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

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.

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.

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.

Reproductive endocrinologist Dr. Guy Ringler — a former faculty member at UCLA and an advisory board member at Men Having Babies — was one of the first doctors in the world to help gay men have children through assisted reprodutive technology.

Spotlight on Men Having Babies & Dr. Guy Ringler

There are many ways to start a family and raise a child. And as recent decades have brought forth milestones in marriage equality and the fight for LGBTQ+ rights, the options for LGBTQ+ family building have also expanded.

According to 2019 data from the Williams Institute, almost 29% of people who identify as members of the LGBTQ+ community are raising children, up from 16.2% between 2014 - 2016. That includes a growing number of gay men who’ve had children through surrogacy, a process in which a woman who is not related to the child — a gestational surrogate — carries a baby who is biologically related to one of the fathers and an egg donor.

Breaking down barriers to LGBTQ+ family building

Reproductive endocrinologist Dr. Guy Ringler — a former faculty member at UCLA and an advisory board member at Men Having Babies — was one of the first doctors in the world to help gay men have children through assisted reprodutive technology. Throughout the twenty-five years that he’s been in practice, he’s seen how scientific advances and cultural changes have broken down barriers for gay men interested in parenthood.

“Over two decades ago, when I began my career, people barely understood the concept of surrogacy for gay men,” he says. “It wasn’t as easy to find women who wanted to become surrogates for gay couples. There was still fear about HIV, and there were questions about the impact of surrogacy on a child’s development.”

The landscape looks a lot different today. Thanks to cultural shifts and greater understanding of the science behind surrogacy — and to awareness-raising organizations like Men Having Babies — there are now more options than ever to become a parent regardless of your sexual orientation or gender identity.

“Greater acceptance of the LGBTQ+ community and marriage equality has opened people’s minds and allowed them to see that gay families can thrive, just like any family,” Dr. Ringler says. “Gay men are now able to plan for a future that we once didn’t know was possible.”

Getting to meet prospective fathers at Men Having Babies’ annual conferences is one of Dr. Ringler’s favorite things about working with the organization. He’s observed a greater number of gay men pursuing parenthood at an earlier age.

“I’m so inspired by the next generation of gay men, who are planning their families in their twenties. That simply wasn’t an option when I was their age.”

Men Having Babies and financial assistance for IVF and surrogacy

There are many steps on the road to parenthood for LGBTQ+ individuals and couples: fertility treatments, legal consultation, and financial planning are all required to start a family.

“Having a baby doesn’t just happen for gay men,” Dr. Ringler says. “It takes thoughtful planning and there are many decisions along the way.”

That’s why support from organizations like Men Having Babies is so critical. The organization started as a program at The Center (formerly the NYC LGBT Center) in 2005 and officially became a nonprofit in 2012. Today, Men Having Babies supports thousands of gay men and couples around the world in starting their families through surrogacy, with monthly workshops, annual conferences and financial resources. 

Determining how to pay for IVF and surrogacy is an important part of planning your family. As part of the process, Dr. Ringler suggests mapping out a vision for your family. Knowing how many children you want can help you prepare for the cost: “When you’re making the commitment to start a family as a gay man, think about how you will financially support the decision. It may feel overwhelming, but it’s similar to the process of buying a house. If it’s really important to you, you can find a way to make it work.”

There are many resources to help alleviate the cost, including Men Having Babies’ Gay Parenting Assistance Program (GPAP) . The program offers different forms of financial support, including:

Discounted and free services donated by more than one hundred leading IVF, surrogacy, egg donation, and legal service providers to prospective parents (Stage I support)

Discounted and donated ancillary services, including fertility medication, escrow services, and insurance resource services (Stage I support)

Cash grants for approved prospective parents based on income eligibility (Stage II support)

Learn more about the criteria for applying to Stage I or Stage II support from the GPAP.

You must be a member of Men Having Babies to receive financial assistance. You can become a member by making an annual donation of $150 or more. Learn more about the membership process.

In addition, EMD Serono offers financial assistance for fertility medications and Family Equality has a list of family-building grants that help LGBTQ+ families afford fertility treatment. Be sure to also ask your fertility clinic or pharmacy about available financial assistance programs and payment plans.

