The effect of initiating testosterone-based and estradiol-based gender-affirming hormone therapy on PrEP uptake: Evidence from whole-of-population administrative data in Australia

Karinna Saxby (), Curtis Chan, Travis Campbell, Clue Coman, Anthony K J Smith and Brendan J Nolan
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Karinna Saxby: Melbourne Institute or Applied Economic an Social Research, The University of Melbourne, Australia, https://findanexpert.unimelb.edu.au/profile/1027826-karinna-saxby
Curtis Chan: Kirby Institute, UNSW Sydney
Travis Campbell: Department of Economics, Southern Oregon University
Clue Coman: Centre for Social Research in Health, UNSW Sydney
Anthony K J Smith: Centre for Social Research in Health, UNSW Sydney
Brendan J Nolan: Trans Health Research Group, University of Melbourne

Melbourne Institute Working Paper Series from Melbourne Institute of Applied Economic and Social Research, The University of Melbourne

Abstract: Background: Trans and nonbinary (‘trans’) people experience a disproportionate HIV burden but use fewer HIV prevention strategies, including pre-exposure prophylaxis (PrEP), relative to the general population. Emerging literature suggests an association between gender affirming hormone therapy (GAHT) and PrEP uptake, however the evidence is mixed and limited to cross-sectional analyses of transfeminine people on estradiol-based GAHT, with no data in transmasculine people on testosterone-based GAHT. Methods: In this quasi-experimental study, we analysed linked, whole-of-population administrative health records (2018-2025) for 5,796 transmasculine and 8,079 transfeminine Australians who initiated testosterone-based GAHT and estradiol-based GAHT. Using a stacked event-study design, we compared changes in monthly PrEP uptake (supply of any PrEP script) in the 36 months before and 24 months after GAHT initiation with contemporaneous changes among people of a similar age who initiated the same regimen in the future. Effects were estimated separately for transfeminine and transmasculine people and compared to uptake 13 to 18 months pre-GAHT. Findings: For both transfeminine and transmasculine people, PrEP uptake did not significantly vary relative to the reference period and was stable over time (

Keywords: transgender; PrEP; HIV; gender-affirmation; hormone therapy (search for similar items in EconPapers)
JEL-codes: I12 I18 J16 (search for similar items in EconPapers)
Pages: 28pp
Date: 2026-09
New Economics Papers: this item is included in nep-mid
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