Shop Alto Essentials to add pharmacy products to any delivery!

Your partner in navigating the ins and outs of prescriptions — at no extra cost.

Alto Pharmacy Technician

Alto Pharmacist

It’s official: Alto Pharmacy is a great place to work! We’re honored to join the community of Great Place to Work-Certified™ companies based on team member feedback and a rigorous assessment of our company’s culture and benefits.

Join us in delivering our industry-leading pharmacy care to millions of people across the country. As a member of the team, you’ll play an integral role in improving our customers’ quality of life and redefining what’s possible in pharmacy. 

Be Part of a Great Place to Work — Join Our Team

Hear first-hand from members of the Alto technology teams.

Read the latest Alto blog posts covering healthcare, family health, managing diseases, and other Alto highlights.

Blog | Alto Pharmacy

If you are considering freezing your eggs, it’s important to take the financial aspects of treatment into account. Here are our top financial planning tips and resources to support your egg freezing journey.

A Financial Planning Guide for Egg Freezing

Egg freezing — a fertility preservation treatment that allows you to freeze unfertilized eggs and store them for later use — has allowed millions of individuals to leave open the possibility of having children in the future and experience more flexibility in their family-planning timelines.

If you are considering freezing your eggs, it’s important to take the financial aspects of treatment into account. While it’s true that egg freezing is a significant investment of time and resources, there are many options for managing or lowering the costs of treatment so that you can move forward with the process. Here are our top financial planning tips and resources to support your egg freezing journey.

Before you can determine how to pay for egg freezing, it’s important to have a sense of the total cost. Keep in mind that egg freezing expenses are ongoing. In the short term, you are accounting for fertility medications and the egg freezing cycle (or cycles). These costs vary from one individual to another, as your reproductive health — including the number of eggs in your ovarian reserve — will inform your individual medication protocol and the number of cycles needed to retrieve your target number of eggs.

Long-term egg freezing expenses include the cost of storing your eggs and in vitro fertilization (IVF) — the process of thawing your eggs, fertilizing them with sperm, and having them placed into your uterus through a non-surgical procedure — if you decide to use them in the future. The length of time that you store your eggs will impact the overall cost. 

You may not be able to accurately predict all of these variables in advance, but identifying your longer-term reproductive goals and mapping out a vision can help you prepare as much as possible for the total investment. Setting up a consultation with a fertility clinic can be a good first step toward getting the information you need about your reproductive health to plan accordingly. The cost of a consultation typically ranges from $250-500, and clinics typically list these fees on their website or can provide specific information over the phone.

Savings and support from family and friends

Depending on your individual circumstances, you may have money in a savings account that you can use for part of your egg freezing expenses. If you have questions about getting started with a savings account, a financial planner or a budgeting tool like NerdWallet, Mint or Savology can help you determine how much money you may need to seek through grants, loans, and other resources.

You may also have family or friends who are able to contribute. If you are comfortable sharing your egg freezing experience with others, consider using fundraising websites like GoFundMe to reach out to your extended network for donations.

Health insurance coverage and workplace benefits

Some health insurance plans offer partial or full coverage of egg freezing-related costs including medications and IVF. Note that most insurance plans have separate medical and pharmacy benefits. In most cases, professional services provided by your doctor or clinic will fall under medical benefits. Fertility medications will likely fall under pharmacy benefits, though in some cases they may fall under your medical benefits.

If you have a health savings account (HSA) or a flexible spending account (FSA) — two types of pre-tax accounts you can use for healthcare expenses — consider planning ahead to use these accounts to reduce the total cost of your fertility treatments and your taxable income.

In addition, some employers offer egg freezing coverage as part of their employee benefits, separate from your health insurance plan. Do not be discouraged if you learn that your employer doesn’t currently cover egg freezing: employers who offer fertility coverage often do so in response to an employee’s request. RESOLVE: The National Infertility Association, a nonprofit that supports individuals and couples affected by infertility, has resources to help you start a conversation with your employer about fertility coverage benefits.

Your total egg freezing expenses also depend on your choice of fertility clinic. Most clinics can share the total out of pocket costs for egg freezing if you do not have any insurance coverage. As you explore your options, call various clinics to ask about costs with a list of questions prepared in advance. Here are examples of questions to ask:

Based on my specific treatment plan, what is the typical all-inclusive cost?