The importance of researching your options

As Dr. Ringler emphasized, gay men building a family through IVF and surrogacy have many decisions to make throughout the process. For that reason, it’s important to thoroughly research your options and to work with a medical team that you trust. Here are some additional considerations to be mindful of as you plan your family.

Understanding the process of IVF and surrogacy

In IVF, eggs and sperm are combined in a laboratory. When gay men conceive through IVF, the sperm will come from one of the fathers and the eggs will come from a donor. Then the fertilized eggs, or embryos, are placed into the uterus of a gestational carrier who will carry the baby to term.

Not only is this an exciting time for expectant dads, as Dr. Ringler notes, but surrogates can play a big role in raising awareness of LGBTQ+ families.

“In my experience, surrogates who are asked when their baby is due while out in public may feel comfortable sharing that they’re having a baby for a gay couple. This helps open up more people’s minds to the possibilities for LGBTQ+ parenthood.”

Understanding your goals for your relationship with your surrogate is one of many key decisions, and there is a spectrum of options. Some couples cultivate intimate relationships with the surrogates while others prefer to remain more detached. There’s no one right choice — it’s all about understanding what’s best for you.

“If your surrogate wants a little distance, that does not mean that they are any less committed to the process,” Dr. Ringler says, adding that it’s important to discuss your preferences in an open discussion with your surrogacy agency.

Deciding who will be biologically related to the child

Another important decision for same-sex male couples is deciding which parent will be genetically related to the child. When heterosexual couples have babies through IVF, both parents can contribute their genetic material, so that the baby is biologically related to both, even when using a gestational carrier. 

But with gay men, only one father can contribute his sperm per pregnancy, so it’s important to discuss this decision with your partner if having a child as a couple. Some fathers fertilize multiple eggs so that both can have a biological connection with one of their children. Taking time to identify your family building goals will allow you and your partner to plan for the financial cost of more than one round of IVF, if you choose to pursue that option.

Keep in mind that you can establish a legal paternal relationship with your child even if you are not biologically related to them. It’s critical to research your state’s laws about legal parentage procedures once your baby is born. Movement Advancement Project’s interactive map on parental recognition laws is a good starting point. 

Be sure to speak with an experienced LGBTQ+ family lawyer in your state before starting the IVF and surrogacy process. There are many forms of financial support to help alleviate the cost of these legal services, like Men Having Babies’ Gay Parenting Assistance Program.

There's a wide selection of available egg donors, and one of the factors to consider as you choose yours is whether they will be anonymous or open. With an open donor, you can more easily answer any questions your child may have about their genetic background. However, some families prefer anonymous donors, and sometimes an anonymous donor’s physical or personality traits better fit your goals. Both paths are viable options, and it all comes down to what’s right for your family.

Regardless of which option you choose, Dr. Ringler notes that you should be prepared to share information with your child about how they were conceived. You can even get creative with how you share their journey: some of Dr. Ringler’s patients have created story books for the whole family to read together, which helps children understand their background and feel proud of who they are.

Seeking support for your family building journey

While there are many paths to take, and many decisions to make, as you build your family, all will lead to the same destination of parenthood.

“I personally had a very close relationship with my mother growing up, and as gay men, we can’t guarantee our children that same experience,” Dr. Ringler says. He notes that if you have an open donor, your child’s biological mother may be able to have a presence in their life, which is another important factor to consider when planning your family.

But regardless of your chosen family structure, “I’ve seen again and again throughout my career that all you need to start a happy, healthy family is love and fun.”

One thing that’s certain: family building as a gay man is much easier to navigate with support from organizations like Men Having Babies. If you’re feeling overwhelmed while planning for a family, remember that you don’t have to go through this journey alone. Men Having Babies understands the challenges specific to building a family as a gay man, and their resources can help you fulfill your dreams of becoming a parent.

Learn how to become a member of Men Having Babies.

At Alto, we’re proud to support Men Having Babies, and we’re happy to be a part of your family building journey if fertility prescription medications become part of your plan. Reach out any time to get started though the Alto app  or phone at 1-800-874-5881.

Get an inside look at the patients team at Alto Pharmacy to learn what it's like to work on Alto's customer-facing apps, which projects are on the horizon, and who makes the best barbecue short ribs.

