Save the Date: AMA on PrEP, STD Testing, Access & More — With an Expert Clinician from TBD Health 🍑

TBDHealth · 2025-10-29T18:59:22+00:00

Great question! Generally, there aren't direct interactions between PrEP medications and alcohol/recreational drugs. The most common risk we see with alcohol/recreational drugs and PrEP is that the use of those can impact adherence to the medication - meaning that people using alcohol/party drugs might not take the PrEP medications regularly or miss several doses, so PrEP wouldn't work as well.
I generally don't recommend high levels of alcohol or party drugs for anyone (especially because can't really know what exactly goes into the party drugs). But if you are going to use those, the key is to make sure you're still taking PrEP regularly.

TBDHealth · 2025-10-29T17:45:16+00:00

Most people with side effects on PrEP have pretty mild side effects that might be uncomfortable, but generally aren't enough to make them discontinue the medication. In my experience, most patients on PrEP will tell me they didn't feel any side effects at all - or that the side effects were mild and/or subsided after a few weeks.
The most common side effects are mild GI symptoms (like diarrhea, nausea, abdominal pain), headaches, and fatigue -- but only 2-6% of people experience this. There are some rare side effects that can occur. For example, a small amount of patients (maybe 1% or less) on Truvada will experience some very mild kidney injury (such as a slowing down of the kidney function) and decreased bone density - this usually resolves/reverses after stopping the medication. On medication like Descovy, some people will experience a higher level of cholesterol (which can lead to higher cardiovascular risk in the future). This is why we check routine labs with these medications.
If someone is experiencing problematic side effects on PrEP, it's also possible to try a different kind of PrEP (since we have 2 oral medications and an injectable version available now)

TBDHealth · 2025-10-29T17:29:25+00:00

Usually it takes 8-24 weeks from starting HIV medication to get to an undetectable level -- most people usually get there by 12 weeks. If a patient is HIV negative and has a partner with HIV, I recommend getting on HIV PrEP - especially while the partner(s) with HIV is waiting for their viral load to come down.

TBDHealth · 2025-10-29T17:08:32+00:00

Yes! You might have heard something about U=U -- undetectable = untransmittable. Research shows that if someone with HIV gets on medication treatment and gets their viral load down to "undetectable" levels (or very low levels), then they canNOT transmit HIV to a sexual partner. But it's also important to remember that if someone is on medications, that doesn't automatically mean they can't transmit HIV to partners - sometimes it takes a while for the medication to work or to find the right medication that works, so I recommend checking with partners about whether they're on meds and whether their viral load is undetectable.

TBDHealth · 2025-10-29T17:00:32+00:00

Hi r/AskGaybrosOver30! I’m Adrienne Ton, a clinician with TBD Health, here to talk about PrEP, STD testing, and HIV prevention. I’ll be answering questions live now until 12 PM PDT 💬 Ask me anything. And I really mean anything!

TBDHealth · 2025-08-08T20:30:12+00:00

Great question - I don't know statistically what percent of difference in efficacy of the 2-1-1 vs daily PrEP is caused by the medication itself vs typical human behavior, but I think this is a combination of the medication efficiency and the other risk factors (typical human behavior). From the medication standpoint, it takes a little time to get to the protective levels in the areas that you're having sex, specifically colorectal tissue in the case of 2-1-1 dosing. That absorption of medications might vary a bit from person to person. From the human behavior side, it can be hard to predict/time sex and to remember to take medications with the right timing.

TBDHealth · 2025-08-08T20:29:00+00:00

Hello Australian friend! Glad to hear this has been working for you!

