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Evidence suggests that gut health may also belong on the list of heart disease risk factors. Here’s what to know about the link between heart health and gut health, including steps you can take to maintain a balanced gut microbiome.

What to Know About the Heart and Gut Health Connection

Different factors can increase your chance of developing heart disease, like age, family history, high cholesterol, and high blood pressure, among others. And now, evidence suggests that gut health may also belong on the list of heart disease risk factors.

There are trillions of bacteria, fungi, and other small, microscopic organisms called microbes housed in your digestive system. They are collectively referred to as the gut microbiome. In recent years, researchers have found that the gut microbiome affects more than your digestive health alone. Heart disease is one of several health conditions that may be at least partially fueled by an unhealthy balance of gut bacteria.

The good news? This is a heart disease risk factor you definitely have control over. Here’s what to know about the link between heart health and gut health, including steps you can take to maintain a balanced gut microbiome.

Metabolites and your cardiovascular system

During the digestive process, microbes produce substances called metabolites. One of these substances in particular, trimethylamine (TMA), is linked to your risk for cardiovascular disease and other chronic health conditions like diabetes.

TMA forms when the bacteria and other organisms within the gut microbiome consume choline, a nutrient contained in red meat, fish, poultry, and eggs. The liver then converts TMA into a substance called trimethylamine N-oxide (TMAO). 

The medical community has identified a connection between high levels of TMAO in your blood and deposits of cholesterol, blood-clotting material, and other substances in your arteries. These substances are collectively referred to as plaque, and its accumulation in your arteries is referred to as atherosclerosis, a leading cause of cardiovascular disease, heart attacks, and strokes.

A 2017 analysis of several studies on the connection between TMAO blood levels and cardiovascular health found a correlation between elevated TMAO levels and serious cardiovascular issues. In the studies, researchers looked at people from different categories of health conditions in multiple countries, like individuals with and without diabetes, and individuals with and without chronic heart failure. 

Each group included individuals with various TMAO levels. The results showed that people with the highest levels of TMAO were 62% more likely to experience serious cardiovascular issues like heart attacks and strokes. The link appeared to be independent of other key risk factors for heart disease like diabetes and obesity.

In addition to the findings about TMAO, researchers have also identified a link between gut health and inflammation (redness, warmth, and swelling around tissues and joints). Inflammation is part of the body’s natural response to an injury, but when it persists after the healing process and becomes chronic inflammation, it can lead to an ongoing high white blood cell count.  

Over time, this elevated level of white blood cells can affect other organs including your heart, lungs, and kidneys, which may influence your risk for heart disease and other chronic conditions like diabetes.

The majority of the body’s inflammatory cells are stored in tissues in your gut, and researchers have found that an inflamed gut can trigger inflammation elsewhere in your body. Certain gut bacteria produce substances that enter your bloodstream and create inflammation in every part of the body that they travel through. This inflammation in the walls of your blood vessels can eventually lead to atherosclerosis.

Researchers are still learning about the gut microbiome’s influence on your risk for various health conditions. One thing they do know for sure is that a healthy gut microbiome is an important component of your overall health, and there are simple steps you can take to maintain a balanced digestive system.

A balanced diet is a great starting point for better gut health. Start by limiting foods that are processed or high in sugar or fat — particularly cookies, sugary drinks, salty snacks, and frozen foods — as these can lead to increased inflammation. Opt for fiber-rich foods like beans, peas, bananas, and asparagus; fermented foods like kimchi, yogurt, miso, and kefir; and collagen-rich or collagen-boosting foods like salmon, mushrooms, and egg whites.

Staying physically active and avoiding unhealthy habits like smoking and heavy alcohol consumption can also improve your gut health. Looking for a fitness routine that fits your schedule and health needs? Aim for about 150 minutes a week or 30 minutes per day. Explore different activities until you find the one that’s right for you — whether virtually or in person.

Over the long term, stress can lead to many physical and mental health problems, including digestive issues. Staying physically active reduces stress, so you’re already tackling this risk factor simply by working out regularly.

