A common misconception of the elderly is that most or all of them disengage in sexual activity as they grow older. Despite this, many seniors continue to engage in sexual activity as they grow older. This means that many folks may continue to require regular sexual health screening to monitor for seually transmitted and blood-borne infections (STBBIs.) You can learn more about STBBI testing methods here.

If you’re comfortable, try to discuss with your primary care provider testing options. You can also try to discuss regular testing with your care providers in a long-term care setting. STBBI testing can be requisitioned by a doctor for collection and analysis through a lab. You can check the DynaLife website for a location that works best for you.

Other STBBI testing locations include:

Edmonton STI Clinic - They currently operate on appointment only, and require a call in the morning to book an appointment. Because appointments fill up quickly, it’s best to call as early as possible. You can learn how to contact them, as well as the services they offer and ongoing COVID-19 precautions on their website.

While you may be on top of your sexual health, you may also face stigma based on your HIV status. This can be painful, especially when due to a misunderstanding of undetectable viral loads (undetectable=untransmittable). As long as you take ART as directed and maintain an undetectable viral load, you cannot sexually transmit HIV. Try to remind your partners of this when you disclose your STI status and testing history.

For many, one part of aging is an increased difficulty maintaining an erection. Many use medications for erectile dysfunction like Viagra and Cialis to help them carry on with a regular sex life. However, this kind of medication can interact with ART regimens. Poppers can also have fatal interactions with erectile dysfunction medication. It’s important to talk to your doctor or pharmacists about potential interactions with your ART. You can also contact nurses at either the Kaye Edmonton Clinic or the Royal Alex Hospital if you have questions about drug interactions.

Royal Alex Hospital:

• 780-735-4811

• Room CSC 137

• 10240 Kingsway Avenue NW, Edmonton, Alberta

Kaye Edmonton Clinic:

• 780-407-1852

• Toll free: 1-844-407-1852

• 3A.101

• 11400 University Avenue NW, Edmonton, Alberta

On top of your sexual activity, you will need regular screenings to ensure you remain healthy. You’ll likely undergo various screenings specific to your needs.

For many of us, the cancer screening process can start when we’re young and continue throughout our lives. Our bodies will require regular check-ups and screening procedures past certain ages to ensure we can live happy and healthy without cancer. Below are various cancer types that will require different screening protocol:

Cervical cancer: If you have a cervix, you will need to get regular pap tests. The Canadian Cancer Society includes information on pap tests for trans men here. Information on Alberta’s Cervical Cancer Screening Program can be found here. Some important information to note includes:

• Start at age 25, or 3 years after becoming sexually active (whichever is later)

• Annual testing will until age 69

• Pap tests should be done every 3 years, or more frequently if there is an abnormal result

• If you have had a hysterectomy (surgery to remove the uterus), talk to your health care professional about whether you need pap tests

• It is important to note that if Alberta Health does not list you as female, you may not receive automatic reminders to get your pap tests

After age 70, you can stop having Pap tests if:

• Your last 3 tests, done within the past 10 years, were normal

• You haven’t had any serious abnormal cell changes in the past

• You had an HPV reflex test result that was negative

Breast Cancer/Chest Cancer Screening: While some individuals might wish to receive screenings earlier due to an increased risk of breast cancer, mammograms (chest/breast x-rays) are not generally recommended before the age of 50. [Note: if you’re under 50 and feel as though you should have a mammogram, speak with your healthcare provider]. 

Breast/chest screening recommendations for different individuals include:

• Trans women/Trans feminine individuals: If you have taken feminizing hormones for 5 years or more, and are between the ages of 50 and 74, the Canadian Cancer Society recommends that you should be screened for breast cancer. You can learn more about breast cancer screening for trans women here.

• Trans men/Trans masculine individuals: Even if you’ve had top surgery, it’s important to monitor for chest cancer/breast cancer if you are between the ages of 50 and 74. You can find out more about chest screening for trans men here.

• Cisgender women: Cis women should be regularly screened for breast cancer between the ages of 50 and 74.

