Case 4: Transgender Women and HIV

Question | Discussion | References | CME Credit

You answered:

	No hormonal therapy should be given. The patient needs antiretroviral therapy and the co-administration of antiretroviral therapy and gender reassignment hormonal therapy is contraindicated.

This answer is incorrect. Although some potential drug interactions do exist with antiretroviral medications and estrogen compounds, a safe antiretroviral regimen can be constructed for transgender patients receiving hormonal reassignment therapy. In addition, providing hormonal therapy may provide an incentive for HIV-infected transgender women to regularly attend medical clinic visits and engage in care for their HIV disease.

Choose another answer:

	Doses of estrogens required for gender reassignment hormonal therapy are typically much lower than doses used for hormone replacement therapy in postmenopausal women.
	Considering this woman’s age, oral ethinyl estradiol (Estinyl) would be preferred over a transdermal estradiol patch. The oral estrogen treatment would have a significantly lower risk of causing thromboembolic complications than a transdermal estradiol patch.
	Anti-androgen therapy with spironolactone (Aldactone) is often used as part of hormonal gender reassignment therapy to further decrease male secondary sexual characteristics.

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