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July 2022 Advice to Be Well From Dr. Mark Bornstein and Dr. Paul Benson

From Dr. Mark Bornstein and Dr. Paul Benson

I’m a transgender female on Estradiol. My new cis-gender male partner is living with HIV. He is taking medication and has an undetectable viral load. I would like to protect myself the best I can from contracting HIV. I’m concerned about taking PrEP at the same time as taking gender affirming hormones. He says he can not transmit the virus because he has an undetectable viral load. What should I do? – PJ

Dear PJ,



This is a great question. If your partner has an undetectable viral load, there is zero chance he can sexually transmit HIV. This is what we call U=U. This stands for Undetectable = Untransmittable. If testing concludes that the viral load is less than 200 copies, HIV cannot be transmitted.

In short, I would recommend PrEP for any individual on hormone replacement therapy (HRT) who is at risk for HIV. Taking PrEP does not affect the amount of estradiol or testosterone in the bloodstream. In other words, PrEP does not affect any part of masculinizing or feminizing HRT.

However, there is more nuance here. Specifically for trans-feminine individuals, there have been a few small studies showing that estradiol lowers the amount of Tenofovir (one of the medications in oral PrEP) in the blood and tissue. Importantly, this small decrease in Tenofovir has not been shown to reduce the effectiveness of PrEP.

While there is no official data available on the effectiveness of injectable PrEP and HRT, there would be no suspected interaction between injectable PrEP and estradiol.

I want to encourage you to continue to have these conversations with your provider. There are constantly new studies and data coming out and we want to empower you to ask questions and be the driver of your health.

The Be Well Medical Center is participating in a long-acting injectable PrEP clinical trial which requires an injection once every six months instead of taking pills. To enter the trial you must be at high risk for contracting HIV. Additionally, the sponsor is giving priority to transgender and African American individuals. For further information on entry into this trial contact the Be Well Medical Center Clinical Trial Department at (248) 544-9300, option 7.

I have been hearing that the monkeypox virus is a LGBTQ+ disease. I am very concerned that any new sexual contact could transmit monkeypox to me. It’s reminding me of AIDS and the early 1980s. I have many sexual contacts through social media. Are my concerns legitimate that this is a new LGBTQ+ disease? – GG

Dear GG,

There is no science behind the idea that monkeypox is a LGBTQ+ disease, and there is no correlation to HIV. Sensational journalistic reporting at this time will only create a stigma that is unfounded, untrue, and not based on any science. The CDC is asking physicians in the United States to be aware of monkeypox in their differential diagnoses when evaluating symptomatic patients without regard to gender or sexual orientation.

Monkeypox has been present in many African countries for decades and has never been considered a gay disease. In spite of the name “monkeypox,” it does not come from monkeys, but from rodents. There has been no definite correlation of monkeypox to men having sex with men to date.

Recently, there have been a couple of hundred cases of monkeypox reported from a dozen or so countries outside Africa, and many of these reported cases are among gay and bisexual men. Statistically, with such a small number of cases outside Africa, a generalization that there is a predilection towards men having sex with men is very premature and not based on statistics and science — it’s especially early to make a correlation when the number of reported cases is so small.

The monkeypox virus is not found and cannot be spread in genital fluids like HIV. Like COVID-19, it can be spread by very close-range respiratory droplets, but unlike COVID-19 virus, it cannot be spread through the air over longer distances. The virus is transmitted by direct contact with an infected individual. Monkeypox usually has symptoms similar to the flu with a rash that could be on the genitalia or other areas on the body.

We hope this information helps. Be Safe…and to your good health we remain.

Since 1980 Dr. Paul Benson’s Be Well Medical Center has been an inclusive medical center celebrating diversity. Do you have a health related question for Dr. Paul Benson and Dr. Mark Bornstein? Submit your questions to [email protected]. This article is a sponsored editorial produced in collaboration with Be Well Medical Center. Between The Lines’s journalism is made possible with the support and partnership of advertisers like Be Well. Learn more about Be Well here.



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