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The thyroid may be small, but it plays a significant role in your overall health and wellness. This butterfly-shaped gland at the base of your throat produces and regulates hormones that influence your metabolism and energy level, cholesterol, heart rate, body temperature, and more.

How to Manage an Overactive Thyroid

Balanced thyroid hormones allow your body’s many systems to properly function, and issues with the thyroid can impact many aspects of your health. There are two main types of thyroid imbalances that may occur: hyperthyroidism and hypothyroidism.

Hyperthyroidism occurs when the thyroid produces too much thyroid hormone, accelerating the metabolism beyond normal.

Hypothyroidism occurs when an underactive thyroid leads to lower-than-normal levels of thyroid hormone.

Without treatment, both hyperthyroidism and hypothyroidism can lead to more serious complications. Below, we explain how to manage these disorders and maintain a balanced thyroid.

Several conditions or health factors may lead to overproduction of thyroid hormone. Graves’ disease, an autoimmune disorder in which antibodies overly stimulate the thyroid, is the leading cause of hyperthyroidism, accounting for 85% of all cases.

The development of thyroid nodules, which are typically benign lumps or growths in the thyroid that produce more hormones than needed

Thyroiditis, or thyroid inflammation, which most commonly occurs after pregnancy due to an underlying autoimmune disease or unknown cause

Excess consumption of iodine — a mineral critical to the production of thyroid hormone — through diet or medications

There are also several known factors that may increase your risk of developing the condition, including:

Health conditions including pernicious anemia, type 1 diabetes, and primary adrenal insufficiency (also known as Addison’s disease)

Hyperthyroidism is associated with a wide range of signs and symptoms such as the following:

Unintentional weight loss even with increased food intake

Enlarged thyroid gland at the base of your neck

Symptoms of hyperthyroidism may be subtle for some individuals. In addition, many common symptoms overlap with those of other health conditions. If you have any concerns about your thyroid health, consult with your provider for an evaluation.

Hyperthyroidism is associated with irregular menstrual cycles, which can lead to difficulty conceiving. Many people initially learn of a hyperthyroidism diagnosis after experiencing fertility challenges. The treatment options described in more detail below can help restore hormone levels and ovulation.

The thyroid affects so many areas of your health and wellness, and untreated hypothyroidism can lead to other health issues such as the following.

An underactive thyroid can increase levels of LDL cholesterol, leading to a greater risk of heart disease and heart failure.

Hypothyroidism is also linked to depression.

An underactive thyroid can affect ovulation, or the release of a mature egg from the ovaries during a menstrual cycle. Treatment for hypothyroidism may address fertility issues by restoring hormone levels and ovulation.

In the long term, untreated hypothyroidism can damage the peripheral nerves, which carry information from your brain and spinal cord to other parts of your body. This can lead to pain, numbness, and tingling.

There are several ways to diagnose hyperthyroidism, including a physical exam, blood tests, and imaging tests.

Your healthcare provider may check your thyroid, eyes, heart, hands, and skin during a physical exam to confirm a diagnosis of hyperthyroidism.

Your provider may recommend thyroid function testing, which consists of measuring your thyroid hormone levels via blood samples. Hyperthyroidism is characterized by elevated levels of the thyroid hormones triiodothyronine (T3) and thyroxine (T4) and lower-than-normal levels of thyroid-stimulating hormone (TSH).

Your provider may also use one or more imaging tests to more closely examine your thyroid, including a radioactive iodine uptake (RAIU) test, a thyroid scan, and a thyroid ultrasound.

There are a variety of treatment options for hyperthyroidism. Your provider will make individualized recommendations based on the cause of your hyperthyroidism and your overall health history.

The following types of medications are commonly used in the treatment of hyperthyroidism.

Anti-thyroid medications including methimazole (Tapazole®) and propylthiouracil (PTU) reduce symptoms by preventing over-production of thyroid hormones. These medications are typically taken for at least a year, though symptoms may improve within weeks or months.

Radioactive iodine is an oral medication that targets overactive thyroid cells, causing the thyroid to shrink and lowering hormone levels within a few weeks. This treatment approach permanently affects thyroid function, so symptoms of hyperthyroidism will not reappear. In most cases, the use of thyroid hormone medications is necessary after this treatment to maintain balanced hormone levels.