Mammograms are generally recommended every two years between the ages of 50 and 74. For more information on the Alberta Breast Cancer Screening Program, click here.

Breast/chest self-examinations are not automatically recommended for most people, particularly those who are not at a higher risk of breast cancer. Studies show that self-exams don’t necessarily save lives and many lumps that are found are not actually cancer. However, if you do find a lump or any other changes to your breast/chest, talk to your health care professional. More information on breast/chest self-exams can be found here.

Colorectal Cancer Screening: Everyone over 50 should be screened for colon cancer. For screening, you can have an annual FIT test, which is a stool (or poop) test that can be done at home. Afterward, the specimen can be taken to a lab for testing.

If there is an abnormal result, you may require a colonoscopy. Colonoscopies are also recommended if you have risk factors such as a family history of colorectal cancer. You can find more information about colorectal screening in Alberta here.

Anal dysplasia: This condition happens when cells around the anus have changed and look different from other cells. They may not be cancerous, but they will need to be monitored or treated to prevent them from becoming cancerous.

People living with HIV are at a higher risk for anal dysplasia. Other risk factors include:

• Being a man who has sex with men,

• Having multiple sex partners, or a partner with multiple sex partners,

• Having anal sex with multiple partners, or a partner who does,

• Having sex with a partner who injects or has injected drugs,

• Having human papillomavirus (HPV), and,

• Being someone who has had cervical dysplasia

Screening for anal dysplasia includes anal pap smears offered annually to folks who identify as MSM, and every 2 years for individuals who’s viral load is suppressed on ART and in a stable relationship. You can learn more about anal dysplasa and anal pap smears here.

Other Cancers:

• Prostate cancer screening (PSA test) is no longer automatically recommended for all people with prostates. You can learn more about prostate cancer screening options here.

• Testicular self-exams are not recommended for most people. If you have an undescended testicle or a personal or family history of testicular cancer, you may need to do a monthly testicular self-exam. You can find more information about this here.

• Information about HPV-related cancers can be found on our HPV page here.

Inflammation is one issue faced by people living with HIV. Research suggests that one issue may be inflammation caused by activation of the immune system throughout the body.  

Immune activation and inflammation can be compared to the cost of idling a vehicle motor, leading to damage the longer it’s left running. HIV replicates on a low level under treatment, which contributes to chronic inflammation. Other factors behind inflammation include:

• Gut microbial passages induced by HIV (leaky gut), causing microbial products to circulate through the body

• Co-infection with the hepatitis virus

• Co-infection with cytomegalovirus

• Immunosenescence; immune aging present in everyone, but more pronounced in people living with HIV

While some think it’s aging that leads to inflammation, it can actually be the other way around. Research suggests the effects of aging can be connected to the impacts of chronic inflammation. Excess inflammation can ultimately lead to various diseases and geriatric conditions:

• Metabolic diseases (type 2 diabetes, metabolic syndrome)

• Cardiovascular disease (atherosclerosis, stroke, heart failure)

• Sarcopenia and physical impairment

• Neurological impairment (alzheimer's disease, parkinson’s disease)

• Chronic inflammatory diseases (rheumatoid arthritis, psoriasis)

• Osteoporosis and osteopenia

• Cancer

• Polypharmacy, or multiple medication regimens

• Sensory impairment

• Impaired mobility and falling

• Cognitive impairment

• Impaired bowel and bladder function

• Frailty, and sarcopenia (loss of muscle mass)

With all this in mind, one of the best ways to help keep down inflammation is to keep taking ART as directed. Suppressing viral replication and maintaining an undetectable viral load will help prevent inflammation from rising and damaging your body. 

Other ways to reduce inflammation can start by improving your gut microbiome. Try a pattern of healthy eating or the Mediterranean diet, including a diet rich in whole grains, fish, fruits, vegetables, nuts, and other healthy foods. Consume prebiotics, omega-3 fatty acids, antioxidant vitamins, polyphenols, and other nutrients, as well as probiotics to help promote a healthy gut microbiome. Be sure to talk to your primary care provider about ways to improve gut health. 