Beyond exercise, check out Insight Timer, an app that offers free guided meditations or Moodfit, a free mood-tracking app. And since there’s an established link between stress and high blood pressure, heart disease, and stroke, these small actions can benefit several aspects of your health at once!

At Alto, we’re committed to making it as simple as possible to protect your heart health and stay on top of cholesterol-lowering or blood pressure management medications.  We will work with your doctor, your insurance (if applicable), and any third party savings programs that you may qualify for to ensure your medications are as affordable as possible. And our team of pharmacists is available to chat whenever questions come up about side effects or how to take your medication properly

Reach out any time by in-app secure messaging or phone at 1-800-874-5881. 

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.

Proactively managing COPD with medication and lifestyle changes can help prevent periods of intensified symptoms, referred to as exacerbations or flare-ups. Here’s more on how to recognize, treat, and prevent COPD flare-ups.

How to Manage and Prevent a COPD Flare-Up

Proactively managing chronic obstructive pulmonary disease (COPD) with medication and lifestyle changes can help slow the progression of the chronic lung disease and prevent periods of intensified COPD symptoms, commonly referred to as exacerbations or flare-ups. 

However, these flare-ups may occur even when closely following your doctor’s individualized treatment plan, especially during the more advanced stages of COPD, so it’s important to have a plan in place to quickly address symptoms. Here’s more on how to recognize, treat, and prevent COPD flare-ups.

Recognizing the symptoms of a COPD flare-up

During a COPD flare-up, symptoms like shortness of breath and wheezing quickly intensify and lung function significantly changes. (Lung function refers to how well your lungs work, specifically how much air they can hold and how easy it is for them to empty air.)

Individual experiences of a COPD flare-up may vary, but many people often notice greater amounts of mucus clogging the bronchial tubes in their lungs and sudden tightening of muscles around their airways. Here are key signs and symptoms to be aware of.

More frequent or more intense coughing, wheezing, or shortness of breath

Changes in the color, thickness, or amount of mucus

Using more oxygen than usual, if your treatment plan includes supplemental oxygen

If you experience any of the symptoms above, the best step is to call your doctor right away. Each COPD flare-up can affect your long-term lung function, so it’s important to address symptoms as quickly as possible.

To effectively manage a COPD flare-up, you’ll want to create a COPD action plan with your doctor. Then, if you experience the signs of a flare-up, you’ll have a specific outline of the actions and medications that can help restore your breathing. Here are some of the medications your doctor may include in your individualized COPD treatment plan.

Short-acting medications like bronchodilators relax your airway muscles and open your lungs to quickly reduce discomfort. Albuterol (branded options include ProAir® HFA, Proventil® HFA, Ventolin® HFA) is commonly used to treat COPD exacerbations. This medication is typically taken through an inhaler, but can also be taken as a liquid solution for nebulizer use. (A nebulizer is a device that turns a liquid medication into a mist that you can inhale through a face mask. It allows the medication to travel quickly to your lungs.)

Although not common, potential side effects of bronchodilators include nervousness or shakiness, headache, throat or nasal irritation, and muscle aches. Your doctor can explain more about the risks and benefits of using a bronchodilator to treat COPD exacerbations when building your treatment plan.

Your doctor may also recommend oral corticosteroids, which are fast-acting medications that reduce swelling in your lungs and open your airways so that more air can move in and out of your lungs. They are primarily prescribed for short-term use, typically five to seven days.

Oral corticosteroids commonly used to treat COPD exacerbations include:

Prednisone (Prednisone Intensol®, Rayos®)

Some people experience mild side effects from short-term corticosteroid use, including swollen hands and feet, elevated blood pressure, increased appetite, and shifts in mood.

Many people with more advanced COPD use supplemental oxygen to increase their tolerance for physical activities, while others use it only to relieve shortness of breath during an exacerbation.

If your flare-up is more mild, you may take oxygen at home. When writing your prescription for oxygen therapy, your doctor will explain how and when to use the oxygen. It is important to follow all of your doctor’s instructions, including the flow rate setting (how much oxygen you’ll need per minute). The American Lung Association has resources for anyone starting oxygen therapy.