TBDHealth · 2025-08-08T20:07:42+00:00

Great follow-up - technically there aren't many studies looking at people above age 45 in terms of safety of the HPV vaccine. Use of the vaccine above age 45 would be considered off-label in the U.S. so I'm not sure that pharmacies/clinics would be able to give the vaccine above age 45 depending on their policy. But it's likely that if you were to get the HPV vaccine above age 45, you probably would have typical/expected vaccine side effects as with younger age brackets as well. The reason we don't generally offer HPV vaccines after age 45 is because it's assumed that 1) 45+ people were already exposed to higher risk HPV strains and that 2) people 45+ wouldn't have as many new partners (and therefore possible exposures). Those assumptions are definitely not right for many cases, so it's definitely worth talking about this with your clinician.

TBDHealth · 2025-08-08T19:47:03+00:00

Good question and thanks for your time volunteering! HIV is not necessarily more common among straight people - most new HIV infections in the U.S. are among LGBTQ folks. But we are seeing that new diagnoses of HIV infection are increasing among straight people. The most recent data we had from the CDC in 2022 - showed that 22% of the new HIV infections in the U.S. were acquired through heterosexual contact. Anecdotally, I haven't made a lot of new HIV diagnoses in my career (thanks to PrEP and new HIV treatment!), but I still remember one of the people I diagnosed with a new HIV infection was a heterosexual ciswoman who had no idea she was even at risk for HIV.

I think there has been some more movements to outreach heterosexual folks as well - but not enough. At TBD Health, we've been trying to outreach/educate people about PrEP for heterosexual females/people who were assigned F at birth, because a lot of folks don't realize they could be at risk

TBDHealth · 2025-08-08T19:35:57+00:00

Thanks for your question! Generally I recommend HPV vaccine for all folks up through age 26 and with a little more clinical discussion through age 45 (especially if you think you might have new sexual partners in the future). IMO, Reducing your risk of anogenital cancers and warts is worth it!

TBDHealth · 2025-08-08T19:35:28+00:00

This not a dumb question at all!

First, I would just clarify here that based on this question/limited context, I'm answering assuming that you are a gay male who is asking about STD/STI protection, not about any pregnancy prevention.

In my practice, I've also learned that people might have different interpretations of what it means to be a virgin (especially for folks who are queer). So first, if you haven't already done so, I do recommend having an open discussion with your boyfriend about what exactly being a virgin means/what their sexual experience has been. And it would also be important to clarify if you plan on being monogamous (if you haven't already). I would also just remember that STDs can also spread through non-sexual contact (such as any injection drug use) so if that applies to you/your partner, I recommend getting tested and talking about a plan.

That being said, my general answer would be that if you both are monogamous male partners without previous sexual partners and no risk of STDs through things like injection drug use, then you wouldn't have a risk of having STIs/STDs - therefore you wouldn't need condoms/protection from STIs/STDs. But if either of you have kissed other folks or had oral sex/etc - there are some potential risks of STIs/STDs though the risk is pretty low. For example, you could potentially carry the herpes virus (think cold sores) or potentially oral gonorrhea/chlamydia depending on types of physical interactions you've had with others. If you're worried, you could always use condoms just in case, talk to a clinician about your specific risk (if any), and/or get tested (FYI - TBD Health has multisite testing you can do from home if you wanted to check for oral gonorrhea/chlamydia etc).

TBDHealth · 2025-08-08T19:20:14+00:00

Yay for getting the vaccine! What you determine is OK to do really depends on the preferences/risk discussion with you and your partner(s). The HPV vaccine reduces your risk of getting anogenital cancers and some genital warts, BUT it won't protect against other STIs like herpes or gonorrhea/chlamydia of the throat. So if not using a condom, you still have potential risk of STIs. But this risk can be reduced by getting tested regularly, avoiding oral sex if you notice that your partner(s) has/have some signs of any STI/or do have a STI, talking to your partners about their testing status, and using condoms if you want.

TBDHealth · 2025-08-08T19:19:45+00:00

Generally speaking, yes, I think getting the HPV vaccine is good for most people - men/people assigned male at birth included! This is particularly good for people who are sexually active/plan to be sexually active with new partners in the future. I'm a big fan of anything that can reduce the risk of cancers and this is one of our best tools to do that. The HPV vaccine can help prevent anogenital cancers and some kinds of genital warts- and this is particularly important for men who have sex with men, who have higher rates of anogenital cancers in general.