On top of managing HIV, ensuring other conditions are effectively managed will help maintain good health. Seeing your doctor regularly to treat ongoing health conditions and screen for signs of new or worsening conditions. If you need help finding a primary care physician, try some of these solutions:

• Call 811 for help finding a primary care provider.

• Contact the Pride Centre for help finding an affirming and inclusive care provider who can care for patients with HIV.

• HIV Edmonton is partnering with Canada Homecare Group to host drop-ins on Thursday evenings from 5-8. You can learn more about the Canada Homecare Group on their website.

• Check the website of the Alberta College of Physicians and Surgeons via their Find a Physician search. Be sure to call ahead to ensure the physicians who are listed are taking patients.

Given the amount of medication already prescribed to treat HIV, folks living with HIV may want to try avoiding adding new medication regimens. Taking multiple medication regimens at the same time is known as polypharmacy.

Some research suggests that elderly people living with HIV may face issues managing medication, especially as age-related conditions or diseases emerge and affect our health as we grow older. A couple of factors were associated with greater challenges managing medication in people living with HIV:

• a detectable HIV viral load

• being co-infected with hepatitis C virus

• having a lower reading level

• having difficulty planning and organizing complex tasks

On top of this, difficulty managing HIV is associated with a greater burden of medication. Maintaining an undetectable viral load is key to helping manage pill burden. One way to prevent polypharmacy is to talk about prescriptions with your primary care provider. Explore alternative ways of treating geriatric conditions to avoid additional or unnecessary prescriptions. 

Some medications can interact with ART, which can worsen the health of folks living with HIV. If you’re concerned about a possible interaction with your ART regimen or if your primary care provider is unsure, you can contact the Northern Alberta Program at either the Royal Alex Hospital or the Kaye Edmonton Clinic: 

Royal Alex Hospital:

• 780-735-4811

• Room CSC 137

• 10240 Kingsway Avenue NW, Edmonton, Alberta

Kaye Edmonton Clinic:

• 780-407-1852

• Toll free: 1-844-407-1852

• 3A.101

• 11400 University Avenue NW, Edmonton, Alberta

If you need help finding a primary care physician, try some of these solutions:

• Call 811 for help finding a primary care provider.

• Contact the Pride Centre for help finding an affirming and inclusive care provider who can care for patients with HIV.

• HIV Edmonton is partnering with Canada Homecare Group to host drop-ins on Thursday evenings from 5-8. You can learn more about the Canada Homecare Group on their website.

• Check the website of the Alberta College of Physicians and Surgeons via their Find a Physician search. Be sure to call ahead to ensure the physicians who are listed are taking patients.

Menopause can occur 2-4 years earlier in folks living with HIV based on a few different factors, including substance use, smoking, or race and ethnicity. It’s often neglected in HIV care; 1 in 5 received treatment for symptoms, less than half are asked about menopause and its symptoms. These symptoms can include:

• hot flashes

• night sweats

• vaginal dryness

• irregular menses

• Vaginal wall thinning and frailty due to estrogen/progesterone decline

• sleep disturbances

• mood chances

• recurrent UTIs

• urinary urgency/incontinence

• Dyspareunia

• Breast symptoms, including soreness and tenderness

• Cognitive issues (concentration issues, forgetfulness)

• Stiffness/soreness/joint pain

• Headaches/migraines/backaches

• Weight gain

• Fatigue

• Palpitations

• loss of libido

While many of these symptoms stop once menopause ends, the duration of vasomotor symptoms varies; the average length is 7.4 years (2.4 years before and 4.5 after final menstrual period.) Some may see a duration of 9.4 years post final menstrual period, others 3.4 years after. You can also address breast related symptoms a few other ways, including:

• Wearing a supportive bra

• Taking a warm shower or placing a heating pad on your breasts

• Limiting caffeine intake

• Quitting smoking

The hormone estrogen has protective effects against menopausal symptoms. Estrogen menopausal hormone therapy (MHT) has benefits for bone health, may also prevent vasomotor symptoms and reduce genitourinary symptoms, mood disruption, sleep symptoms, joint pain, and hot flashes. 