Beta blockers can control associated symptoms such as a rapid heartbeat, nervousness, or tremors. These medications cause the heart to beat more slowly and less forcefully. They will not change hormone levels and are typically used in tandem with anti-thyroid medications or radioactive iodine therapy. Commonly prescribed beta blockers include atenolol (Tenormin®), bisoprolol (Zebeta®), metoprolol tartrate (Lopressor®), metoprolol succinate (Toprol-XL®), acebutolol (Sectral®), and propranolol (Inderal®).

Some cases of hyperthyroidism require removal of part or all of the thyroid gland in a procedure known as a thyroidectomy. While this is effective at treating hyperthyroidism, it can result in hypothyroidism, which requires ongoing use of thyroid supplements.

Iodine consumption can contribute to the development of hyperthyroidism or worsen symptoms. Managing hyperthyroidism often includes monitoring iodine intake.

If your provider recommends following a low-iodine diet, try to avoid or limit your intake of seafood and seaweed, which have the highest iodine content of all foods. Other high-iodine foods to consume in moderation include milk and dairy products, egg yolk, and iodized salt.

Never make significant changes to your diet without first consulting your provider or a nutritionist.

The most common cause of hypothyroidism is an autoimmune disorder called Hashimoto's thyroiditis.

Other significant contributing factors include:

Thyroid surgery, which can affect hormone production

Radiation therapy to treat cancer, if targeting the head or neck

Anyone can develop hypothyroidism, but several known factors may increase your risk, including:

Sex - the condition occurs more frequently in women than in men

Age - the condition occurs more frequently in those over 60

Having another autoimmune disorder such as type 1 diabetes or celiac disease

Symptoms of hypothyroidism often develop gradually, over the course of many years. These are among the most common and significant:

If you have symptoms of hypothyroidism, your doctor will likely use a thyroid stimulating hormone (TSH) test to confirm a diagnosis. This simple blood test measures the levels of thyroid hormones in your blood.

One challenge of diagnosing hypothyroidism is that symptoms frequently overlap with those of other health issues.

Hypothyroidism is manageable. Treatment allows you to control symptoms such as elevated LDL cholesterol levels and weight gain, preventing potential health complications.

The main goal of treatment is to increase your thyroid levels. Levothyroxine (Levo-T®, Synthroid®, Tirosint®), a synthetic thyroid hormone taken orally, is often the starting point.

Another synthetic thyroid hormone, liothyronine (Cytomel®), may also help treat low thyroid levels.

There are formulations that combine levothyroxine and liothyronine.

The majority of individuals with hypothyroidism need to take medication every day on an ongoing basis, though some mild cases are resolved with short-term treatment.

How to Manage an Overactive or Underactive Thyroid

Birth control is essential healthcare, allowing you to prevent pregnancy and take charge of your reproductive health. There are many contraceptive methods to choose from. Learning more about the available options can help you, and in some cases, your partner, make the best decisions for your needs and reproductive goals.

Choosing the Right Birth Control for You | Alto Pharmacy

Read on for an overview of some common birth control methods. Our list focuses on hormonal birth control, which contain synthetic versions of estrogen and progesterone. These two hormones play a significant role in reproduction.

There are other options for contraception that must be used every time you have sex, including condoms and diaphragms. When used correctly, condoms and diaphragms are 98% and 88% effective at preventing pregnancy, respectively.

Permanent birth control is also available in the form of surgical procedures (tubal ligation for women and a vasectomy for men). These procedures must be performed by a healthcare provider. Discuss your options for contraception with your provider.

In addition, there are two options for oral emergency contraception to be taken after unprotected sex: levonorgestrel (Plan B®, Mirena®, Kyleena®) and ulipristal (Ella®). Levonorgestrel is sometimes available without a prescription. Ulipristal is prescription-only.

Like all forms of hormonal birth control, the pill stops ovulation, which is the release of a mature egg from the ovaries during each menstrual cycle. The hormones also thicken cervical mucus, an additional layer of pregnancy prevention that keeps sperm from reaching an egg, should one be released.