If your COPD has progressed to a later stage, some flare-ups may require treatment in a hospital setting. This allows healthcare professionals to more closely observe your symptoms and monitor vital signs like your pulse, temperature, and blood pressure. Consult with your doctor about specific symptoms to look out for that may indicate a need for more intensive treatment or monitoring.

How to lower your risk of COPD exacerbations

There are many steps you can take to lower your risk of a COPD exacerbation and reduce the frequency of COPD-related hospitalizations.

First, it’s important to closely follow your doctor’s recommendations, including taking any maintenance medications exactly as prescribed. (We designed our app to make it as simple as possible to do so, with medication management tools like reminders and auto refills that help you stay on track.)

In addition, try to limit your exposure to leading triggers of COPD exacerbations, including cigarette smoke (this includes secondhand smoke), indoor and outdoor air pollution, cold air, and household dust.

To keep the air inside your home as clean as possible, avoid perfumes and cleaning and hygiene products with strong odors. Use air purifiers and vacuum cleaners with a high-efficiency particulate air (HEPA) filter.

Lastly, the flu and pneumonia can worsen COPD symptoms and potentially lead to a flare-up, so it’s important to get your yearly flu shot and ask your doctor or pharmacist if you are eligible for the pneumonia vaccine.

We’re here to support your COPD treatment

COPD flare-ups can cause discomfort, but we’re here every step of the way to help you manage symptoms and get the medications you need, with free same-day delivery and easy-to-use medication management reminders in our app.

And our team of pharmacists are always here to answer your questions by phone or through the Alto app. Reach out any time by phone at 1-800-874-5881 or in-app messaging.

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.

September is Pulmonary Fibrosis Awareness Month, an annual month of education and action to bring attention to chronic lung disease.

Pulmonary Fibrosis Awareness Month: Understanding the Lung Disease

September is Pulmonary Fibrosis Awareness Month, an annual month of education and action to bring attention to chronic lung disease. A 2020 survey conducted by the Pulmonary Fibrosis Foundation found that 86% of Americans did not know the symptoms of pulmonary fibrosis, which affects more than 130,000 people in the United States. 

This lack of awareness may stem from the fact that pulmonary fibrosis presents with symptoms similar to more common respiratory conditions like COPD, as well as the fact that pulmonary fibrosis is a group of many lung diseases.

Greater education around this progressive lung disease is critical: the more you know how to recognize the signs of pulmonary fibrosis, the more likely you are to receive a diagnosis at an earlier stage, should you be affected. Better understanding of pulmonary fibrosis starts by simply knowing the facts, so, take a few minutes to learn more.

There are more than 200 types of pulmonary fibrosis. In each type, the lungs become scarred, making it difficult to breathe. Unlike COPD and some other lung diseases, pulmonary fibrosis falls under the umbrella of interstitial lung disease. Pulmonary fibrosis damages interstitial lung tissues, which are the cells that fill the space between blood vessels and other structures inside the lungs like the trachea and bronchial tubes.

Another way that pulmonary fibrosis differs from COPD is that it has a wider range of causes beyond cigarette smoking alone. Long-term exposure to pollutants and toxins, certain medical conditions and medications, and radiation therapy can also play a role in causing pulmonary fibrosis.

The most common type of pulmonary fibrosis is idiopathic pulmonary fibrosis (IPF), which literally means pulmonary fibrosis of an unknown cause. While doctors are unable to isolate a single cause of the condition in these cases, the following risk factors may increase your chance of developing IPF:

A diagnosis of a condition that often co-occurs with pulmonary fibrosis (also referred to as a comorbidity) such as acid reflux, sleep apnea, or pulmonary hypertension

While researchers continue to work toward a cure, a combination of medications, oxygen therapy, and active lifestyle choices can slow the progression of pulmonary fibrosis. Getting diagnosed at an early stage is key to a better prognosis.

These are the most common symptoms of pulmonary fibrosis:

Since many of these symptoms overlap with those of COPD and other lung diseases, additional tests, including blood and imaging tests and pulmonary function tests, are often needed to confirm a pulmonary fibrosis diagnosis. Your doctor may also take into account the presence of the known risk factors mentioned above when determining if you have pulmonary fibrosis, including any related health conditions.