Despite the benefits, estrogen MHT also comes with risks. Currently, no trials of MHT to address menopause exist with folks living with HIV to determine risk of ART interactions (NRTIs and INSTIs are safe to take with MHT.) Amprenavir (Agenerase) and unboosted fosamprenavir (Lexiva) are not recommended for co-administration with estrogen. Discuss the treatment risks with your primary care provider, and how to best address symptoms (transdermal, oral, or vaginal MHT, or alternatives.)

Even during or after menopause, sexual well being is possible! Ensure STI screening often to keep on top of sexual health. Most importantly, maintain ART to suppress viral load, as being undetectable=untransmittable (U=U).

 People living with HIV may see greater cardiovascular health impacts. This may be due to a few different factors, such as:

• Chronic inflammation and immune activation by the virus,

• Metabolic side effects of different ART regimens, and,

• Smoking; people living with HIV are more affected by it, losing more years to smoking (12.3) than HIV negative folks (5.1). 

In light of this, keeping away from or quitting smoking is important for people living with HIV to maintain heart health. Maintaining a balanced cholesterol level can improve outcomes for people living with HIV as they get older. For those going through MHT, estrogen can increase good cholesterol (HDL) and decrease bad cholesterol (LDL). MHT can also dilate blood vessels and reduce inflammation. 

On top of quitting smoking, it’s important to maintain a continued and uninterrupted regimen of ART. Maintaining an undetectable viral load will help reduce the effects of chronic inflammation. Other medical considerations to watch for include monitoring and treating hyperlipidemia, hypertension, and diabetes mellitus (DM).

Some medications used for cholesterol, namely statins, can reduce immune activation and the inflammation that follows. This effect can greatly benefit people living with HIV who can see inflammation and cholesterol levels impact their cardiovascular health. Some research shows that omega 3’s can be taken to improve inflammation and triglyceride levels in people living with HIV, either through supplements or in diet.

In addition to these measures, exercise for 30 minutes a day five days per week (150 minutes) can improve cardiovascular health. Other aspects of a healthy lifestyle include a healthy diet, such as the mediterranean diet, or a diet high in antioxidants. Try to manage stress levels through healthy stress outlets and mental health supports.

Bone density is a key health concern for many as they age. For folks living with HIV, bone density can be affected by a few different factors, including certain drugs used in ART, the virus itself, and lifestyle factors.

When treating HIV, certain medications involved in ART can have different effects on the body. Tenofovir disoproxil (TDF), as well as certain protease inhibitors (PIs) and protease inhibitor-ritonavir (RIT) affect bone density. Inflammation and viral proteins also contribute to bone density loss by increasing bone resorption and decreasing bone formation.

Furthermore, lifestyle factors can play a role in bone density. Smoking, alcohol/opiate/substance use, hypogonadism, low body weight, and low vitamin D levels all contribute to bone health decline. Loss of estrogen levels in menopause also affects bone health. Overall, the decline in bone density can lead to an increased risk of frailty, osteoporosis, osteopenia, and fracture when falling

To address and prevent bone density loss, monitor your overall bone health with bone mineral densitometry (BMD) tests. Discuss them with your healthcare provider, as well as supplementing vitamin D (800 - 2,000 UI per day) and optimizing calcium intake (1.0 - 1.2 g per day). Make sure calcium supplementation doesn’t interact with your ART regimen.

To meet some of your nutritional needs, consider a diet with food rich in vitamins and minerals. Ensure you also get enough vitamin B12 in either your diet or through supplements. Osteoporosis Canada has resources to help you find foods to incorporate into your diet to meet your nutritional needs.

To address fall and fracture risk, talk to your doctor about the use of a cane or walker. Alberta Health can help with fall prevention strategies based on your activity level, diet, and smoking status. Osteoporosis Canada has a link to an online fracture risk assessment tool called FRAX to yield a 10 year possibility of a major fracture in the spine, hip, or forearm. Some experts recommend counting HIV as a secondary cause of osteoporosis.

