Special clinical considerations
Transgender men
There are very few data regarding PrEP knowledge, acceptability and use in transgender men. Nor are there data regarding whether GAHT influences PrEP drug levels or vice versa in transgender men. A 2016 review of HIV and STI research undertaken in transgender men was unable to find any data on the use of PrEP in transgender men (17). In a 2017 study of 181 transgender youth from the USA, of 42 people identifying as transgender men (23.2%), only 16 had ever used HIV prevention services and none had ever used PrEP (18). Transgender men were significantly less likely to have ever used PrEP than transgender women (18). To optimise HIV prevention and PrEP use, clinicians caring for transgender men need to actively raise PrEP as an HIV prevention option for them and take a sensitive and detailed sexual behaviour history bearing in mind that transgender men may be sexually active with male and female partners. Gender-affirming care should be provided to transgender men by health practitioners. For more information see: a language guide: Trans and gender diverse inclusion