There is little to guide the use of PrEP in people who identify and/or present with a gender different than the sex they were assigned at birth, or who don’t identify with one of the binary genders of male or female.
The only data that does exist—in people assigned male sex at birth, but who identified themselves as transgender in a study—included too few people in this category to reach definitive conclusions.
While there are reasons to suspect that PrEP will offer at least some protection for insertive or receptive vaginal or anal sex, there may be differences in how well it works or how safe it is for transgender people taking sex hormones.
Nevertheless, there are trans persons taking PrEP, two of whom are profiled in this issue. As is the case for anyone, the heart of making the decision about whether PrEP is right for you lies in identifying your risks and what you feel comfortable with.
Fortunately, several demonstration projects have sought to recruit trans persons. What’s more, there are grant opportunities for several large demonstration projects devoted exclusively to research on PrEP in trans persons, so hopefully more information will come out in the next two or three years.