If you’re over the age of 50, make considerations for ART that don’t affect bone health. If you already have osteoporosis, discuss bisphosphonates with your healthcare provider; weekly alendronate taken orally, or zoledronic acid by IV yearly. These can be given for 3-5 years and assessed for long-term bone effects.

While all of these are important, a healthy lifestyle can offset many of the harmful effects on bone health. Quit smoking, moderate alcohol use, and engage in physical activity often. Check out this infographic for more information about fitness into old age. Try also to avoid medications that also affect bone health: PPIs (ulcers), steroids (asthma, rheumatoid arthritis), depo-provera (contraceptive injection).

As people age with HIV, they may face varying degrees of disability. These can be characterized by periods of greater ability and condition management, and periods with less ability in the realm of physical, social, mental, or cognitive health. These periods with lesser ability can be episodic, meaning they form non-permanent periods or “episodes” in one’s life. Despite this, they can have a real impact on someone’s quality of life.

Episodic disability can exist throughout an aging person’s life and across various dimensions. These dimensions can include:

• Symptoms/Impairments: 

  • Averse effects of HIV or medication regimes, 

  • Mental health concerns like depression, stress, and anxiety,

  • Fear, embarrassment, loneliness, shame or lack of self esteem

• Difficulties with day-to-day activities

• Challenges to social inclusion

  • Parental roles

  • Work & school settings

  • Personal relationships

  • Other social settings, roles, and activities

• Uncertainty

  • Precarious living or employment situation

  • Ongoing or new health concerns

  • Uncertain finances

Furthermore, various factors can influence the dimensions of disability. Social supports from friends, family, partners, pets, and community, from healthcare services, or from policies like housing or income assistance can reduce the burden of disability. Certain living strategies can help folks keep their mind off of the impact of HIV, help folks maintain a sense of control over their life, and maintain social interaction with others.

These can include:

• Social supports

  • Support from friends, family, partners, pets, and community

  • Support from healthcare providers and services

  • Program and policy support, such as income or housing assistance

• Social stigma

• Living strategies

  • Seeking social interaction with others

  • Maintaining a sense of control over one’s life

  • Blocking HIV out the mind

  • Other attitudes and beliefs

• Other factors like aging

While all of these can play a role in disability episodes, rehabilitation can help folks regain control of their health. Rehabilitation can take a variety of forms, and be helpful for neurological health (neuropathy and stroke), musculoskeletal health (weakness), cardiorespiratory health (fatigue, reduced activity tolerance, and overall cardiac rehabilitation) and with comorbidities, such as chronic or persistent pain.

Some rehabilitation practices can help with a variety of issues. For example, physical therapy can help with physical health while also helping rehabilitate psychological and cognitive health. Working with a physical therapist can help restore physical function and reduce social isolation. You can discuss with your primary care provider where physical therapy can help your own symptoms.

Despite the benefits, there is often limited access to physical therapy:

• Alberta Health will only cover physiotherapy sessions for patients who have undergone hip and knee joint replacement, fractures, and orthopedic surgeries. Physiotherapy for sprains, strain, tendinitis, bursitis, etc won’t be covered.  

• WCB will cover workplace and motor vehicle injuries.

• Most physiotherapy sessions will need to be covered by extended or private insurance plans. 

• If you have no other coverage, you can ask your physical therapist to apply to AHS for a review of your case to see if treatments can be covered. 

One way to improve physical ability and prevent disability is to engage in regular exercise. On top of benefitting physical health, regular exercise can help fight social isolation and improve other aspects of your mental health. Regular group fitness classes aswell as virtual at-home fitness classes are available through the YMCA; search for ones that are right for you.

It’s also important to remember other aspects of one’s health when considering rehabilitation options, too. There can be competing priorities and health factors to consider, such as social stigma, multi-morbidity, and the episodic nature of a disability. Not all rehabilitation measures are right all the time, so it’s important to discuss your options with your healthcare provider.

