectable, you do not transmit HIV sexually. That is the substance of Undetectable = Untransmittable.

What that means in practice is that a mixed-status relationship has two independent layers of protection available. Your treatment keeps your viral load suppressed. Your partner, if they want it, can take PrEP — daily pills, injectable cabotegravir every two months, or twice-yearly lenacapavir.15 Neither of you needs to organize your relationship around fear, and neither of you needs to accept the other's anxiety as a permanent condition.

Disclosure is a separate question from transmission risk. There is no medical requirement to disclose your HIV status to every partner when you are undetectable and cannot transmit — though laws in some states still criminalize non-disclosure regardless of viral load or actual transmission, which is a policy failure rather than a scientific one. Deciding who to tell, when, and how is a safety calculation as much as an ethical one, especially for trans women, who face elevated rates of intimate partner violence.

Two practical notes. Testing needs to follow anatomy, not gender: if you have receptive anal or oral sex, gonorrhea and chlamydia testing needs to be done at those sites, and site-specific screening is standard in CDC guidance.20 If you have had vaginoplasty, ask specifically how your surgical anatomy should be screened — the answer depends on the technique used, and a provider who has not thought about it should look it up rather than guess.

Care navigation — insurance, records, and getting the name right

The Ryan White HIV/AIDS Program is the backbone of HIV care for people who are uninsured or underinsured in the United States, and it served 11,085 trans people in 2022 — about 2.8% of all clients.5 Its outcomes for trans clients are decent but not equal: retention in care at 73.5% and viral suppression at 86.4%, compared with program-wide averages of 77.5% and 89.6%.5 Among trans clients with unstable housing, those figures fell to 67.5% and 73.6%.5 Housing is doing more work in that gap than anything clinical.

One more structural note. Federal guidance recommends that clinics collect gender identity and sex assigned at birth as two separate questions, and that HIV surveillance systems do the same.5 Where systems only record a binary sex field, trans women get filed as men, disappear from the data, and then get described as a population with "insufficient evidence" — which becomes the justification for not funding services. Poteat's team noted that laboratory-confirmed HIV data for trans women existed for only 15 countries at the time of their global review.4 Being counted is a prerequisite for being served.

Trans youth and trans elders

Two age groups are consistently underserved at opposite ends of the same continuum.

Younger trans people

Thirty-one percent of trans and nonbinary people newly diagnosed with HIV in 2022 were between 13 and 24 years old.5 That concentration in adolescence and young adulthood collides with the period when family rejection, school pushout, and housing instability are most acute, and when consent laws and insurance dependency make confidential care hardest to obtain. WHO's key populations guidelines explicitly identify lowering the age of consent for health services, and considering exceptions to standard consent policy, as enabling interventions.19 Lenacapavir's FDA approval covers adolescents weighing at least 35 kg, which matters for young people for whom carrying a daily pill bottle is itself a disclosure risk.15

Trans elders and long-term survivors

Trans women who have been living with HIV for decades are aging into questions the research is only starting to address: bone density after years of tenofovir disoproxil fumarate and hormone therapy, cardiovascular risk, and how hormone regimens should change with age. Federal guidance recommends DEXA bone density screening by age 50 and careful antiretroviral selection to avoid stacking cardiovascular and bone risk, with transdermal estradiol the lower-thromboembolism option where cardiovascular risk is elevated.5

The other thing trans elders carry is institutional memory — of the AIDS crisis, of buyers' clubs and street outreach and funerals, and of the fact that trans women were doing HIV work long before anyone funded it. Publications like POZ, Positively Aware, and TheBody have documented those histories in first person for decades, and they are where a lot of trans women first saw themselves described as people with futures.