What is included in the treatment cost and what is not?

Can you provide a detailed list of procedures and costs?

What is the typical cost of fertility medications for my treatment plan?

You may also want to ask if they will store eggs for up to a year as part of the cost of an IVF cycle, which is a common practice at many clinics.

In addition, some fertility clinics offer no- or low-interest payment plans. During your search, ask various clinics about any available financial assistance.

Many individuals and couples fund a portion of their egg freezing expenses through a personal loan. There are companies that provide loans for fertility treatments, with flexible monthly payment options, including Lending Club and CapExMD. Some lenders focus exclusively on fertility, including Origin Finance, and can lend enough to cover the entire cost of the treatment, with plans starting around $250/ month. (Great news: the Origin application fee is waived for Alto customers!)

Regardless of which lender you choose, verify the interest rate and any other fees. Many of these companies have budgeting tools on their websites so that you can get a sense of what your monthly payments will be before you decide to take out a loan.

In addition, many companies and organizations offer grants that help cover a portion of fertility treatment costs. Some are based on income level and demonstrated financial need while others are designed to support specific groups including members of the LGBTQ+ community and people of color.

Fertility for Colored Girls (FFCG) offers grants for Black women and couples.

Men Having Babies, which supports gay men and couples in starting their families through surrogacy, offers income-based cash grants through the Gay Parenting Assistance Program. (If you are starting a family as a gay man, your path to parenthood will likely include an egg donor and IVF but not necessarily egg freezing.) In addition, Family Equality has a list of family-building grants that help LGBTQ+ families afford fertility treatment.

You can also search for additional grant opportunities through RESOLVE.

In addition to applying the loans or grants mentioned above toward your fertility medication expenses, some fertility medication manufacturers offer patient assistance programs in partnership with fertility clinics to further alleviate these expenses.

If Alto is your fertility pharmacy, your fertility medication protocol likely includes medications manufactured by EMD Serono or Ferring Pharmaceuticals. EMD has several programs that lower the cost of fertility treatment, including the Compassionate Care program, which offers income-based assistance for fertility medications that aren’t covered by insurance, and special opportunities for military veterans and cancer survivors.

Ferring Pharmaceuticals also offers financial assistance programs to offset the cost of fertility medications, including the HeartTomorrow program for individuals who elect to freeze their eggs, and special opportunities for military veterans and cancer patients.

Read our previous blog to learn more about EMD Serono's financial assistance programs and how to apply.

Your choice of fertility pharmacy matters

There’s one more factor that can significantly impact the cost of your fertility medications: your choice of fertility pharmacy partner.

Alto is committed to your financial well-being alongside your physical health. To help you save as much as possible on your fertility medications, we’ll automatically search for and apply any savings, as well as connect you with any outside programs that require you to apply directly.

We know that managing the costs of egg freezing is just one part of your fertility journey, and we’re here to make the process as easy as possible. We offer a convenient and supported pharmacy experience, with fast, reliable delivery of your medications and fertility resources like personalized injection guide videos and access to fertility-trained pharmacists.

In addition to local service offerings at our brick-and-mortar locations, we’re serving more patients throughout the United States through our mail order service. We offer free FedEx next-day delivery of all fertility medications and supplies to patients served via mail order.

If you’re interested in learning more about how Alto can support your fertility treatment, you can request a price quote online. 

Editor’s Note: This post was originally published in March 2022 and has been updated for accuracy and completeness.

This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or another qualified health provider with any questions you may have regarding a medical condition.

Infertility is often thought of as exclusively a women’s health issue, but the truth is that it can affect anyone regardless of gender. We explain more including male infertility causes, symptoms, and treatment options.

Male Infertility: Causes, Symptoms, and Treatment

Infertility is often thought of as exclusively a women’s health issue, but the truth is that it can affect anyone regardless of gender. About one-third of infertility cases include factors exclusively related to male reproductive function.

If you’ve experienced infertility, you’re not alone: about 9% of men and 11% of women in the U.S. have faced fertility challenges. And while these challenges may feel overwhelming, they do not necessarily mean that you won’t be able to start a family one day — there are a variety of fertility treatment options for both men and women to support your family building journey.