Being resilient will also improve your overall health and how you respond to disability. Our social and family connections can help us rely on those closest to us in times of need. Try to build your support networks through your born or chosen family, and form relationships with others in your community. You can also join social groups or events for seniors, including HIV Edmonton’s talking circle led by someone living with HIV on Wednesdays at 1 p.m. Other events for seniors can be found on the Edmonton Senior Coordinating Council’s website.

HIV does not directly invade neurons. However, it can affect neurological function by infecting cells within the nervous system called glia. Inflammation in the brain and spinal cord triggered by the virus can also affect neurocognitive functioning over time. Symptoms caused by HIV’s impact on the central nervous system include:

• confusion and forgetfulness

• inability to concentrate

• behavioral changes

• headaches

• mood disorders (anxiety disorder and depression)

• movement problems (loss of movement control) including a lack of coordination and difficulty walking.

Decline in cognitive performance related to HIV is called HIV-associated neurocognitive disorder (HAND) and is classified as asymptomatic (symptom-free, mild/subtle impairment), mild (modest decline in neurocognitive health), and HIV-related dementia (severe impairment, often only seen after failing adherence to ART).

Several factors related to HIV can contribute to HAND. These include:

• having a low CD4 count, high viral load, a long duration of unsuppressed HIV,

• prior central nervous system disease, and,

• low or interrupted adherence to combined anti-retroviral therapy (cART).

You can talk to your HCP about referrals for HAND and mental health condition treatment.

Before diagnosing HAND, it’s important to rule out several other conditions like other opportunistic infections to the central nervous system, especially in patients with low CD4 count. They should also rule out viral nutritional and metabolic diseases (hyperthyroid disease, low B12 intake), and vascular and neurodegenerative disease.

To treat HAND, it’s important to maintain a reduced viral load. You can also discuss with your healthcare provider adjusting for central nervous system penetration to improve efficacy. It’s also important to treat comorbid Hepatitis C and cardiovascular disease, and treat or reduce the impact of other predictors for neurocognitive symptoms. These can include:

• Stress, anxiety, depression, PTSD

• Age

• Income level causing stress and poor nutrition

• Educational level/attainment

• Reading/reading quality

• Insulin resistance

• Hepatitis C/liver fibrosis

• Cognitive activity and employment

• Treatment status (viral load, CD4 count)

• Ongoing substance use

• Prior head injury

• Obstructive sleep apnea/disturbed sleep

• APOE-4; genetic mutation increasing risk for alzheimer’s disease

One thing to remember is that we can maintain and improve cognitive health in a number of ways even as we age. Improve memory storage and recall by repeating information over and over again in your mind. Try to avoid multitasking; focus on one thing at a time to improve memory retention. Improve neuroplasticity by increasing cognitive stimulation and regular social interaction.

On top of all this, what’s good for our bodies is good for our brains. Quit smoking, limit alcohol and substance use, get regular exercise, get a good night’s sleep regularly. Manage stress and negative moods, and eat a diet rich in foods and vegetables. Keep on top of medications and discuss them and their side effects with your doctor.

When it comes to our brains, it’s use it or lose it. Challenge and stimulate your brain daily and pursue cognitively challenging interests like reading, learning one new thing every day, remembering three things from your day, learning a new language. Creating an environment rich in social and cognitive stimulation will help keep our brains healthy.

Hormones are the chemical messengers that send signals throughout your body. These messages help influence our body functions on many levels, including our immune system, appetite, sleep, and more. Hormone production will naturally decline as we age, and HIV has also been shown to affect our ability to produce various hormones.

Testosterone: Primarily thought of as a male sex hormone, testosterone is found in most people. Low testosterone may cause:

• lower libido (sex drive)

• infertility

• loss of appetite

• fatigue

• reduced heart function

• loss of bone mass

• depression

• inability to grow muscle mass (even when working out), which can lead to wasting

• reduced strength and ability to do everyday tasks

• trouble maintaining balance

Keeping on top of your testosterone levels can be helped with testing. Blood tests can help monitor your current hormone levels and determine if you need treatments like testosterone supplementation. All folks taking testosterone HRT may need special considerations for the physiology, so be sure to consult with your primary care provider or endocrinologist about what your needs might be.

