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October 11 marks National Coming Out Day, an opportunity to celebrate all those who have come out as LGBTQ+ and recognize the courage they’ve demonstrated by choosing to be their authentic selves.

Celebrating National Coming Out Day at Alto

October 11 marks National Coming Out Day, an opportunity to celebrate all those who have come out as LGBTQ+ and recognize the courage they’ve demonstrated by choosing to be their authentic selves. In honor of this annual celebration, we sat down with two Alto team members — Ben Romero (he/they), Business Operations Manager for Health Plans and Travis White (he/him), Senior Software Engineer — who generously shared their experiences of coming out as bisexual/queer. Here are their stories, in their own words.

Ben: Like a lot of folks, I avoided coming out for most of my life. I grew up knowing that I wasn’t exactly straight and later recognized that I’m bisexual. I remember my entire experience around my sexuality being wrapped in shame. I would reluctantly conform to heteronormativity just to avoid the fear of being outed or questioned. It wasn't until college that I first felt like I could open myself up to the experience and validation that I deserved. By the time I graduated from college, I had a refreshed sense of my place in the world, but I was still hiding my sexuality from my family.

Five years after college, I was finally ready to be open with my family about being bisexual, and it was the first time I felt as if I had to “come out.” At the time I was engaged to my non-binary/queer partner. My family knew my partner as a woman, but my partner was also beginning to validate their nonbinary gender experience. All I could think about was how much of a disservice it would be to our identities as a queer couple if we started our marriage having to assume more invalidating heteronormative assumptions. I first told my closest family members — my younger brother and parents — who supported me unconditionally and showed me so much love. Not every family member was as accepting of my sexuality, which was really disappointing, but I had more than enough support from my chosen family to finally overcome the fear that I had held on to for so long. 

Travis: I realized I wasn’t completely straight at some point in high school. Growing up Catholic, I was always taught that men are attracted to women and that being gay was a sin. So when I found myself attracted to both girls and guys during high school, I wondered what was wrong with me. I brushed it off and ignored that aspect of my sexuality for a long time, which I would later come to regret since it definitely fed into ongoing anxiety and depression in college.

I first came out to my closest friends during my junior year of college. By that point, I had fully accepted that I wasn’t straight, but I had never acted on my bisexuality. I had only dated girls, so my friends saw me as completely straight. I couldn’t quite figure out how to tell them, and it ended up happening organically while hanging out on a Friday night. We were playing a game around the table that required everyone to share something no one else knew about them. Something came over me and I decided to throw caution to the wind with a, “by the way… I’m bi.”  

I came out to my parents several years later when I was working my first engineering job out of college, living in Silicon Valley and loving life. I knew that if they chose not to accept me, it was going to be their loss. After a night out (and an amazing prime rib dinner) when they were in town, I told them that there was something I wanted to tell them about myself - that I am bisexual. My dad’s first response was, “What does that mean?” I informed them that it means I am attracted to both men and women, though more recently, I’ve come to think of myself as being attracted to interesting people regardless of the gender they identify as. My parents were very supportive, but truthfully I had reached a point where I could be accepting of the worst-case scenario. 

Ben: I was most grateful for the sense of relief I experienced. Despite facing criticism and homophobia from some of my siblings after coming out, I couldn’t shake the sense of pride I felt from allowing myself to be unapologetically queer and visible. I’m finally allowing this part of me to flourish and grow. It’s liberating to be radically honest with yourself and others, regardless of what anyone else may think. I’ve now come to identify with the term queer in addition to bisexual. Part of the growth I’ve experienced involves unlearning so much of what I’ve been socialized to believe about the gender binary, and I’m just now starting to understand where I exist outside of it.  

Travis: When I came out to my friends during college, we stayed up talking until very late into the night. I left feeling a huge weight lifted off of my shoulders — and so full of love and support from some of the people I was closest to.

And later when I came out to my parents, they accepted me with open loving arms, for which I’m grateful, but I was also prepared to move forward with my life even if they did not accept me as my true authentic self.

What resources, support groups, or communities did you rely on when coming out? 

Ben: The isolation of being in the closet can sometimes lead to stories or expectations of yourself that aren’t necessarily helpful, or true. For me, as a bisexual, some of those expectations sounded like “I’m not queer enough,” “I don’t fit into the queer community,” or “people won’t believe I’m bi/queer.” I looked to my queer friends and even to LGBTQ+ advocates on social media and was relieved to find that they had many of the same fears about coming out as I did. I found that learning from other people’s experiences could help validate my own feelings, even if we had a different orientation or gender. As a queer Latinx, I also sought validation from people who shared similar intersections around my identity, which helped me navigate the concerns I had about coming out to my family.

Travis: My friends were very supportive so I was really able to lean on them. It was also helpful to just search online for other people’s coming out stories. Before I could tell my family, I knew I had to reach a point where I would be secure in my identity regardless of the outcome of that conversation. Part of the reason it’s so important to share coming out stories is because hearing other people’s experiences helps inspire you to do the same.

What advice would you give to others considering coming out? 

