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Can I Take Hormones and ARVs? Learn About Drug Interactions Between HIV Meds and Gender-Affirming Hormones

June 19, 2017

Hormones used for transgender therapy have not been tested in the lab for interactions with other drugs. Instead, the much lower dose of ethinyl estradiol (a form of estrogen) in birth control pills is used as a guide. Hormone therapy for transwomen, whether tablets, patches, or injections, requires a much higher dose of estrogen than that used in birth control pills. An increase in blood levels of a drug generally increases the risk of a side effect. A decrease in blood levels generally decreases the efficacy of a drug. Hormone dosage that is increased due to HIV medication needs to be reduced immediately upon discontinuation of the HIV drug (or drugs) due to dangerously high levels when off the HIV therapy.

NOTE: This is not a comprehensive list.

Levels of ethinyl estradiol are INCREASED by:

  • Edurant (rilpivirine)
  • Crixivan (indinavir)
  • Reyataz (atazanavir)
  • Intelence (etravirine)

Levels of ethinyl estradiol are DECREASED by:

  • Prezista/Norvir (darunavir/ritonavir)
  • Stribild (elvitegravir/cobicistat/tenofovir DF/emtricitabine)

Has NO EFFECT on levels:

  • Isentress (raltegravir)
  • Tivicay (dolutegravir)
  • Truvada (tenofovir DF/emtricitabine)
  • Selzentry (maraviroc)
  • Viread (tenofovir DF)

NO DATA available:

  • Evotaz (atazanavir/cobicistat)
  • Prezcobix (darunavir/cobicistat)
  • Ziagen (abacavir)

Special thanks to Andrew Macdonald, Pharm.D., A.A.H.I.V.P., of Community, a Walgreens Pharmacy, in Oakland, California, for reviewing and updating this drug chart.

See the "HIV Drug Interaction Checker" from the University of Liverpool, an invaluable resource for anyone living with HIV, at The checker quickly looks up known drug interactions between HIV medications and other drugs. It is updated every one to two weeks. Some dosing recommendations given. Free app available for Android and Apple smartphones.

See also "A Transgender Therapy Primer" from the July/August 2008 issue of Positively Aware.


  1. Hormone therapy for HIV-positive transgender patients should be prescribed according to the same standards of care regardless if they are receiving antiviral therapy or not.
  2. In diabetic patients on testosterone, blood sugar decreases, requiring adjustments in dose of their diabetic medication.
  3. Testosterone may also potentiate the blood thinner warfarin (Coumadin).
  4. There are no published pharmacokinetic studies looking at drug-drug interactions with HIV medications and spironolactione (brand name Aldactone) or finasteride (brand name Proscar).
  5. It is important to monitor liver function.
  6. Clinicians should monitor hormone levels while patient is on ART in order to assess for elevated or subtherapeutic levels, as well as ongoing viral load monitoring.
  7. Clinicians should also be aware of possible increase in cardiovascular disease and osteoporosis among HIV-positive patients on hormones.
  8. More research is needed on interactions between oral, injectable, and transdermal hormones and ART medications.

This article originally appeared in the May/June issue of Positively Aware and was cross-posted with the permission of TPAN. Read the original article.

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This article was provided by Positively Aware. Visit Positively Aware's website to find out more about the publication.

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