Below, we explain more about male infertility, including causes, symptoms, and treatment options that can help you build or add to your family.

Male infertility most often stems from issues with sperm production. In some cases, it may be a problem with the quality of your sperm, like how fast or how well your sperm move. In other instances, it’s a matter of sperm quantity: you may not be able to produce any sperm, or you may have a low sperm count (the threshold is typically a sperm count under 15 million sperm per milliliter of semen.)

Issues with sperm production or function may be caused by the following:

Hormone, pituitary gland, or immune system problems

Hemochromatosis, a condition in which you have an excess of iron in your system

Lifestyle and environmental factors can also play a role: heavy smoking (20 or more cigarettes per day), consistent heavy drinking or binge drinking (for men, five or more drinks in a two-hour timeframe), drug use, and exposure to toxins like endocrine disruptors contained in plastics and pesticides have been linked to male infertility.

Beyond issues with sperm production, anything that blocks a reproductive organ can interfere with the flow of semen, including inflammation from a sexually transmitted infection, scar tissue from surgery, or swollen veins in any of your reproductive organs. Additional factors in male infertility include erectile dysfunction, premature ejaculation, liver or kidney disease, and treatment for seizure disorders.

You may have a greater chance of experiencing fertility issues if you have had any of the following:

Inflammation of your prostate or genital infections

Certain prescription medications may also increase your risk of infertility, including:

5-alpha-reductase inhibitors, a medication class used to treat prostate enlargement and hair loss, which includes finasteride (Propecia®) and dutasteride (Avodart®)

Alpha blockers like silodosin (Rapaflo®), tamsulosin (Flomax®), alfuzosin (Uroxatral®), terazosin (Hytrin®), and doxazosin (Cardura®), which are used to treat prostate enlargement

Some selective serotonin reuptake inhibitors (SSRIs) used to treat depression and anxiety, including sertraline (Zoloft®) and paroxetine (Paxil®)

Spironolactone, which may be used to treat high blood pressure or acne

Cimetidine, which is used to treat acid reflux and gastroesophageal reflux disease (GERD) 

If you and your partner are unable to conceive after trying for at least a year, one or both of you may be experiencing infertility. If you have experienced any of the following symptoms, you may wish to consult with your doctor about a potential diagnosis of male infertility:

Problems with ejaculation, including delayed ejaculation

If you have previously had surgery in your genital area, you should also consult with a doctor about potential infertility issues.

To evaluate you for an infertility diagnosis, your doctor will first ask questions about your medical history, including your sexual history and any other factors that may affect your reproductive health and fertility. They may also do a physical exam to check your genitals for any abnormalities.

The next step is typically a semen test, sometimes called a sperm count. Your doctor will ask you for a sample of semen. During their evaluation, they will look at how many sperm you produce and whether the sperm are normal in shape and movement — healthy sperm have an oval head and long tail.

Your doctor may recommend additional tests, including blood tests to evaluate your hormone levels and to rule out other health conditions, and genital ultrasounds to identify potential reproductive health issues.

Thanks to the medical community’s advances in fertility treatment and technology, infertility issues do not mean that you won’t be able to build a family. There are a range of treatment options that can help increase your chances of conception. Your doctor will make recommendations for the best course of treatment based on the underlying cause of your fertility issues.

Oral medications such as the following are the firstline treatment for most cases of male infertility.

Clomid® is an oral medication that can increase testosterone and sperm production as well as improve sperm motility.

Letrozole (Femara®) is an oral medication that can improve sperm count and motility. A non-steroidal aromatase inhibitor, it functions by decreasing estrogen production.

Anastrozole (Arimidex®) is another oral non-steroidal aromatase inhibitor used to increase sperm count and improve sperm motility. It can also help restore the testosterone-estrogen balance for some men experiencing infertility.

Additionally, tadalafil (Cialis®, Adcirca®), vardenafil (Levitra®, Staxyn®), and sildenafil (Viagra®, Revatio®) may be used to treat erectile dysfunction, a factor in male infertility.

