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Area of Science:

  • Reproductive Health
  • Infectious Disease Prevention
  • Transgender Health

Background:

  • Efficacy of pre-exposure prophylaxis (PrEP) and factors influencing HIV transmission in transgender men (TGM) are not well understood.
  • Testosterone's impact on the vaginal microbiome, cervicovaginal fluid (CVF) tenofovir concentrations, and inflammatory markers in TGM on PrEP requires investigation.

Purpose of the Study:

  • To explore the effect of testosterone on the vaginal microbiome in TGM on PrEP.
  • To assess the impact of testosterone on CVF tenofovir concentrations in TGM on PrEP.
  • To determine the influence of testosterone on CVF inflammatory markers in TGM on PrEP.

Main Methods:

  • Cervicovaginal fluid (CVF) was collected from 13 TGM (7 on testosterone) and 32 cisgender women (CGW) on PrEP.
  • Vaginal microbiome composition, CVF tenofovir concentrations, and CVF inflammatory markers were analyzed and compared between groups.

Main Results:

  • Cisgender women had a significantly higher proportion of vaginal Lactobacillus compared to transgender men (78% vs 24%).
  • Transgender men on testosterone showed a trend towards lower Lactobacillus proportions (14% vs 35%) and the lowest CVF tenofovir concentrations (884 ng/mL), though not statistically significant.
  • No significant differences in genital inflammatory markers were observed between groups, nor a correlation between inflammation and tenofovir levels.

Conclusions:

  • Findings suggest a potential link between testosterone use, reduced Lactobacillus dominance, and lower tenofovir concentrations in CVF among transgender men.
  • These biological changes may have implications for HIV acquisition risk via vaginal sex in transgender men on PrEP.
  • Larger studies are necessary to confirm these associations and their clinical significance.