Get to Know the Team That Builds Alto's Customer-Facing Apps

Imagine an app that allows you to buy things and have them delivered to you the same day, for free. Now take that app and put it in a highly regulated space like pharmacy. You face the challenge not only of building an e-commerce platform from scratch, but also of navigating medication pricing, federal and state regulations, and patient safety—and that's just the way the Patients Team likes it.

"It's a really exciting and fun problem to solve," says Mike Riess, the team's Engineering Manager. Software Engineer Angelique Nehmzow agrees: "There's a really strong product and design aspect, like more traditional startups, but then everything gets a little bit more interesting because it's healthcare."

Below, we chat with the team to learn what it's like to work on Alto's customer-facing apps, which projects are on the horizon, and who makes the best barbecue short ribs.

What does the Patients Team do at Alto? 

Ask anyone on the team why they joined, and chances are, they'll tell you they wanted to be on the product team closest to Alto's customers: "We really try to own the customer experience," says Peter Zeng, the latest Software Engineer to join the team. "If a customer is coming to the web app, or they're coming to our mobile app, we want to make sure that they're able to onboard with us as easily and conveniently as possible."

The team is also responsible for the customer experience beyond onboarding, from the moment a customer schedules a medication for delivery to the time that it shows up on their doorstep. "We already offer great services like free, same-day delivery and cost savings. The Patients Team empowers customers to make the most of our offering," Nehmzow explains. "You can see what prescriptions you have, check on the status of your order, and schedule automatic refills. In a more traditional pharmacy, you don't get that kind of visibility. You have to call them up or even wait in line in person. At Alto, it's a different experience."

What was it like in the team's early days?

Today, there are eleven engineers on the team working to build that better end-to-end experience—but it wasn't always that way. When the team first formed in 2019, it consisted of just three members: Riess, Brian McRae, and Andy Lau, all of whom are still on the team.

"The first priority for us was just stabilizing the foundations," Riess says of the team's early days. Every other week, the three team members, along with Alto co-founders Matt Gamache-Asselin and Jamie Karraker, would meet to audit the app's core flows. "For the first three months we probably didn't make it through some flow at least 50% of the time," Riess recalls. "There would be a ton of bugs in the onboarding experience, things that weren't working with the flows or navigation or deep linking."

Among the team's first projects was a redesign of the checkout flow. "There was a lot of work to be done to streamline the checkout flow, which is pretty much the main function of the app," says McRae, who initially joined the team as a software engineer and later transitioned into product management. "We had to make it easier to add a payment, add your addresses, everything you need to do to schedule your prescription for delivery."

"The growth of the team, in terms of both size and stability of the platform, has allowed us to swing at more interesting bets for the company," Riess says. In particular, the Patients Team has turned their attention toward experiences personalized for specific medical conditions.

"Different customers have different needs. A customer who wishes to start a family will have a different experience than a customer who needs to order their routine heart medications that they've been taking for the last eight years,” McRae says. “The challenge for us is how we serve all these customers well through the app."

"I think that's where Alto can be such a differentiator," Riess adds. "A world-class pharmacy experience is about so much more than just dispensing medications. We want to build tools for customers that help them get the most out of their medications—everything from simple videos teaching them how to perform injections safely at home to the ability to synchronize deliveries for multiple prescriptions for managing complex health conditions."

With these new projects on the horizon, engineers have ample opportunity to focus on the areas that excite them most. "We're full-stack and mobile and web," Nehmzow says. "Part of the team focuses more on experimentation, iterating quickly, and using data to make decisions. Part of the team focuses more on platform work, tooling, and improving the developer experience. There are a lot of areas to explore and contribute to."

One spring night, the Patients Team gathered in a back yard in San Francisco’s Mission District for short ribs and an impressive spread of side dishes. "Kudos to Robbi, who's the grill master. I just provide the grill!" Nehmzow says, laughing. While the team barbecue was the first time some members had met in person, Zeng notes that the team has been supportive of one another even while working remotely during the pandemic.

"The first real project that I was assigned to was working with the communications system. Before writing my first piece of code, I spent two weeks exploring what already exists and understanding the different parts of the system," Zeng says. "I've been really impressed with how understanding my teammates have been. They make the space for you to learn all the different pieces of code we own."