A long-term lung disease like pulmonary fibrosis may affect you both physically and emotionally, and it’s important to surround yourself with support. In addition to having a strong care team, there are many opportunities to connect with other individuals living with the condition, who understand your experience better than anyone.

The Pulmonary Fibrosis Foundation offers both virtual and in-person support groups. The PFF also has a phone group for all members of the pulmonary fibrosis community called PFF Voices, where you can discuss any pulmonary fibrosis-related topic or concern. The group meets on the third Thursday of every month.

The American Lung Association’s Better Breathers Club has a variety of resources for individuals living with lung diseases, including virtual meetings. The ALA also supports free online communities on Inspire.com that offer peer-to-peer support for people living with lung diseases, and there is a group specifically focused on living with pulmonary fibrosis. You need to create an Inspire.com account to access the group.

If you are caring for someone with pulmonary fibrosis, there are also resources to help you navigate your loved one’s treatment needs.

Read the Pulmonary Fibrosis Foundation’s suggestions for caregivers.

The PFF also offers a phone group created specifically for caregivers called PFF Caring Conversations, where you can share your experiences as a caregiver. The group meets on the first Tuesday of every month.

The American Lung Association supports an Inspire.com group for pulmonary fibrosis caregivers called Caring for Pulmonary Fibrosis. You need to create an Inspire.com account to access the group.

Alto is here for you, too. We want to make it as easy as possible to follow the treatment your doctor has recommended, so we offer free hand-delivery of your medication, automatic savings investigations, and easy medication management tools through our website and app. And our team of pharmacists is always here to answer your questions.

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

Our pharamcists explain more about the various types of allergies, how an allergist or immunologist can help, and when it may be time to see one.

When to See a Healthcare Specialist for Allergy Treatment

There’s a wide spectrum of allergy conditions, from mild seasonal allergies to more severe symptoms that persist year round. It makes sense, then, that there is also a spectrum of allergy treatment options.

Some people are able to manage mild symptoms with occasional use of over-the-counter allergy medications, including oral antihistamines like Claritin®, Allegra®, and Zyrtec®; decongestants like Afrin® and Sudafed®; and nasal corticosteroids like Flonase® and Nasacort®. But if allergies impact your focus at work or school, or prevent you from living a more active life, you may consider consulting with a healthcare professional about treatment options.

In addition to your primary care provider, there are specialists with extensive training in allergy treatment such as allergists and immunologists. They can help you better understand the cause of your symptoms so that you can determine a more effective allergy treatment plan. Below, we explain more about the various types of allergies, how an allergist or immunologist can help, and when it may be time to see one.

There are many types of allergies, but all are produced by a reaction in your immune system. In people with allergies, the immune system interprets substances like dust, pollen, and pet dander as harmful. The immune system then kicks into defense mode, producing antibodies to attack the allergen, which in turn causes symptoms such as wheezing, sneezing, and itching in the eyes, nose, ears, or mouth.

There is often a hereditary component to allergies, so you may be more likely to develop allergies if you have a family history of the condition. While many allergies begin during childhood, they may also occur for the first time in adulthood. Some childhood allergies improve with time, but they can also reappear later in life after years without symptoms.

Here are some of the most common allergy conditions. 

Allergic rhinitis is a broad term for any sinus-related allergic reaction. Symptoms generally include watery eyes; itchy eyes, nose, ears, and mouth; runny or stuffy nose; sneezing; puffy eyes; and post-nasal drip. This reaction can be triggered by a range of allergens and may occur year round or seasonally.

Pollen and outdoor mold typically trigger seasonal allergic rhinitis — sometimes referred to as hay fever — while dust mites, pet dander, and indoor molds can trigger these symptoms at any time of year in certain individuals.

Asthma is a lung condition in which the airways narrow and become inflamed, making it difficult to breathe. Coughing, wheezing, and shortness of breath are some of the most common symptoms. As with allergies, there’s a wide spectrum of severity. For some individuals, asthma symptoms are an occasional annoyance, but for others they can be life-threatening.