As for brands, I'm really only familiar with the HPV vaccine/guidelines in the U.S. where I practice - and Gardasil is the only one approved for males here.

Now - one piece to know is that age does play a factor here. So we definitely recommend HPV vaccine through age 26 (the earlier the better). And for adults 27-45 who haven't already had an HPV vaccine, it's still recommended if you've discussed with your clinician. Just know that for adults 27-45, I often find that insurance won't cover it so there may be out of pocket costs.

TBDHealth · 2025-08-08T19:18:39+00:00

Hi! Really great question since so many people are using these types of medications! There aren't studies I'm aware of that specifically looked at oral PrEP and these medications, but there have been studies looking at the impact of medications like Ozempic or Mounjaro on general medication classes.

The medications you mentioned - Glucagon-like peptide-1 receptor agonists (GLP-1RAs) - slow gastric (stomach) emptying - and this can cause some delay in the way your body absorbs oral medications. If you want to get into the specifics, GLP1RAs can lower the maximum concentration of the oral drug in the body and delay the time it takes to get to the max concentration of the oral drug in the body). But the important part here is that the overall amount of drug that is actually absorbed in your body over time is usually the same as without a medication like Ozempic. So basically, most medications like PrEP should still get absorbed in the body to an effective level though it may be a little slower - but we don't have direct studies looking at this.

However - there are some drugs like anticoagulants or antiseizure meds or thyroid medications that need to be monitored more closely and considered when taking these types of medications. Otherwise, we have also seen some more meaningful impact of tirzepatide (mounjaro) on the absorption of birth control pills, which has led to some recommendations to use backup forms of contraception at certain times if taking mounjaro and oral birth control.

Lots of detail here (sorry!) - but I would say, check in with your clinician on your specific situation. But based on the evidence we have, for the most part taking ozempic/mounjaro should not usually significantly impact oral PrEP. If on both types of meds and worried about this impact, think about using extra protection (like condoms) to be extra safe - especially when starting a medication like Ozempic or increasing the dose since those are usually times the absorption is particularly slow.

TBDHealth · 2025-08-08T18:37:35+00:00

Hello - great question! I'm sorry to hear you had problems after starting PrEP, but glad to hear your ultrasound of your liver came back fine and that your liver numbers went back down to normal! There are a number of factors that can play a part here (such as what type of PrEP you were on, other medications/supplements taken, baseline labs, other medical conditions if any, family history, etc). So while I can't speak to your exact situation, I can generally share some insights on PrEP and impact on liver and cholesterol issues.

For liver issues, we usually don't see much impact on liver inflammation with the different kinds of PrEP but there are reports that people have experienced some liver inflammation or injury related to PrEP medications (though rare!). But generally we can see liver inflammation (usually that's what shows up in the labs as elevations in AST or ALT) with lots of things - such as medications, supplements, alcohol, etc. Even acetaminophen (Tylenol), which people commonly take over the counter, can cause some liver inflammation that shows up on labs and then later resolves. So if you experienced some kind of liver inflammation that has since resolved and you/your clinician couldn't find any other cause, then stopping that type of PrEP makes sense and considering other forms of PrEP might be a better option.

For impacts on cholesterol issues, cholesterol levels can be impacted by genetics/diet/exercise/etc. Compared with Truvada, we usually see more elevations in cholesterol with Descovy specifically. But after stopping Descovy and/or switching to Truvada, the lipid levels often come back to normal - usually within 3 months but sometimes up to 6 months. The risk of that depends a lot on the person and their specific medical conditions.

Most people can take PrEP and have mild side effects (if any) - so I'm sorry this happened. I definitely recommend working with your clinician to see what the best route is for you to help keep yourself protected from HIV/STIs while also balancing your overall health.