An evaluation is typically scheduled after 3-6 months of treatment. If oral medications haven’t been effective by this point, a provider may recommend injectable gonadotropin therapy or assisted reproductive technology (ART) treatments.

There are two types of hormones used in injectable gonadotropin therapy: human chorionic gonadotropin (hCG) and follicle stimulating hormone/luteinizing hormone (FSH/LH).

hCG treatment triggers the testes to produce testosterone, which leads to production of new sperm. Common hCG medications used to treat male infertility include Pregnyl®, Novarel®, and Ovidrel®. 

FSH/LH treatment triggers production of new sperm. Common FSH/LH medications used to treat male infertility include Gonal-f®, Follistim®, and Menopur®.

hCG treatment can be used alone to stimulate sperm production, but FSH/LH treatment must be used in tandem with hCG treatment. If hCG treatment is not successful after six months, FSH/LH treatment may be added to a medication protocol.

While injectable therapies are effective, they take time to work. The length of treatment ranges from six months to 1-2+ years. Keep in mind that once new sperm is produced, it takes an additional 3-4 months before it is available. 

Assisted reproductive technology treatments

There are several fertility treatment options that can increase your chances of conceiving a child, including in vitro fertilization (IVF) using a technique called intracytoplasmic sperm injection (ICSI) and different forms of artificial insemination like intrauterine insemination (IUI).

In intracytoplasmic sperm injection (ICSI) a single sperm can be injected directly into an egg. This procedure is often incorporated into an IVF cycle for many couples affected by male infertility. IVF is a process in which eggs and sperm are fertilized in a laboratory and then placed into the uterus with the potential outcome of a pregnancy. Women trying to conceive may undergo IVF treatment if their partner is experiencing male infertility to increase their chances of conceiving. ICSI can be the fertilization method used in IVF.

In IUI, sperm that have been washed and concentrated are placed directly into your partner’s uterus around the time that they are ovulating, helping your sperm reach an egg more easily.

Since lifestyle habits like heavy smoking or alcohol use can affect sperm production, you may be able to increase your sperm count with healthy choices like exercising regularly and abstaining from cigarettes, alcohol, and drugs.

A fertility pharmacy partner you can rely on

At Alto, we understand that there are many paths to parenthood, and that each individual or couple’s needs are different. Our team of pharmacists is experienced in male infertility treatment options, and we’ll be here at every step of the way if fertility medications become part of your plan. 

Reach out through in-app messaging or by phone at 1-800-874-5881.

All third party trademarks (including logos and icons) referenced by Alto Pharmacy remain the property of their respective owners. Unless specifically identified as such, Alto’s use of third party trademarks does not indicate any relationship, sponsorship or endorsement between Alto and the owners of these trademarks.

Editor’s Note: This post was originally published in April 2022 and has been updated for accuracy and completeness.

For nearly 50 years, RESOLVE — a national patient advocacy organization — has been both a go-to resource for individuals and couples experiencing infertility and a leading advocacy voice.

What to know about RESOLVE: The National Infertility Association

Infertility is often misunderstood and stigmatized, and it’s easy to feel isolated when you are experiencing difficulty starting a family. For nearly 50 years, RESOLVE — a national patient advocacy organization — has been both a go-to resource for individuals and couples experiencing infertility and a leading advocacy voice, helping pass laws across the country to make family building options more accessible.

Simeonne Bookal, Senior Manager, Access to Care, and Tracie Sullivan, Senior Manager, Grassroots Outreach, recently spoke with Alto about some of the challenges their organization has overcome, what’s coming up next, and why we need more honest conversations about infertility.

RESOLVE has supported individuals and couples through infertility challenges for nearly 50 years. What’s the biggest obstacle you’ve had to overcome as an organization?

Tracie: I focus on RESOLVE’s grassroots advocacy efforts and help lawmakers understand the challenges of family building and the need for legislation that removes barriers to family building options. I continue to see so much stigma and shame around infertility, even in 2021. Part of that comes from misconceptions about infertility and surrogacy.  

I would say, though, that we are generally moving in a positive direction, with greater awareness of infertility and all the accompanying challenges. In recent years, celebrities and other influencers have come forward and shared their experiences with infertility, which has opened the gate for more conversations.

