In a world where affirming care for transgender individuals is still battling misinformation and access barriers, a newly released study brings important clarity—and relief—for many in the community. Published April 8, 2025, this comprehensive systematic review provides reassuring news: hormone therapy (HT) and HIV treatment, specifically antiretroviral therapy (ART), are generally safe to take together. But as with most things in medicine, the details matter.
Let’s break down what this means for transgender people, particularly those living with HIV, and why it matters so deeply.
The Big Picture: What the Study Looked At
Transgender individuals often undergo hormone therapy—estrogen or testosterone—as part of their gender-affirming care. Some are also living with HIV and require ART to stay healthy and undetectable, meaning the virus cannot be transmitted. But combining multiple medications raises concerns about drug-drug interactions (DDIs). These interactions can sometimes cause medications to work less effectively or lead to side effects.
This new systematic review dug into clinical studies and real-world case reports to understand how HT and ART interact in transgender individuals. It looked at data from over 1,700 people across various studies, including transgender women (those assigned male at birth who identify as women) and transgender men. The researchers also examined interactions involving other medications like warfarin (a blood thinner) that may be prescribed for additional health conditions.
The Findings: Mostly Safe, But Monitor Closely
Here’s the heart of the good news: most combinations of hormone therapy and HIV treatment did not result in clinically significant interactions. In other words, the changes in how the drugs are absorbed or processed in the body were so small they didn’t affect safety or effectiveness. This means transgender individuals can generally receive both life-saving HIV treatment and affirming hormone care without compromising either.
However, there were important exceptions:
- Efavirenz, an older HIV medication, was found to reduce estrogen levels, potentially impacting the effectiveness of feminizing hormone therapy. This might lead to less desired physical changes or a return of gender dysphoria.
- Some ART combinations, like ritonavir-boosted regimens, were found to interact with medications like warfarin, requiring higher doses of the latter and close monitoring to avoid complications like blood clots or bleeding.
- For people taking PrEP (pre-exposure prophylaxis for HIV prevention), changes in blood levels of tenofovir or emtricitabine were noted in some studies—but these didn’t appear to reduce the overall effectiveness of PrEP.
These findings highlight a crucial takeaway: safe does not mean “set it and forget it.” Close medical monitoring and individualized care remain essential, especially when starting or switching medications.
What This Means for Transgender People Living with HIV
Transgender people—especially trans women—are disproportionately impacted by HIV due to systemic barriers like healthcare discrimination, housing insecurity, and lack of access to employment. Being able to safely access both ART and gender-affirming care is not just a medical issue; it’s a human rights issue.
This study is a meaningful affirmation that transgender people do not have to choose between their health and their identity.
But it also reminds us of the need for gender-competent clinicians who understand the nuances of DDI risk, monitor hormone levels and HIV treatment closely, and don’t dismiss the lived experiences of their patients.
Practical Recommendations for Clinicians
The review offers some concrete tips for healthcare providers:
- Monitor hormone and ART levels regularly, especially when patients are on regimens with known interactions like efavirenz or warfarin.
- Consider switching to non-oral estradiol (like patches or injections) if interactions with oral versions are suspected.
- Use simplified regimens when possible in resource-limited settings to minimize interaction risks.
- Educate patients on potential symptoms of hormonal imbalance or ART failure—and trust them when they speak up.
The Emotional Weight Behind the Data
Behind every statistic is a person—a trans person who has likely fought tooth and nail for access to basic care. This review does more than catalog molecular pathways; it challenges the fear-based narrative that gender-affirming hormone therapy is “too risky” when paired with life-saving HIV treatment.
It says, You deserve both. You deserve all of it.
What’s Next?
While the findings are encouraging, the researchers stress that more high-quality studies—especially randomized controlled trials—are needed. Current research is often limited by small sample sizes and the underrepresentation of transgender individuals in clinical research. There’s also a need to study how DDIs evolve over time and affect long-term health.
But for now, the message is clear: with thoughtful care, transgender individuals can safely receive both ART and HT—and that’s one less barrier between them and the life they deserve.
The Bottom Line
This review is more than a medical milestone—it’s a step toward equity, a rebuttal to stigma, and a call to action. Clinicians, researchers, policymakers, and allies must continue pushing for data, dignity, and comprehensive care. Transgender health is not niche medicine. It’s human medicine.
Let’s keep building a future where transgender individuals can thrive— not just survive.