There are two types of birth control pills:

Combination pills, or combined oral contraceptives (COCs), contain both estrogen and progestin. (Progestin is a synthetic form of progesterone.) COCs are the more common of the two types.

Progestin-only pills (POPs) contain only progestin.

In both cases, the pills come in a pack and you take one every day.

Many individuals choose the pill for its affordability and effectiveness. However, it must be taken on time every day in order to prevent pregnancy. You may find it helpful to combine taking your birth control with another daily habit such as brushing your teeth, or to set a reminder on your phone. The Alto app has medication management reminders to help you continue with your treatment.

While the pill is 91% effective at preventing pregnancy when taken as prescribed, it does not offer protection against sexually transmitted infections (STIs). If you have an STI or are unsure about a sexual partner’s health history, use condoms every time you have sex to protect your health and your partner’s.

The birth control ring, also referred to as the vaginal ring, consists of a small, flexible ring worn inside of your vagina. It releases hormones, which are absorbed through the vaginal lining, for ongoing pregnancy prevention. Like birth control pills, these hormones prevent ovulation and thicken cervical mucus.

There are two types of birth control rings. NuvaRing® lasts for up to five weeks. It is worn continuously and typically replaced about once a month. It may also be used to skip your period.

An Annovera® ring lasts for a year. You wear it in your vagina for 21 days, take it out for seven days, and then put it back in your vagina to restart the cycle.

A vaginal ring must be used correctly to offer full benefits. That includes replacing it when needed and, in the case of an Annovera ring, taking it out and putting it back in on time. To stay on schedule, set reminders or alarms on your phone, or keep track on a calendar. You can also check out Planned Parenthood’s free birth control reminder app, Spot On.

The birth control ring is prescription-only. It does not offer protection against STIs.

The transdermal contraceptive patch releases estrogen and progestin through the skin and into your body to prevent pregnancy. There are two branded options available in the U.S.: Xulane® and Twirla®. Both patches may be worn on your belly, butt, or back. The Xulane patch can also be worn on your upper arm.

The birth control patch is worn for a total of 21 days. You will need to replace the patch during that time, wearing a new patch each week for three weeks. During the fourth week, you will not wear a patch so that menstrual bleeding may occur. The cycle then restarts.

A patch must be used correctly and on schedule to offer effective pregnancy prevention. Set reminders or alarms on your phone, keep track on a calendar, or use a birth control reminder app.

The birth control patch is prescription-only. It does not offer protection against STIs.

The birth control shot, also referred to as the depo shot or Depo-Provera®, is an injection administered about every three months. It contains progestin and works similarly as the above forms of hormonal birth control to prevent pregnancy.

Many individuals choose the shot for the convenience of the injection schedule and privacy. In order to experience the benefits of the birth control shot, you must stay on track and get a new shot every 12-13 weeks. In most cases, a doctor or nurse will give you the shot. In some cases, you may be able to get a supply of shots from a health center to self-administer.

Use a birth control reminder app or a calendar to stay on track with your injections.

Long-term use of the Depo-Provera shot may increase an individual’s risk for significant and potentially irreversible bone mineral loss. Additionally, it has been associated with an increased risk of breast cancer and is not recommended for those with a known or suspected breast malignancy.

There are two types of longer-term birth control: intrauterine devices (IUDs) and birth control implants. Both methods release hormones into your body to prevent pregnancy.

The implant (Nexplanon®) is a tiny, thin rod implanted into your arm that offers pregnancy prevention for up to five years. It must be implanted in a doctor’s office. If your family planning goals change, a doctor can easily remove the implant before it expires.

The IUD is a small device implanted into your uterus that prevents pregnancy. There are different types of IUDs that offer protection for varying amounts of time.

Hormonal IUDs release progestin to prevent pregnancy. There are four FDA-approved hormonal IUDs in the U.S.:

Paragard® is a copper IUD that does not contain hormones. It prevents pregnancy for up to 12 years.

An IUD must be implanted by a healthcare professional. It is reversible and can be easily removed.