Simeonne: To build on Tracie’s point, when public figures do come forward and share their experiences with infertility, it’s often after they’ve had a happy ending, not when they’re struggling the most. We’re continually trying to broaden the conversation so that people feel empowered to share when they’re in the most difficult part of their infertility journey. 

On a different note, the pandemic has been one of the biggest challenges we’ve had to tackle as an organization. For us, pivoting to virtual programming isn’t just about moving online, it’s about finding ways to offer the same quality of services and events as we did pre-pandemic. 

We’ve had success with virtual events, including our advocacy day and programming for National Infertility Awareness Week 2021. Many people have found our virtual support groups to be really accessible, and that’s been an opportunity for us to reconsider how we can most effectively bring people together.

What can we look forward to from RESOLVE in the near future?

Simeonne: Like many organizations, RESOLVE is invested in making our programming as inclusive and diverse as possible. Something I’m really excited about, which emerged from our conversations about inclusion and diversity, are more tailored support groups.

We recently launched a men’s support group and a BIPOC (Black, Indigenous, and People of Color) support group. I think we’ll continue to see a trend of more specific support groups over time, in recognition of how many different experiences of infertility exist.

What would you tell someone who’s nervous about joining an infertility support group?

Simeonne: Just give it a try. There’s no commitment required, and you can talk as little or as much as you want. It may feel intimidating to share something so personal with a group of strangers, but many people find it easier to discuss infertility in our support groups than with family and friends since you’re speaking with people who understand what you’re going through. 

Also, now is an ideal time to get started, since many of our groups are meeting virtually. You don’t even have to leave the house, you can just log on.

What’s happening in the legislative landscape in regards to family building opportunities?

Tracie: Right now, 19 different states have passed fertility insurance coverage laws, 13 of which include IVF coverage. (Editor’s note: Fertility insurance coverage laws require health insurance providers to offer coverage for diagnosing infertility and treatment. There is significant variation in state-level legislation, and not all states with fertility insurance coverage laws require health insurers to cover assisted reproductive technology (ART) procedures like IVF.)

And 11 states have fertility preservation laws that support people navigating medically-induced infertility, including cancer patients and survivors. (Editor’s note: Fertility preservation treatments like egg freezing and sperm freezing allow individuals to have biological children in the future after changes to their reproductive health. Many individuals living with health conditions that impact fertility explore these treatment options, as do others who wish to delay starting a family.)

RESOLVE is actively working to pass fertility insurance coverage laws in other states, and to improve the legislation that is already in place. For example, in some states with fertility insurance coverage legislation, there are restrictions to coverage access, including marriage requirements and five-year waiting periods for fertility treatment, which don’t align with current medical care standards. 

In other states, coverage is limited to diagnosis and testing and does not include treatment. We also support federal legislation that improves access to family building. Our goal is to make these benefits as inclusive and accessible to as many individuals and families as possible. 

We have a great resource on our website that explains more about infertility insurance and offers a state-by-state breakdown of fertility insurance coverage laws.

View RESOLVE’s guide to infertility coverage by state.

The financial cost of fertility treatment can feel overwhelming. Can you share any resources that help make fertility treatment more accessible?

Simeonne: There are many resources out there that can help alleviate part of the financial burden — from manufacturers’ patient assistance programs to scholarships, grants, and coverage at work programs — but it does require a bit of research. 

We have a list of infertility financing programs and services on our website, which includes some patient assistance programs, and another page with scholarships and grants that you can apply to. 

In addition, RESOLVE’s Coverage at Work initiative was created to support employees and employers in adding fertility insurance coverage to their companies’ healthcare plans.

Tracie: We’ve been happy to see that more employers are offering coverage, even in states that don’t have laws related to infertility coverage. If family building options aren’t covered through your employer’s healthcare plan, we always encourage people to ask for support. You’ll be helping many more people going through the same experience by bringing attention to the need for coverage.

View RESOLVE’s toolkit for employees seeking fertility insurance coverage.

What do you enjoy most about being a part of RESOLVE?

Simeonne: I feel grateful to work for an organization that’s making a direct impact in so many people’s lives. I love getting messages from support group members sharing what this resource means to them. I feel a greater connection to my work and a deeper sense of motivation knowing it touches so many people during a time in their life when it’s easy to feel alone. 