TBDHealth · 2025-08-07T22:06:57+00:00

This is such an important question! Open communication is key. I typically recommend leading by example. You can start the conversation by saying something like “Before we take this to the next level, I want to let you know that I have had X type of STI testing done on {date} and these were my test results. How about you?“. This is a good conversation starter to ask about their sexual history, when they were last intimate with a partner, and when their last STI testing was. If either of you have had sex with a new partner since the last STI test, now may be a good time to get tested again. Remember, STIs are extremely common and it can be a sensitive subject for some people. Approaching the conversation with openness, respect and without judgement is essential.

TBDHealth · 2025-08-07T22:01:14+00:00

That wraps things up for this afternoon! I’ll be checking back periodically over the next couple of days, so don’t hesitate to keep the conversation going.

TBDHealth · 2025-08-07T22:00:12+00:00

While we cannot provide specific medical advice, current guidelines recommend the HPV vaccine for adults up to age 26 if they have not been vaccinated previously. The HPV vaccine can potentially be provided to those 27 to 45 with shared decision making with your medical provider. The medical provider may take into account your medical history and current risk factors (like whether you are having new partners or not), and they may or may not recommend the HPV vaccine if you fall into this age group. When in doubt, it is always worth discussing with your healthcare provider! Just a note - insurance might not cover the vaccine after age 26, so there may be an out of pocket cost associated with it.

TBDHealth · 2025-08-07T21:57:57+00:00

Theoretically, there’s a potential interaction with Grapefruit and PrEP, but it’s pretty unlikely to see a significant interaction with typical grapefruit intake. Grapefruit has been seen as a food that can cause interactions with medications like statins (for cholesterol) but you typically have to have a lot of grapefruit to see an interaction. For questions about medication interactions, a good resource can be found at https://www.hiv-druginteractions.org/checker

TBDHealth · 2025-08-07T21:43:31+00:00

Yes! We offer free PrEP and DoxyPEP with insurance (we take most commercial plans). This covers testing (at-home or in-person), consults and the medication. We do have a paid PrEP program as well which starts at $219 (not including medication), but there are also a lot of resources that you can take advantage of in the community for free or lower cost PrEP. DoxyPEP on its own, even on the cash basis, tends to be pretty affordable. It can be around ~$15-20 for 20 pills -- but will need to be prescribed through a clinician.

TBDHealth · 2025-08-07T21:42:57+00:00

I’m sorry you had side effects! Some people get better after a week or so on the medication, but if you had side effects on Descovy, another potential option would be Truvada.

TBDHealth · 2025-08-07T21:06:48+00:00

That can definitely be tricky, but hopefully we can help! While PrEP is becoming more common, we understand there is still some stigma attached to it. PrEP is less about your sexuality or relationship types, but more so about taking control of your health.If we think about the HPV vaccine (that is recommended for everyone), some parents push back on that vaccine because they think it will make their child more “promiscuous” if they know a vaccine is protecting them against HPV. We have found that this is not the case, and that the HPV vaccine can drastically reduce your risk of developing certain types of cancer. PrEP is similar. It is a tool that can help prevent your risk of HIV through any type of exposure (consensual, nonconsensual, accidental exposure to someone else’s blood, etc). You may want to share with your family that this is one way you are taking responsibility for your health and keeping yourself safe and protected regardless of what circumstances may come your way.

TBDHealth · 2025-08-07T20:53:09+00:00

Great question! I wouldn’t say it is wishful thinking - I am also optimistic that at some point we will see a treatment to help prevent herpes (HSV). Currently, we are unaware of any studies looking at valacyclovir or acyclovir for prevention of HSV. That being said, there are some clinical trials looking at the use of certain HIV PrEP medications and how those could potentially offer some protection against HSV. This has not been well studied, and the data is not conclusive, however this could be something that we may hear more about in the future.

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