That culture of support is by design, reflected in the six principles—complete with matching emojis—at the top of the #patients-team Slack channel: "Empower each other," "be an owner," "find the path," "learn by doing," "embrace complexity," and "foster trust." 

While these principles echo Alto's company-wide values, they are unique to the Patients Team. "For a long time, we were the only external-facing product team at Alto," Riess says. "These principles were intended to be this motivation around how we win. It's a combination of how we treat each other, how we reason about decision making, and how we approach solving a problem that's never existed before."

As the team looks toward the future, those principles have never been more relevant: "We have a goal and an area we want to focus on, but in terms of which projects we're going to do, it's not a top-down thing," Nehmzow says. "It's very much, 'We're going to figure out how to solve this problem together, even when it's difficult.' That's my favorite part about the team."

The Patients Team is hiring! Learn more about open positions here.

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. 

Many states have patient assistance programs to help people with a variety of insurance statuses access PrEP and related medical services at little to no cost. Here’s a breakdown of how to apply.

What to Know About State-Funded PrEP-DAP Programs

Cost is often a barrier to starting PrEP, a medication that can lower your risk of sexual transmission of HIV by 99% when taken daily. Fortunately, the HIV prevention landscape is rapidly evolving, and PrEP is now more accessible than ever.

As of this January, most private insurance plans must cover PrEP for HIV prevention without charging any out-of-pocket costs. In addition, many states have patient assistance programs to help people with a variety of insurance statuses access PrEP and related medical services at little to no cost. Here’s a breakdown of how to apply for state-funded PrEP drug assistance programs — also referred to as PrEP-DAP or PrEP-AP programs —  in four of the states that Alto serves.

The State of California’s PrEP Assistance Program (PrEP-AP) helps cover PrEP-related medical expenses, with different benefits for individuals without insurance, those with private insurance, and those with Medicare.

You can receive Truvada®, one of the two FDA-approved PrEP medications, free of charge through Gilead’s Advancing Access® Program. California’s PrEP-AP will also provide financial assistance with all other medications on the PrEP-AP formulary for HIV prevention and treatment of sexually transmitted infections (STIs) and the following PrEP-related medical services:

To be eligible for the assistance, you must receive all PrEP-related medical services at approved locations within the California Department of Public Health’s Office of AIDS PrEP-AP Provider Network. Search for a California PrEP-AP provider or enrollment site near you. 

Gilead’s Co-Payment Assistance Program covers up to $7,200 of Truvada® copays per calendar year. Once you’ve met this threshold, California’s PrEP-AP will cover any remaining PrEP copays for the rest of the calendar year, in addition to assistance for out-of-pocket costs for PrEP-related medical services and all other medication on the PrEP-AP formulary for HIV prevention and STI treatment. To be eligible for assistance with PrEP-related medical services, you must see a provider in your insurance plan’s network.

If you have prescription medication coverage through Medicare, you are not eligible for financial assistance from Gilead, but California’s PrEP-AP offers financial assistance with copays for all medications on the PrEP-AP formulary including Truvada®.

If you do not have prescription medication coverage through Medicare, you are eligible to enroll in Gilead’s Patient Assistance Program and receive Truvada® free of charge. In addition, California’s PrEP-AP will provide assistance with all other medications on the PrEP-AP formulary.

Anyone who has outpatient coverage through Medicare is also eligible to receive assistance from California’s PrEP-AP for PrEP-related medical services. However, you must see a provider in your plan’s network.

To be eligible for California’s PrEP-AP, you must:

Have a negative HIV test dated within six months of the PrEP-AP application

Have an annual Modified Adjusted Gross Income (MAGI) that does not exceed 500% of the Federal Poverty Level based on family size and household income

Not be fully covered by Medi-Cal or other third party payers

Be enrolled in the manufacturer's assistance program, if eligible

Colorado’s Public Health Intervention Program (PHIP) helps cover PrEP expenses for anyone living in Colorado who has an income less than 500% of the Federal Poverty Level.

If you have insurance, you must apply for the Gilead copay card to receive the assistance. If you do not have insurance, you must apply for Gilead’s Advancing Access program and see an approved PHIP-PrEP medical provider.