Tracie: I also love seeing the difference that RESOLVE makes for so many people. Many of the laws our community has helped advocate for take years to pass, but when they do, thousands of people get the coverage they need to start a family. And I feel lucky to work alongside such a passionate group. Many of our advocates are people who have completed their family building journeys but want to be there for others.

The importance of seeking support when experiencing infertility 

It is understandable to feel overwhelmed when navigating infertility and exploring your family building options. While each individual journey is unique, there are others willing to share their experience and offer support as you take the next steps to start a family. RESOLVE can help you connect with other individuals affected by infertility and explore your options for financing fertility treatment.

Search for a RESOLVE support group and learn more about how to seek fertility insurance coverage from your employer.

At Alto, we understand the complexities of fertility treatment and the challenges of infertility, and we are here to support you in starting a family if fertility medications become part of your path to parenthood. With Alto, you’ll never have to worry about whether medications will arrive on time, and you’ll have support at every step of the way — we offer a variety of resources including one-on-one consultations with fertility-trained pharmacists to ensure that you’re never alone in navigating fertility treatment.

Learn more at alto.com/fertility or reach out at any time by phone at 1-800-874-5881 or in-app messaging. 

About RESOLVE: The National Infertility Association

Established in 1974, RESOLVE: The National Infertility Association is a non-profit organization with the only established, nationwide network mandated to promote reproductive health and to ensure equal access to all family building options for men and women experiencing infertility or other reproductive disorders. One in eight U.S. couples of childbearing age is diagnosed with infertility. RESOLVE addresses this public health issue by providing community to these women and men, connecting them with others who can help, empowering them to find resolution and giving voice to their demands for access to all family building options. For more information, visit www.RESOLVE.org.

RESOLVE: The National Infertility Association

For many transgender men and women, hormone replacement therapy is an important component of their transitioning process. Here is an overview of hormone replacement therapy medications and side effects.

What to Know About Transgender Hormone Therapy Side Effects

For many transgender men and women, hormone replacement therapy is an important component of their transitioning process, allowing them to develop physical traits aligned with their gender identity. Taking this step to feel more comfortable in your body is a big decision, and there are many factors to consider as you determine if gender-affirming hormone replacement therapy is right for you. 

Below is an overview of hormone replacement therapy medications and side effects to help you learn more about the process.

Hormone replacement therapy for transgender women

Estrogen and testosterone-blocking medications help transgender women develop a more feminized appearance in line with their gender identity while transitioning. It reduces the discomfort of gender dysphoria, the distress caused by having a gender identity that differs from the sex you were assigned at birth. Many transgender women experience less emotional distress, improved personal relationships, and a better overall quality of life as a result of hormone replacement therapy.

Feminizing hormone replacement therapy causes a variety of physical changes like breast development and facial and body hair reduction. You may also experience a loss of muscle tone and changes in your body shape as the body redistributes fat cells.

Feminizing hormone replacement therapy medication and timing

While your healthcare provider will help you develop an individualized treatment plan, feminizing hormone therapy often begins by taking 100 to 200 milligrams daily of a diuretic called spironolactone to begin blocking male hormone receptors and suppress testosterone production. Some individuals begin taking estrogen immediately, in tandem with spironolactone, to further reduce testosterone production and develop more feminine characteristics. In other cases, estrogen is introduced after several weeks of spironolactone use. Your doctor will recommend the best plan for your needs.

There are various methods for administering estrogen, including orally, by injection, or as a cream, gel, spray, or patch. Commonly used forms of estrogen during a male-to-female transition include:

Oral: Estradiol tablets. 
Note that your doctor may advise you to let the tablets dissolve under your tongue rather than swallowing them. This is called sublingual administration, which may lower your risk for blood clots since it bypasses the liver.

Injections: Estradiol valerate (branded options include Delestrogen®) and estradiol cypionate (branded options include DEPO®-Estradiol)

Feminizing hormone replacement therapy side effects

You may experience one or more of the following hormone replacement therapy side effects. Your doctor can advise you about the potential risks and benefits prior to starting hormones.