There are many factors to consider when choosing a birth control method. While many individuals find these forms of longer-term birth control more convenient, they are typically more expensive than other forms of contraception.

Timing is essential with many forms of hormonal birth control. We make it easy to stick to the schedule, with free same-day delivery and medication management reminders in the app. In addition, our pharmacists are available until 9 pm PST (12 midnight EST) on weeknights to answer any questions you may have.

To learn more, reach out any time through secure in-app messaging or by 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.

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.

Polycystic ovary syndrome (PCOS) is a condition that affects women of reproductive age and is characterized by a hormone imbalance. It can impact many areas of a woman’s health, including menstrual cycles, fertility, insulin levels, and risk of cardiovascular disease.

How Polycystic Ovary Syndrome (PCOS) Affects Fertility

Symptoms of PCOS can be treated through a combination of medications and lifestyle changes. Here’s what to know about the condition’s causes, symptoms, and treatment options.

Polycystic ovary syndrome has three defining symptoms: high levels of male hormones, irregular menstrual cycles, and the development of cysts in the ovaries. These features overlap.

Many women with PCOS have higher levels of androgen hormones, which are responsible for the development of certain male characteristics. For those with PCOS, overproduction of androgens leads to irregular menstrual cycles, hair loss, extra growth of hair on the face and body, and acne.

The cysts that develop in the ovaries are small follicles containing an immature egg. Since these eggs do not reach maturity, ovulation — the release of a mature egg from the ovaries — does not occur. The absence of ovulation leads to further imbalance of hormones, as progesterone decreases.

PCOS is the leading cause of female infertility.

Polycystic ovary syndrome can develop at any age after puberty. It is estimated that 5-10% of women between the ages of 15-44 have the condition.

The specific causes of PCOS have not been identified, but the medical community believes that condition is the result of several intersecting factors: insulin resistance, higher levels of androgens, higher levels of inflammation, and an irregular menstrual cycle.

Some evidence suggests that PCOS may have a genetic component. You may have a higher risk of developing PCOS if you have a mother, sister, or aunt with the condition. Obesity is also a risk factor.

Common symptoms of polycystic ovary syndrome include:

Irregular, absent, or abnormally short (i.e., less than 21 days) menstrual periods

Excess hair on the face, chin, chest, abdomen, or upper thighs, also referred to as hirsutism

Weight gain or difficulty maintaining a healthy weight

Patches of darkened skin, particularly on the neck, in the groin, and beneath the breasts

Small flaps of excess skin near the neck or armpits, sometimes referred to as skin tags

Infertility, defined as the inability to get pregnant after twelve months or more of unprotected sex

The hormone imbalances that characterize PCOS can affect many areas of a woman’s health, including the following.

Infertility is a common symptom of PCOS, as hormone levels interfere with ovulation, an important step in reproduction. However, PCOS is a highly treatable cause of infertility. Many individuals and couples affected by PCOS do become pregnant after fertility treatment.

During pregnancy, women with PCOS may face a greater risk for miscarriage, high blood pressure, and gestational diabetes. They are also more likely to deliver prematurely. If you have PCOS, you can set yourself up for a healthy pregnancy by maintaining a healthy weight and blood sugar levels before trying to conceive and during pregnancy.

Insulin is a hormone naturally produced in the pancreas. It helps convert sugar, or glucose, into energy. Type 2 diabetes occurs when blood sugar levels rise due to issues with the body’s production or use of insulin. Since insulin resistance is often a symptom of PCOS, many individuals with the condition have a greater risk for type 2 diabetes.

Individuals with PCOS are also more likely to develop metabolic syndrome, a group of conditions associated with a higher risk for diabetes and heart disease, including:

Abnormal cholesterol or triglyceride levels

Endometrial hyperplasia, a condition in which the lining of the uterus becomes too thick, is also associated with PCOS. It can increase a woman’s risk for endometrial cancer.

The process for diagnosing PCOS includes a conversation about your health history, a physical exam, and several tests that can rule out other causes of PCOS symptoms.

During the physical exam, a healthcare provider typically measures blood pressure, body mass index (BMI), and waist size. They will also check your skin for extra hair, acne, or discoloration.