Florida — the access map

Florida is one of the highest-burden HIV states in the country. The Florida Department of Health reported 4,725 new HIV diagnoses in 2023 and 128,497 people living with diagnosed HIV statewide at year-end. Statewide, 81% of people diagnosed in 2023 were linked to care within 30 days, 79% were in care, and 70% had a suppressed viral load.21 Florida's HIV diagnosis rate was the third-highest among U.S. states in the most recent year ranked.21

Here is a gap worth knowing about if you live here: the state's HIV epidemiology report breaks its data down by male and female only, and does not report figures broken out by gender identity.21 Trans women in Florida are in that data, filed under a category that does not describe them. That invisibility is exactly what the two-step data collection recommendation is meant to fix, and it is a reasonable thing to raise with your county health department or local Ryan White planning council.

The political weather in Florida has made gender-affirming care harder to obtain and harder to talk about. Two things remain true. Ryan White funding follows HIV status, not gender identity, and clinics receiving it are obliged to serve you. And the federal HIV treatment guidelines that recommend gender-affirming care models remain the standard of care your provider is expected to know — you can bring them into the room.5

Advocacy — who is doing the work

Almost every improvement described on this page exists because trans women demanded it. The iPrEx trans subgroup analysis happened because trans advocates insisted the data be examined, and HPTN 083's 10% enrollment floor for trans women was a design decision won through pressure. The ACTG A5403 "GET IT RiGHT" study — a 48-week trial enrolling 90 trans women living with HIV to compare bictegravir-, dolutegravir-, and darunavir-based regimens with study-supplied estradiol — exists because the community would not accept "no data" as a permanent answer.7

The organizations are worth knowing by name. The TransLatin@ Coalition, founded in 2009 by Bamby Salcedo, organizes around identity documents, immigration, employment, housing, and health care for trans Latina immigrants — including the HOPE House transitional housing program, built on the premise that housing is HIV prevention.22 Positive Women's Network-USA organizes women living with HIV, including trans women, around policy, and the Sero Project works on HIV criminalization, which shapes disclosure decisions and safety in ways that rarely appear in clinical literature.

UNAIDS supplies the accountability metric for whether this work is being taken seriously: of 138 countries reporting, 47 do not engage trans people in policy processes at all.3 Where trans people are at the table — as in the Brazilian services expansion and the Trans Amigas navigation programme — outcomes improve.3 "Nothing about us without us" is not a slogan in this field. It is an implementation finding.

What you can do this week

If you take one thing from this page, take this: the interaction fear that keeps trans women from filling antiretroviral prescriptions is, for modern regimens, largely unfounded — and the fix for the parts that are real is a conversation, a lab draw, and sometimes a regimen switch. Not a sacrifice.

If you are living with HIV

• Name the hormone question out loud at your next appointment. Forty percent of trans women have adjusted their HIV medication over this worry and fewer than half told anyone.5 Ask directly: "Does my regimen affect my estradiol levels, and can we check?"
• Ask what class your antiretroviral is in. If it contains ritonavir, cobicistat, efavirenz, or etravirine, ask whether an unboosted integrase inhibitor is an option for you.5
• Ask for hormone levels to be monitored and titrated — that is what the guidelines recommend, not guesswork.5
• If anyone has ever conditioned your hormones on your HIV adherence, know that federal guidance identifies that practice as associated with worse viral suppression.5 You can ask for a different provider.

If you do not have HIV

• PrEP will not take your hormones from you, and your hormones will not take your PrEP protection.913
• Ask about all three delivery options — daily pills, cabotegravir every two months, or lenacapavir twice a year.15 If pills are a disclosure risk in your living situation, say so; that is a legitimate clinical consideration.
• Ask about doxy-PEP if you have had syphilis, chlamydia, or gonorrhea in the past year — CDC recommends providers offer it to trans women in that situation.20

For everyone

• Ask whether hormones and HIV care can happen in the same place. Integration is a graded recommendation, not a luxury request.5
• Get your chosen name into the chart, and ask that it be used at the front desk too.
• Ask about housing, food, and transportation assistance. These are the variables most strongly associated with viral suppression in trans women, and there is often funding for them.25
• Find your people. Peer navigation and community connection show up repeatedly in the outcome data. They are not extras.5

You are not a statistic in an odds ratio. You are a person with a treatable condition, a body that deserves to look and feel like yours, and a legal right to care that addresses both at once. The evidence is on your side more than the last two decades of silence would suggest.