Allergy-triggered asthma, which is relatively common in children, occurs when allergens affect the lungs and lead to asthma symptoms. Allergy-triggered asthma can result from allergens linked to both seasonal and year round allergies.

If you or your child suffer from allergy-induced asthma, allergy medications will likely be a part of your asthma treatment plan, but they are not a substitute for asthma medication. In addition to consulting an allergist, speak with your primary care provider as soon as asthma symptoms appear so that you can find the best treatment plan.

Many common skin conditions, including eczema and hives, are an allergic reaction caused by various triggers, including pet dander and certain types of medication or food. Part of an allergist’s role is to help you determine if a skin condition is allergy-related. A dermatologist can also help you understand the underlying cause of your skin condition and recommend treatment options.

For some individuals with severe allergies, exposure to an allergen can become life-threatening. This is called anaphylaxis, an extreme allergic reaction to food, medication, or venom. Bee stings or foods like peanuts and tree nuts are among the most common triggers of anaphylaxis.

If you have been diagnosed with anaphylaxis, your healthcare provider will likely prescribe epinephrine to use in the event of an emergency. This medication prevents anaphylactic shock from becoming life-threatening.

When should I see an allergist or immunologist?

Allergy and immunology is an area of medicine focused on the treatment of conditions related to the immune system, including allergies. Allergists and immunologists are specialists in diagnosing allergy conditions and asthma. (In the United States, the two roles are essentially interchangeable.) They can help identify the specific triggers of your allergy symptoms and prescribe the most effective medication for your allergies. To be certified by the American Board of Allergy and Immunology, these specialists must complete two or three years of study in allergy and immunology in addition to a three-year residency after earning their medical degree.

If your allergy symptoms persist after trying over-the-counter medications and consulting with your primary care provider, it may be time to see an allergist or immunologist for more lasting relief. And if you have used over-the-counter medications for longer than several weeks to treat allergy symptoms, you may also benefit from consulting a specialist, as these medications aren’t meant for long-term use and become less effective with time

Understanding the source of your allergy symptoms is key to effective treatment, and allergists and immunologists are able to help you identify your trigger(s). They may recommend a skin test in which they will lightly prick or scratch your finger with a small amount of a suspected allergen, like pollen. Then, they can watch how your body absorbs that substance to determine if you have an allergic reaction. They may also use a blood test to determine what’s triggering your allergies.

Avoiding allergens as much as possible plays a big role in controlling symptoms. However, if you are unable to avoid the substance that triggers your allergies, a specialist can recommend treatment options, including prescription medications and immunotherapy.

It may be possible to train your body to become less allergic to a specific trigger through a process known as immunotherapy. In this preventative treatment, a doctor will gradually give you larger doses of the substance that triggers your allergies. As you become exposed to larger amounts of the allergen, your immune system will become less sensitive to it. Ideally, this will help you experience fewer allergy symptoms when you encounter the allergen in the future.

There are several types of immunotherapy, including allergy shots and sublingual tablets, which are placed under the tongue. This treatment approach is most effective if a doctor has isolated one or more specific allergens as the source of your symptoms, which is why testing is so important.

Choose a reliable and flexible pharmacy partner

Alto makes it as simple as possible to follow the treatment your doctor recommends. Our team of patient care pharmacists will work with your doctor to get you the allergy or asthma medications you're prescribed at the best price, and we’re happy to answer your questions about medication side effects or any other health concern. Reach out any time through phone at 1-800-874-5881 or in-app messaging.

In recent years, dry powder inhalers have become increasingly common in asthma treatment thanks to their ease of use and portable size. Read on to learn how to use a dry powder inhaler correctly.

What to Know About Dry Powder Inhalers

Medications play a critical role in managing asthma by reducing the frequency and severity of symptoms and allowing for a more active life. There are a variety of asthma medications that your healthcare provider may prescribe for you, including quick-relief medications to treat acute symptoms and long-term control medications to prevent flare-ups.

Most asthma medications are taken via an inhaler. There are three types of inhalers used for asthma treatment: hydrofluoroalkane (HFA) inhalers, sometimes referred to as metered dose inhalers, dry powder inhalers (DPIs), and the less commonly used respimat inhalers.