Your doctor will likely conduct a pelvic exam to check for signs of high androgen levels and abnormalities with your ovaries. Then, a pelvic ultrasound, or sonogram, will check the ovaries for cysts and scan the uterine lining.

Blood tests may be used to measure levels of androgens as well as hormones linked to other health conditions with similar symptoms as PCOS. You may also be tested for high cholesterol and diabetes.

If other health conditions have been ruled out, you must have at least two of the following symptoms to be diagnosed with PCOS:

Irregular, absent, or abnormally short menstrual periods

Signs of high androgen levels such as hirsutism, acne, or thinning of hair on the scalp

PCOS and related medical conditions can be managed through a variety of treatments including medications and lifestyle changes. Treatment is tailored to an individual’s health history, PCOS symptoms, and reproductive goals. Here’s how different treatment options target various symptoms of PCOS.

Hormonal birth control, which may contain both estrogen and progestin, is often used to regulate a woman’s menstrual cycle. It can also reduce hirsutism and acne and lower the risk of endometrial cancer. Many women who do not have plans to get pregnant use hormonal birth control as a long-term treatment for PCOS.

Metformin, an oral medication most commonly used to treat type 2 diabetes, is sometimes used off-label to treat PCOS. It improves the body’s response to insulin and can lower blood sugar and androgen levels. In some cases, it may be effective at restoring ovulation, though it typically does not treat hirsutism or acne.

Anti-androgen medications such as spironolactone (CaroSpir® and Aldactone®) block the effects of androgens and treat hirsutism. They are often used in combination with birth control and should not be used during pregnancy or when trying to conceive.

Maintaining a healthy weight can help regulate menstrual cycles. It may also improve insulin levels and treat excess hair growth and acne. Additionally, following a heart-healthy diet and staying physically active is especially important for those with PCOS.

In many cases, metformin or lifestyle changes can help address ovulation issues associated with PCOS. There are additional treatments that restore ovulation in women with PCOS, including oral medications used to treat infertility such as Clomid® and Femara® and injectable fertility medications including gonadotropins.

A procedure called laparoscopic ovarian drilling is a fertility treatment typically reserved for cases when medication is not effective.

PCOS treatment looks different for each individual, and our team has the expertise to support your personal health journey. Whether you are getting started with hormonal birth control, metformin, or fertility treatment, we’re here to simplify medication management and keep you supported.

We offer free, same-day delivery seven days a week, with temperature controlled packaging that ensures fertility medications always arrive in the right condition. And we’ll 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.

Skin, the body’s largest organ, protects you against disease and infection and regulates your body temperature, among other crucial functions. It’s important to take good care of this vital and complex organ, as there are a variety of skin problems that can occur, including serious issues like skin cancer. Here’s what to know about the structure of your skin and how you can protect it.

An Introduction to Skin Health

Your skin is composed of three layers: the epidermis (top layer), the dermis (middle layer), and the hypodermis (bottom layer). Each layer has an important purpose.

The epidermis is what you see when you look at your skin. It prevents infections by blocking bacteria and germs from entering your bloodstream. There are three types of cells in the epidermis:

Squamous cells, which form the top layer of the epidermis

Basal cells, which sit beneath the squamous cells

Melanocytes, which produce melanin — the pigment that gives skin its color — and are located at the bottom of the epidermis

Skin cancer first develops in the epidermis, with the three most common types of skin cancer affecting one of the three cells above.

The dermis, the middle layer of skin, plays an important role in your overall skin health. It contains collagen, a protein that keeps skin cells strong and healthy, and blood vessels that deliver nutrients to the epidermis. In addition, its sweat glands help regulate your body temperature, its hair follicles stimulate hair growth, and its nerves allow you to experience the sensation of touch.

The bottom layer of your skin is the fattiest, cushioning your muscles and bones when you fall and protecting you from the cold or extreme heat. The dermis’ nerves and blood vessels continue in the hypodermis, where they expand and reach the rest of your body.

