PrEP for transmen: how to get it if you wanna get it on

Only fairly recently the Dutch government has made PrEP legally available (for HIV prevention) and a little more affordable than it used to be. For me however 60 euros a month is way too much still.
I know there is a way to get it through your own doctor here, and that there are a few pharmacists in Amsterdam that buy it in bulk and sell it for 35 euros a month – but that’s still a lot for me + I might have to pay for the special medical exams.
There are also ways of buying PrEP online – but please be well informed.

It’s clear that FTM’s needs are not being met right now, even in the Netherlands. But the same goes for transwomen, and even cis women as well. More research needs to be done for all but  cis men.

Before getting my pills under the counter I’m currently first trying to gather information on how PrEP for transmen works. Medically I mean. For cis men it takes only a few days for it to catch on, so they can frolic happily about and bareback (anal) with much less risk of catching HIV. Of course you can still catch other STI’s but HIV is one with a bigger impact than most others.
If you want to know the general risks of each kind of sex act, use the very informative HIV Risk Estimator from the US Centers for Disease Control here.

Here is a very informative video for beginners:
note there are two different ways of using PrEP:

  1. taking it only when you need it 2 hours before sex (=on-demand) in a high dosage, also called ‘event-driven PrEP schedule’ (only before and after sex),
  2. taking it every day to build up constant protection, but on lower dosage

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Some more info after gathering it from several online resources:

PrEP offers trans men almost 100% protection against HIV when taken correctly and constantly.
PrEP offers trans men protection during both front hole and anal sex.

Starting PrEP

Trans men need to take PrEP every day for at least 7 days to reach maximum protection. Sometimes it can take up to three weeks, so take your medication daily, every day.

SIDE EFFECTS

There are some side effects associated to PrEP use but a lot of people don’t experience any of them, and if they do it’s usually for a short period while their body adjusts to the drug.

How you take PrEP depends on the type of sex you have.

Daily PrEP is the only option for:

  • front hole sex, if you are the penetrative sex partner

Daily PrEP is recommended for:

  • receptive front hole sex
  • penetrative sex, when a person has had a phalloplasty.

If receptive anal sex is this is the only sex you have more dosing options are available.
You are at higher risk with the front-hole because the cervix doesn’t take PrEP in as easily as all other tissue.

Stopping PrEP – temporarily or permanently

You can decide to stop taking PrEP whenever you want. But don’t stop taking the pills on the day you decide. You need to keep taking your daily dose for 7 days after your last risk of exposure to HIV – condomless sex, for example. If you only have receptive anal sex, you need to dose for 2 sex free days .

PrEP and hormone therapy

Testosterone is safe to take at the same time as PrEP. PrEP does not cause fat redistribution in the body or face. Taking testosterone is likely to stop your periods and greatly reduce your chance of getting pregnant. But testosterone is not contraception and it is still possible to get pregnant, unless you use effective contraception, sterilisation or a hysterectomy.

PrEP and contraception, conception and breastfeeding

When you take PrEP as a trans man, you can safely:

  • Take hormonal birth control – ‘the pill’. It is safe and both will work if taken correctly.
  • Get pregnant. PrEP prevents HIV, not pregancies.
  • Conceive and carry a baby. It is safe for you and your baby.
  • Breastfeed safely.

PrEP and STIs

You need to take other precautions, such as using condoms, to help prevent all STIs other than HIV. And… PrEP does not protect transmen from pregnancy!

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