In recent years, dry powder inhalers have become increasingly common in asthma treatment thanks to their ease of use and portable size, which makes them convenient to use if symptoms flare up unexpectedly. As with any device, proper use of your DPI is essential to receiving the full benefits of your medication, and it’s important to be mindful of several differences between DPIs and other inhalers. Read on to learn how to use a dry powder inhaler correctly.

A dry powder inhaler is a handheld device that allows you to inhale your asthma medication in the form of a dry powder. It is a breath-activated device, so it will activate and release your medication automatically as soon as you start inhaling. Unlike HFA inhalers, which use a chemical propellant to deliver a dose of your medication in aerosol form, DPIs do not contain any ingredient other than the medication itself.

Your doctor may prescribe a DPI because of  dosage reliability. With an HFA inhaler, it may be difficult to know that you’ve received the entire metered dose. In contrast, most DPIs are specifically designed with a spinning technology that ensures you receive the full dose of your medication. DPIs also typically give you a visual indication that the full dose has been delivered. For example, the Advair Diskus® has a built-in dose counter which updates after each use.

If your doctor prescribes your medication to be administered with a DPI, your prescription will include both the DPI device and the medication. Commonly prescribed DPI medications include the Advair Diskus®, the Pulmicort Flexhaler®, and the Asmanex Twisthaler®.

How to use a dry powder inhaler correctly

Here is a step-by-step breakdown of how to use a dry powder inhaler correctly.

Remove the cap from your dry powder inhaler if there is one.

Load a dose of medicine, if needed. Some DPIs have a supply of medicine in them already while others require you to load each dose of medication. Follow your healthcare provider’s guidance.

Tilt your head back and breathe out to empty your lungs as much as possible. Make sure to hold your inhaler away from your mouth while you exhale, as breathing into your inhaler can blow out some of the medicine.

Place the mouthpiece of your inhaler in your mouth. Close your lips tightly around the opening so that the medicine cannot get out.

Inhale quickly and deeply for 2-3 seconds. Since DPIs are breath-activated, it’s important to breathe deep and fast so that the right dose of medicine is triggered.

Once you have inhaled the powder, remove the inhaler from your mouth and hold your breath to let the medication settle into your lungs. Then exhale slowly.

If your doctor has prescribed more than one dose of your medication, wait about a minute before taking your next dose.

If you are using an inhaled corticosteroid, gargle and rinse your mouth afterward with water to prevent throat irritation and oral yeast infections, two potential side effects of this medication class.

You may not necessarily taste or feel the dry powder after taking your medication, but as long as you’ve followed the steps above, you will receive the full dose.

It’s normal to have questions when starting a new medication, and our team of pharmacists is here to offer guidance. We can walk you through the steps of using your inhaler, discuss potential side effects, and answer any other questions you may have. In addition, we offer free, same-day delivery and medication management tools like reminders and auto refills in our app to make it as simple as possible to stay on track with managing your asthma.

To learn more or get started, reach out any time through in-app messaging or by phone at 1-800-874-5881. 

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. 

Lung cancer screening, a test that detects the cancer before any symptoms have appeared, is critical for anyone with a high risk of lung cancer. Here's what to know.

What to Know About Lung Cancer Screening

Lung cancer, the leading cause of cancer death among both men and women, is more likely to be cured when detected early. The five-year survival rate is about 60% when the disease is confined to one lung. 

However, the majority of cases are diagnosed after the cancer has already spread to both lungs or other organs, at which point  the five-year survival rate is 20% or less. Delayed diagnoses are due in part to the fact that lung cancer symptoms often do not appear until the disease has progressed to more advanced stages.

This is why lung cancer screening, a test that detects the cancer before any symptoms have appeared, is critical for anyone with a high risk of lung cancer. Some studies have found that screening detects 80% of lung cancer cases at an early stage. Read on to learn more about what to expect during lung cancer screening and whether it may be right for you.