The sun emits a form of electromagnetic radiation called UV radiation that can damage the skin both directly and indirectly. This damage occurs gradually over time, potentially resulting in skin health issues such as:

Freckles, moles, and other benign skin growths

Skin cancer is one of the most common types of cancer in the U.S. It primarily occurs in parts of your body that receive the most sun exposure, such as your face, neck, hands, and arms, but it may develop anywhere.

Skin cancer can affect anyone, but you may be at a higher risk if you have lighter skin, a family history of skin cancer, prevalent moles, a history of severe sunburns, or a weakened immune system.

There are three common types of skin cancer: basal and squamous cell carcinomas, which develop in the epidermis’ basal and squamous cells, and melanoma, which develops in the melanocytes. Basal and squamous cell carcinomas are very treatable. Melanoma is the most serious type of skin cancer since it can spread to other organs if not detected early.

Limiting your exposure to UV rays is the most important thing you can do to prevent skin cancer and other types of skin damage. Wear a broad-spectrum sunscreen with a sun protection factor (SPF) of 15 or higher every day, even if it isn’t sunny, since up to 80% of UV rays can pass through clouds. Be extra careful around bright surfaces like snow, water, and sand, which can amplify UV exposure and increase your risk of a sunburn.

The strength of the sun’s rays fluctuates throughout each day, and from one day to the next. Avoid direct sunlight as much as possible between 10 am to 4 pm daylight savings time (9 am to 3 pm standard time), when UV radiation is at its strongest.

You are exposed to more UV radiation at higher altitudes, where more UV rays can reach the Earth’s surface. Check the UV Index for a daily forecast of local UV radiation strength on a scale of 0 to 11. Extra precautions against UV rays are recommended when the index is a three or higher. Protective clothing like long-sleeve shirts and wide-brimmed hats can help keep UV rays away from your skin.

It’s also best to avoid tanning beds, which use UV radiation and can increase your risk for skin cancer.

Unlike many other types of cancer, skin cancer is often visible. Checking your skin regularly to identify new or changing skin growths such as moles can help you detect any potential issues early on, when they will be easier to treat.

Skin cancer can take various forms. In general, if you see anything new, changing, or unusual, schedule an appointment with a dermatologist as soon as possible. Here are common signs of skin cancer to watch for, according to The Skin Cancer Foundation:

A skin growth that increases in size and appears pearly, transparent, tan, brown, black, or multicolored

A mole, birthmark, or brown spot that increases in size, thickness, changes color or texture, or is bigger than a pencil eraser

A spot or sore that continues to itch, hurt, crust, scab, or bleed

An open sore that does not heal within three weeks

You can also use the first five letters of the alphabet as a tool for recognizing melanoma warning signs in particular:

Asymmetry: Unlike a round or oval mole, melanomas tend to be asymmetrical, with one side of the growth appearing differently from the other. For example, one side may appear darker and raised while the other looks lighter and flat.

Border: The borders of melanomas are uneven, in contrast to the smoother borders of common moles.

Color: Benign moles are often just one shade of brown, but melanomas may have multiple shades of brown, tan, or black. Other colors like red, white, or blue may appear as it grows. Many health experts also consider it to be a melanoma warning sign if a skin growth is darker than others.

Diameter: While it’s best to detect melanoma before it grows, scan for any skin growth the size of a pencil eraser or larger, approximately ¼ inch in diameter.

Evolving: Changes in size, shape, color, or elevation may be a warning sign of melanoma. Watch for new symptoms like bleeding or itching as well.

Even if you don’t see anything unusual during these scans, it’s important to visit a dermatologist at least once a year for an exam as part of your overall preventative care.

At Alto, a pharmacist is your partner in health. If you take medication, we will work with your doctor, your insurance (if applicable), and any third party savings programs that you may qualify for to make your medications as affordable as possible. And our team of pharmacists is available to chat whenever questions come up. Reach out any time through in-app secure 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.

Blog

How to Manage an Overactive or Underactive Thyroid

Choosing the Right Birth Control for You

How Polycystic Ovary Syndrome (PCOS) Affects Fertility

An Introduction to Skin Health

What to Know About Transgender Hormone Therapy Side Effects

Why Gut Health Is Key (and How To Improve Yours)

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