You can apply online or by mail. You must provide the following documents:

Proof of income (one month's worth of paystubs, award letter, etc.)

Gilead Co-Pay Card, if you have insurance

PHIP is not eligible for those with Colorado Medicaid. However, if you have Colorado Medicaid, your PrEP costs should be covered at a $1-3 copay for both medication and related medical services.

The New York State Department of Health’s AIDS Institute has a PrEP assistance program for individuals without insurance. The program covers the cost of PrEP-related medical services including HIV testing, counseling, STI testing, and primary care services. The cost of PrEP itself will be covered through manufacturer-sponsored patient assistance programs, to which healthcare providers affiliated with the program can help you apply.

Eligibility is based on financial and medical need. Learn more about how to apply and search for a New York State PrEP-AP provider near you.

Washington State’s PrEP Drug Assistance Program (PrEP-DAP) provides financial assistance with  PrEP and related medical services.

The program covers the cost of Truvada®. The Washington Department of Public Health contracts with Ramsell Corp® to provide pharmacy benefits for program participants. You must use a pharmacy contracted with Ramsell for PrEP-DAP to receive the financial assistance (Alto is contracted with Ramsell).

In addition, Washington’s PrEP-DAP also covers many of the PrEP-related lab and medical services including baseline and monitoring tests for STIs, kidney function, and Hepatitis B. If you have insurance, the program covers your portion of insurance deductibles, copays, and coinsurance up to a certain limit. To confirm the current maximum amount of financial assistance for individuals with insurance, call 360-236-3412 or 877-376-9316 (toll free) or email PrEPDAP@doh.wa.gov.

If you do not have insurance, the program will cover all of the costs up to the maximum amount of covered services.

To be eligible for Washington’s PrEP-DAP, you must live in Washington State, test negative for HIV, and meet one of several defined risk factors, described in more detail here.

There are several FDA-approved medication options for PrEP: Truvada®, Descovy®, and Emtricitabine 200 mg/Tenofovir 300 mg (generic Truvada, which became available in October 2020). PrEP may be right for you if you have a partner who is HIV-positive or unsure of their HIV status, or if you have multiple partners. It also reduces the risk of getting HIV from intravenous drug use by about 74%. Consult with a healthcare professional if you have any questions about whether PrEP is the right choice for you.

A negative HIV test is required before starting PrEP. Your doctor or pharmacist may also recommend additional tests to ensure that it’s safe for you to use PrEP. Initial baseline testing may include:

You will also have to visit a healthcare provider while taking PrEP for follow-up testing including:

Pregnancy testing and discussion of pregnancy plans every 3 months

HBV DNA testing every 6 to 12 months while taking PrEP if you have hepatitis B

We’ll help you get PrEP at the most affordable price

Alto will coordinate with your doctor and your insurance provider to ensure you’re receiving the best PrEP option for your needs at the most affordable price. We offer discrete, private packaging and free, same-day delivery along with in-app reminders to stay on track. And our pharmacists — who have deep expertise in many clinical areas, including HIV treatment and prevention — are directly available through phone or within the Alto app to answer any questions.

Reach out any time to get started by phone at 1-800-874-5881 or download the app for secure messaging! 

The face of fertility treatment continues to evolve, with more and more LGBTQ+ couples and individuals seeking to become parents. Learn more about the fertility considerations specific to TGNB individuals.

Fertility Options for Transgender, Gender-Queer, and Nonbinary (TGNB) Individuals

The face of fertility treatment continues to evolve, with more and more LGBTQ+ couples and individuals seeking to become parents. Transgender, gender-queer, and nonbinary (TGNB) individuals have multiple options for starting a family, including fertility preservation treatment and using a donor or surrogate for several or more of the components of biological conception. Below, we explain more about the fertility considerations specific to TGNB individuals and potential paths to explore as you plan to start a family.

Each person’s journey to parenthood looks different. Transgender, gender-queer, and nonbinary individuals have specific factors to consider in planning for a family, as the biological process of transitioning may affect your ability to conceive.