Smoking is the number one cause of lung cancer, contributing to 80-90% of lung cancer fatalities. However, there are additional risk factors to developing lung cancer:

Exposure to radon, a naturally occurring gas that can get trapped in houses and buildings, and the second leading cause of lung cancer

Exposure to asbestos or other carcinogens like uranium, diesel exhaust, and inhaled chemicals in the workplace

Radiation therapy to the chest during cancer treatment

While lung cancer symptoms typically appear once the disease has progressed to a more advanced stage, some people do experience some of the following early signs of lung cancer:

A cough that does not go away or gets worse

Chest pain that often worsens with deep breathing, coughing, or laughing

Infections such as bronchitis and pneumonia that don’t go away or keep coming back

Many of these symptoms overlap with those of other respiratory conditions like COPD, and you should schedule an appointment with your doctor as soon as possible. Even if you do not have lung cancer, it’s important to identify the cause of these symptoms and treat them, if needed.

What happens during lung cancer screening?

During your lung cancer screening, doctors will use a non-invasive test known as a low-dose computerized tomography (LDCT) scan to search for abnormal spots in the lungs that could be cancer. 

During the scan, you will lie still on a long table as it slides through a machine that uses a low level of radiation — about half of what you’re exposed to naturally from the environment every year, and much less than what you’d be exposed to in a standard CT scan — to create images of your lungs. It is painless and will take less than a minute.

If you are experiencing signs of a respiratory infection such as congestion, runny nose, sore throat, and body aches, or if you recently recovered from one, let your doctor know as it may affect the results of an LDCT scan. They will let you know if you should reschedule.

There are several possible outcomes of an LDCT scan. If the screening test detects abnormal spots, often called a nodule, you may need additional tests to determine if you have lung cancer. 

For small nodules, doctors often recommend another LDCT scan after a few months to see if the nodule has grown. If the nodule is bigger, your doctor may order additional testing like a positron emission tomography (PET) scan or a biopsy, a procedure that removes a piece of the nodule for lab testing, to find out if it is cancerous.

In cases where lung cancer screening does not detect any abnormal spots, your doctor may recommend continuing with annual screening depending on your risk.

Since lung cancer screening involves exposure to radiation, doctors primarily reserve screening for people at high risk of developing lung cancer, namely older adults who have smoked heavily for many years. 

The U.S. Preventive Services Task Force (USPSTF) — an independent group of prevention experts who help healthcare providers make informed recommendations for their patients — recommends annual LDCT lung cancer screening for people who meet each of the following criteria:

Have a 20 pack year or more smoking history

Smoke now or have quit within the past 15 years

A “pack year” is defined as smoking an average of one pack of cigarettes per day for a year.  The 20 pack year history threshold could be met by smoking one pack a day for 20 years or two packs a day for 10 years. It’s important to share all the details of your smoking history with your doctor so they can determine if you would benefit from lung cancer screening.

Your doctor may also recommend lung cancer screening if you were treated for lung cancer more than five years ago, have another serious lung disease such as chronic obstructive pulmonary disease (COPD), a family history of lung cancer, or have been exposed to asbestos at work.

They will also take your overall health into account, as lung cancer screening is typically recommended for individuals who would be physically able to tolerate treatment for early-stage lung cancer and lung surgery, if it is needed.

While lung cancer screening saves lives — without screening, 70% of lung cancer cases would be detected at a later stage — it carries some risks, like all screening procedures.

First, while the level of radiation you are exposed to during an LDCT scan is not significant, it can potentially become harmful with repeated scans. In addition, when screening for any disease, doctors will sometimes find abnormalities that look cancerous but are not, which is referred to as a false positive. They may also find cancers that grow so slowly they would never lead to symptoms.

The frequency of false positives continues to decline every year. Currently, about 12-14% of lung cancer screenings have a false positive, similar to the rates for mammograms. False positives are even less common with continued annual LDCT screening since it is easier to identify notable changes between the scans. 

Plus, as the technology behind lung cancer screening evolves, doctors have a clearer understanding of who actually needs follow-up testing after the initial LDCT scan. Ultimately, it is important to discuss the benefits and risks of lung cancer screening with your doctor and work together to determine if you would benefit from it.

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