1. What does front hole atrophy from testosterone mean for HIV or STI risk? Does it increase risk? How best to reduce risk if not using condoms?

There is very limited research into the experience of atrophy, we know it can happen but we don’t know why it happens to some men and not others, and what the prevalence is. 



Atrophy as a risk factor for increased HIV or STI risk is also unknown, however, the thinning, drying or otherwise degrading of tissue (such as through genital atrophy) makes the path of HIV into the bloodstream and the transfer of (STI) bacteria onto the mucosa much easier. 



There are a number of safe sex and risk reduction strategies that can be used if condoms aren’t used such as Pre Exposure Prophylaxis (PrEP), Treatment as Prevention (TAsP) and Post Exposure Prophylaxis (PEP) for preventing HIV transmission, regular testing is also important to identify and treat STIs. Lube is also 100% your friend in terms of not exacerbating any tears associated with atrophy. 



You can read all about this on GRUNT here. Another great website is Know The Risk, it is very cis male centric but is does provide good tips on reducing risk as well as a risk calculator. 


Thanks for supporting GRUNT!

2. What other important stuff should I know about PEP?

Asking for something like PEP can be awkward but it’s important to remember that taking PEP is about taking responsibility for your own health and nothing to feel ashamed about.


Sometimes hospital staff may not know what you are talking about when you ask for PEP but don’t give up. Call a state-based PEP info line and they can sort it out with you. As can your local sexual health clinic.


You can also insist on seeing someone who does know about PEP (like the on call infectious diseases staff member). PEP is available in Australia so make sure you speak up and get what you need.


Sometimes staff members might get caught up on the mechanics of how and why you have sex, particularly when talking about PEP to a trans guy. A good way to clarify with staff is to ask,


“ïs this question directly related to your assessment about if PEP is a good treatment option for me?” You are also not required to disclose to anyone that you are trans.

trans couple and their shadows

3. What about pregnancy when cis and trans men have condomless sex?

Thanks for checking out GRUNT and for reaching out to us. You have asked a very good question indeed.


There isn’t much in the way of formal resources or research that focus on reproductive health for trans men who have receptive sex with cis men. Indeed, as with many other communities, we learn about risk and experience from discussing it with each other while continuing to advocate and demand that our population of men be included in critical areas of research such as sexual and reproductive health.


We know that the use of testosterone for medical transition is not 100% effective in preventing pregnancy, however, the chances of a man who uses testosterone and who has also ceased menses for 6+ months falling pregnant is very slim, perhaps as likely as a cis woman taking birth control pills falling pregnant – not 100%.


Progesterone only (non-estrogen) biomedical methods include: implant (Implanon or Nexplanon), hormonal IUDs (Mirena, Skyla, and Liletta), the shot (Depo Provera) and even some kinds of birth control pills.


Our mates at Original Plumbing asked an OB/Gyne this very question a few years ago – their answer.


At the end of the day though, it’s always important to talk through reproductive health questions and concerns with your GP. Even if it’s awkward and you’re worried they might not know the answer, it is well and truly their job to find out.

4. I've recently been diagnosed with HIV. Who can I contact for support?

The best people to give real-world advice about living with HIV are other people living with HIV (PLHIV).


The Institute of Many (TIM) is a peer-run community of people living with HIV that welcomes all trans people. Their Facebook page is here.


PASH.tm can also support you to get the support you need at AIDS Councils and PLHIV organisations. Don’t hesitate to contact us.


Next Steps is also a resource for people recently diagnosed with HIV. It covers a range of issues including treatments and monitoring, transmitting and preventing HIV, safe sex, relationships, sexually transmitted infections, your rights, recreational drugs, and having children.


The HIV Tests and Treatments website explains common tests used for monitoring your health, provides information about available treatments, and can help you with your decisions about whether to start HIV treatment.


AFAO’s page for partners, family and friends also contains information and suggestions on how to best support a recently diagnosed loved one.