A blood clot in a deep vein (also known as deep vein thrombosis) or in your lungs

High levels of triglycerides, a type of fat found in the blood

Feminizing hormone replacement therapy may also increase your risk for some chronic health conditions. Since estrogen affects how your body responds to insulin, it can lead to changes in your blood sugar levels and a greater risk for type 2 diabetes. Research into the impact of estrogen on your cardiovascular system is ongoing, and some studies have found a connection between estrogen therapy and a greater risk for heart disease and stroke. You may also face a greater risk of breast cancer after starting hormone replacement therapy.

Certain underlying health conditions may increase your risk of health complications related to the use of estrogen and testosterone-blocking hormones. It’s important to share your full medical history with your doctor, especially if you’ve had a hormone-related cancer, like prostate cancer, or a history of blood clots.

Gender-affirming hormone replacement therapy may affect your fertility, as it impacts sperm production. While some transgender women can produce sperm again after stopping hormone treatment, research indicates that this may not be the case universally, and there is a risk of permanent infertility with long-term use of hormones. If you would like to have biological children, ask your doctor about your options with freezing your sperm before starting hormones.

Hormone replacement therapy for transgender men

Hormone replacement therapy for transgender men during a female-to-male transition also combats gender dysphoria, leading to reduced emotional discomfort and better overall mental health.

During the process, you will take testosterone, which decreases estrogen production and suppresses menstruation. Testosterone is typically administered by injection (branded options include Delatestryl® and Tesamone®) or as a gel applied to the skin (branded options include AndroGel®, Testim®, Fortesta®, and Axiron®). In some cases, it may be applied as a patch or pellets positioned under the skin. If you have a persistent menstrual flow, your doctor might recommend taking progesterone to control it.

You may observe some of the following physical changes within several months of starting hormones, though individual responses to treatment varies:

Masculinizing hormone replacement therapy side effects

There are several potential side effects that transgender men may experience as a result of hormone replacement therapy, including the following:

Masculinizing hormone replacement therapy may also increase your risk for type 2 diabetes and cardiovascular disease.

You are more likely to experience one or more of these health complications if you have had breast cancer or have a history of blood clots. It may be unsafe to continue with hormone treatment if you are pregnant or breastfeeding. Be sure to discuss the potential risks and benefits of hormone replacement therapy with your doctor, and make sure they are aware of your full medical history.

Masculinizing hormone therapy and fertility

While some transgender men have sucessfully undergone egg freezing or IVF after starting hormone therapy, long-term use of hormones may lead to permanent infertility. If you want to leave open the possibility of starting a family by having children biologically, consult your doctor about your options for egg freezing before starting treatment.

Given that individual responses to testosterone treatment vary, you have a chance of becoming pregnant even while taking hormones. Your doctor can advise you about your options for birth control.

Baseline and follow-up testing for hormone replacement therapy

Before you begin hormone replacement therapy, your doctor will order tests to measure your baseline lipid, blood sugar, liver enzyme, and electrolyte levels, which may change throughout the course of your treatment. Your doctor will also evaluate your medical history to identify any health conditions that may affect treatment. This is also a good opportunity to discuss reproductive health and fertility considerations, including potential contraception options if you are a transgender man.

Throughout hormone therapy, you will have regular follow-up appointments with your healthcare provider to document physical changes in your appearance and monitor the impact of hormones on your lipids, blood sugar, and liver enzymes.

Hormone replacement therapy affects you emotionally as well as physically. In the long term, gender-affirming treatment, including both hormone therapy and surgery, can lead to better mental health, reducing the need for depression and anxiety-related treatment. 

Your doctor will likely ask questions related to your mental health during your initial consultation — including any symptoms of gender dysphoria that you have experienced and how they impact you at work, school, or home — and continue the conversation throughout your treatment.

It’s important to be honest with your doctor about how you are feeling — your mental health matters as much as your physical health. Don’t be afraid to ask for mental health-related resources if you need extra support, and remember that your doctor is here to help you without judgment.

View the National Institute of Mental Health’s suggestions for finding mental health treatment, and the Human Rights Campaign’s list of LGBTQ mental health resources.