Thyroid hormones: The most common type of thyroid problem in people living with HIV is hypothyroidism, which interferes with the thyroid’s ability to produce hormones managing metabolism. There are different types of hypothyroidism, such as primary (including Hashimoto's thyroiditis), secondary, and tertiary hypothyroidism.

Some specific risk factors for hypothyroidism related to HIV include a low CD4 count, active opportunistic infections, and use of the HIV drug ritonavir (Norvir, also in Kaletra). Some other risk factors unrelated to HIV include:

• A family history of thyroid disease

• Sex (cis-women are more likely than men to develop thyroid problems)

• Age (cis-women over 60 have a one in five chance of having thyroid disease)

• Autoimmune disease (such as lupus, multiple sclerosis or rheumatoid arthritis)

• Using certain medications, such as:

  • The antidepressant lithium (Carbolith) 

  • The heart medication amiodarone (Cordarone)

  • The tuberculosis drug rifampin (Rifadin, Rofact), and,

  • Some anti-seizure medications; carbamazepine (Tegretol), phenytoin (Dilantin) and phenobarbital.

There are many symptoms of hypothyroidism, including fatigue, depression, difficulty concentrating or “brain fog”, weight gain, and high cholesterol. Other symptoms include:

• cold hands and feet, or low body temperature in a comfortable room

• dry, rough or scaly skin

• split, peeling or breakable fingernails

• hair loss

• difficulty sweating 

• constipation

• muscle weakness, stiffness, or pain

If you have these symptoms present, then discuss thyroid screening with your HCP. You’ll require symptom assessment, a physical examination, as well as some blood screening to identify the type of hypothyroidism you’re experiencing. Thyroid hormone replacement can then be used to combat hypothyroidism, available in different strengths as levothyroxine (Eltroxin, Euthyrox and Synthroid.) It may take weeks to become effective, and in some cases may not relieve symptoms. Continue to talk to your doctor about your symptoms.

Dehydroepiandrosterone (DHEA): DHEA is a hormone leading production of androgens (like testosterone) and estrogens, and helps stimulate growth hormone production. Levels of this hormone steadily decline with age, and folks living with HIV often have low levels of DHEA. Supplementation of DHEA by HIV specialists may help improve energy, protect the body against the impact of stress, and restore immune function. 

However, DHEA is a powerful steroid and taking too much can raise a person’s estrogen or testosterone to abnormally high levels. DHEA should only be used under medical supervision and should only be considered when tests show hormone levels are lower than optimal.

Drug-related hormone issues: Certain drugs used to treat other conditions may also affect hormone levels. Those living with HIV may want to discuss alternative options with their healthcare provider. These medications include:

• Rifampin (rifadin, also in rifater, used to treat tuberculosis, may cause cortisol to become too low and can also contribute to hypothyroidism)

• Opiates (can reduce lutenizing hormone, an ovulation trigger in cis women and a testosterone trigger in cis men)

• Cytovene (ganciclovir, used to prevent cytomegalovirus), 

• Megace (megestrol acetate, used to treat breast and uterus cancer), and 

• Nizoral (ketoconazole), used to treat skin infections such as athlete's foot, jock itch, ringworm, and certain kinds of dandruff, can suppress sex hormones and adrenal corticosteroid hormones

For folks undergoing HRT, available data show that most HIV drugs are safe to take with estrogens. Tenofovir disoproxil fumarate (Truvada) for HIV prevention (pre-exposure prophylaxis, or PrEP) can be safely taken with feminizing hormones but should be taken regularly. Two HIV drugs that should not be taken with estrogens: amprenavir (Agenerase) and unboosted fosamprenavir (Lexiva). 

Sadly, little data is available for folks using masculinizing hormones in HRT. Despite this, there is no known interaction between HRT and most ART drugs. Further, the inclusion of HRT alongside HIV care can help trans folks living with the virus take their medications regularly and on time. 

When it comes to transgender folks and HIV care, it can be difficult to find a provider who is competent with both. This underlines the importance of having HIV care providers who are also competent in caring for trans and gender diverse patients.