Many transgender and nonbinary individuals take hormones like testosterone, estrogen, and testosterone blockers, or anti-androgens, while transitioning. Testosterone suppresses feminine physical traits and induces masculine ones in transgender men and some nonbinary individuals, such as facial and body hair and a deeper voice. Estrogen increases feminine characteristics like breast development and facial and body hair reduction in transgender women and some nonbinary individuals.

Researchers are still learning about the impact of testosterone and estrogen therapy on long-term reproductive function. While prolonged testosterone and estrogen use often stop sperm production and ovulation, respectively, some evidence, like a 2019 study on transgender fertility from Boston IVF, suggests that these effects are reversible upon discontinuation of the treatment.

Based on eight years of patient data, the Boston IVF study found that transgender men who underwent egg freezing for fertility preservation had similar egg yields as cisgender women, or women whose sex assigned at birth was female. More than half of the study’s transgender male participants had taken testosterone before pursuing ovarian stimulation treatment, all of whom had discontinued use of the hormone for an average of four months prior to starting their egg freezing cycle.

While the study’s results affirm that hormone therapy may not necessarily prevent you from having children biologically, every person’s situation is different. If you are considering hormone therapy and want to have children in the future, consult with your doctor about the possibility of freezing your eggs or sperm for future use, a process we explain in more detail below.

In addition, there is currently no definitive evidence that testosterone therapy will prevent individuals assigned female sex at birth from becoming pregnant. Depending on your ideal timeline for starting a family, you may also want to discuss contraception options with your healthcare provider.

For many transgender and nonbinary individuals, gender confirmation surgery is an important aspect of transitioning. It plays a crucial role in addressing gender dysphoria, the distress caused by the disconnect between your gender identity and the sex you were assigned at birth.

Depending on the circumstances, gender confirmation surgery may permanently affect your reproductive function. For instance, hysterectomies are performed in some female-to-male transitions, which prevents the possibility of carrying a child in the future. The removal of testicles during a male-to-female transition may also impact your ability to have biological children.

By planning for the future and discussing your reproductive options with your healthcare provider before undergoing gender confirmation surgery, you may be able to preserve your fertility options.

Fertility preservation treatment for TGNB individuals

Many transgender and nonbinary individuals choose to preserve their eggs or sperm for future use before beginning the biological process of transitioning. Sperm freezing helps transgender women plan for a future family before starting estrogen therapy. 

This is a fairly simple process in which a sperm sample is either surgically retrieved or collected by the person freezing their sperm. Doctors will then analyze that initial sperm sample to determine if additional samples are needed. Your sperm will then be stored in vials with cryoprotectant agents that will help ensure its long-term viability.

In egg freezing, transgender men take fertility medications to stimulate egg production. Once the eggs are developed, your doctor will retrieve them from you in a minimally invasive procedure. Your eggs can then be frozen and stored for later use. Depending on how many eggs are yielded, you may have to undergo more than one cycle of egg freezing.

Read our previous blog to learn more about what to expect during egg freezing.

Fertility treatment and conception options

Transgender and nonbinary individuals and families have multiple options for having children biologically, including intrauterine insemination (IUI) and in vitro fertilization (IVF).

In IUI, transgender women can use their frozen sperm and have it placed into their partner’s or a surrogate’s uterus. If you elect to use a surrogate, they will also take on the role of egg donor, meaning that they will be the biological mother of your child.

In IVF, eggs and sperm are combined in a laboratory. The fertilized eggs, or embryos, are then placed into the uterus with the potential outcome of a pregnancy. As with IUI, transgender individuals have multiple options with IVF. 

Blog

When to See a Healthcare Specialist for Allergy Treatment

Spotlight on Men Having Babies & Dr. Guy Ringler

Get to Know the Team That Builds Alto's Customer-Facing Apps

What to Know About Transgender Hormone Therapy Side Effects

What to Know About State-Funded PrEP-DAP Programs

Fertility Options for Transgender, Gender-Queer, and Nonbinary (TGNB) Individuals

Hello, San Diego!

What to Know About Lung Cancer Screening

Prioritize Your Health with Preventative Care

How Anticoagulants Prevent Blood Clots From Forming

How Does Alto Pharmacy Work with Health Insurance? We Answer Your Top Questions.

How Updated CDC Guidelines Can Expand PrEP Access

Switch to a better pharmacy.