Alto is here to support your journey with hormone replacement therapy. Our team of patient care pharmacists has experience working with the LGBTQ+ community and is available to answer any questions you have about the process.

We also make it as simple as possible to stay on top of your medications, with same-day delivery and mediation management tools like reminders and auto refills in our app. Reach out any time to get started by phone at 1-800-874-5881 or download the app for secure messaging with our care team. 

EMD Serono has several patient assistant programs designed to reduce the cost of fertility treatment, including special opportunities for military veterans and cancer survivors.

A Guide to EMD Serono’s Financial Assistance Programs for Fertility Medication

Fertility preservation treatments like egg freezing and IVF are significant investments, both emotionally and financially. Fertility medications used to support egg production, retrievals and implantations often contribute to these expenses. 

At Alto, we support your financial well-being alongside your physical health, working with your doctor, your insurance (if applicable), and any third party savings programs that you may qualify for to make your medications as affordable as possible. In addition to automatically applying any coupon savings, we’ll connect you with any outside programs that require you to apply directly.

If Alto is your fertility pharmacy, your fertility medication protocol likely includes medications manufactured by EMD Serono. EMD Serono has several patient assistant programs designed to reduce the cost of fertility treatment, including special opportunities for military veterans and cancer survivors.

Read on to learn more details about eligibility for EMD Serono patient assistant programs and how to apply. You can also read our previous post on managing the costs of fertility treatment to learn about Alto’s additional financial support for fertility treatment and medications.

The EMD Serono Compassionate Care program provides discounted medication to eligible self-pay patients pursuing fertility treatment based on financial need or military status. 

Compassionate Care provides discounts off the self-pay price of EMD Serono fertility medications, including: 

for income-based eligible patients, savings of up to 50%

for active, retired, and veteran military, a minimum of 10% off based on income up to 50% off. 

Eligibility is based on your annual gross household income and first-time participation in the Compassionate Care program. 

Compassionate Care covers the following treatments: 

Gonal-f® RFF* Redi-ject™ pen 300 IU, 450 IU and 900 IU

Gonal-f® Multi-Dose vial 450 IU and 1050 IU

The Compassionate Care program is available only at participating pharmacies and patients must present a valid prescription for an eligible drug. The program is available for multiple cycles each calendar year for eligible patients. You must reapply each year.

View additional program details and apply here.

The EMD Serono Compassionate Corps program provides free medication to eligible, uninsured veterans injured in the line of duty or their spouses. To be eligible, you must be a retired military veteran or the spouse of a veteran who meets the following criteria:

Is infertile due to a service-related injury

Is not privately or publicly insured for infertility medications

Has been diagnosed by a physician as infertile and requiring in-vitro fertilization (IVF)/assisted reproductive technology (ART)

Is not eligible for coverage under the Fertility Veterans Act

The program is available for up to two cycles per calendar year. You must reapply each year.

Download the Compassionate Corps application.

If you’re a veteran who does not qualify for Compassionate Corps, you may still qualify for the Compassionate Corps program to receive up to 50% off your medications through the Compassionate Care program.  

Certain types of cancer can affect fertility in both men and women, whether it’s due to the removal of organs related to reproduction or a change in hormone levels following treatment. If you are considering starting a family after your cancer treatment, fertility preservation options can make it easier to conceive.

To help ease the financial burden of this process, EMD Serono donates fertility medications to eligible cancer survivors diagnosed during their reproductive years through the Livestrong Fertility Discount program.

EMD Serono’s Financial Assistance Programs for Fertility Medication

Blog

A Financial Planning Guide for Egg Freezing

Male Infertility: Causes, Symptoms, and Treatment

What to know about RESOLVE: The National Infertility Association

What to Know About Transgender Hormone Therapy Side Effects

A Guide to EMD Serono’s Financial Assistance Programs for Fertility Medication

National Infertility Awareness Week 2021

Rev. Dr. Stacey L. Edwards-Dunn on Her Mission To Improve Black Fertility Care

Managing the Costs of Fertility Treatment

All About the Thyroid

IVF and Egg Freezing: What to Expect and How to Prepare

Fertility Acronyms, Explained

Fertility Patient Story: Tiffany Shares Her Experience with Alto

Switch to a better pharmacy.