Ben: Above all, put your safety first. Try your best to not take on the burden of guilt for not being your authentic self — that is not a reflection of you, but a reflection of how our environment can fail to provide the validation we deserve. Take your time and build your comfort with folks who will validate your experience. There’s a whole community of people who will back you up and care for you if someone you come out to is hurtful or invalidating. 

Travis: Do it if, and when, you’re ready. You can never control how others will react, so just accept that other people’s responses have nothing to do with you. It took me years to reach that point with my family. It can be incredibly tough, and you can never know in advance how anyone will respond, but if they cannot accept you for your true authentic self, there are plenty others out there who will.

Do you have any suggestions for allies? 

Ben: I would stress the importance of familiarizing yourself with queer history and how our struggle for acceptence has evolved over the years. The LGBTQ+ community and allies have so much to be proud of today, like the repeal of “Don’t ask, don’t tell” (a former U.S. policy that directed military applicants to not disclose their sexual orientation), the legalization of gay marriage, and more queer representation on our screens — just to name a few.

At the same time, while all of those are certainly celebratory milestones, I ask that allies also recognize that our pride comes from so much more than a handful of legislative victories over the last decade. Our pride comes from the queer folks who came before us and fought for our visibility by rallying voices to speak out against injustice. Allies can research events such as the Compton’s Cafeteria riot, the Stonewall uprising, or the works of the Combahee River Collective. Understanding this historical context is important for also understanding the intersectional nature of the LGBTQ+ struggle for acceptance and restorative justice. Even though we have much to celebrate, our struggle continues as we fight for those who are still excluded or marginalized. 

Travis: Listen. The number one thing you can do is to listen and accept what someone in the LGBTQ+ community is telling you as their truth. It may change in the future — and that’s okay! Sexuality and gender are not a binary, and both can be incredibly fluid.

For parents: how you discuss sexual orientations and gender identities at home can leave a lasting impact on your children. I remember asking my mother about her thoughts on gay marriage, and she shared a more traditional view of marriage as a union between a man and a woman. That stuck with me for a long time and is a key reason I waited so long to tell them who I truly am. Read your toddler a book about a gay couple that gets married, teach your teens about prominent members of the LGBTQ+ community (and why they’re important), and if your LGBTQ+ child asks you to drive them to gay prom, treat the scenario as completely normal — because it is.

Why is it important for you to work at a company that values diversity in all forms? 

Ben: For me it’s a requirement that a company I work for prioritizes diversity and inclusion. I appreciate that Alto provides visibility into the progress that we’ve made towards building a diverse team that reflects the diversity of the patients we build solutions for. We also hold space to identify the work that still needs to be done. It’s really validating to have your background recognized at company celebrations and events or in spaces like employee resource groups (ERGs)*. It’s also important that we do all we can in our everyday actions to foster a collaborative and inclusive environment — one where people feel comfortable enough to be their authentic selves and not like they have to mask their gender, race, neurodivergence, or any other part of their identity. 

Travis: The U.S. — and the world — is made up of so many different people. There’s diversity of thought and beliefs, educational experiences, socioeconomic status, gender, race, A homogenous company that doesn’t mirror that diversity  will never be able to serve the entire population, and will miss out on a lot of opportunities. Alto’s mission is to fulfill medicine's true purpose — to improve quality of life — for everyone who needs it. The key word to me is everyone, and to truly fulfill the promise of that mission, we need a company as diverse as our customers. I personally find it rewarding to work at a company that values diversity and has strong representation of many identities, because that’s how the best ideas come to fruition and ultimately how the most positive impact is achieved.

At Alto, we believe in a world where every perspective matters. Diversity fosters creativity and creates innovation, and we welcome candidates of all backgrounds, skill sets, and experiences. To learn more, read Why We Prioritize Diversity at Alto. 

For more information on how to make your workplace safe and equitable for LGBTQ+ team members, read 11 Simple Ways You (Yes, You!) Can Make Your Workplace More LGBTQ Inclusive. 

If you or someone you know is considering coming out, we encourage you to review these resources:

Parents, Families, and Friends of Lesbians and Gays (PFLAG) Recommended Reading: Coming Out

*ERGs are meant to empower community groups within an organization by directly linking decision makers and implementing policies that support the group’s specific needs. The groups often center around a shared identity or experience and focus on building community, providing support, and contributing to its members’ personal and professional well-being. By creating an open forum for employees to come together, discuss challenges and opportunities, and foster a sense of belonging, ERGs help both individuals and organizations thrive.

The Next Evolution of Our Company Values

A lot has changed at Alto since Matt and I first set out to transform the pharmacy experience back in 2015. (For one thing, we no longer work out of a storage closet.) In the past two years alone, we’ve quadrupled our team to more than 1,000 Altoids and opened new locations in Denver, Las Vegas, Seattle, New York City, Houston, Dallas, San Jose and San Diego.

Our mission — improving the quality of life for everyone who needs medicine — will never change, but a team of 1,000 needs a different recipe for success than one of 100. And as our team continues to grow, along with our geographic footprint, we’ve revisited our core values so that we can move forward with intention and clarity during this next phase of Alto’s journey.

Here are the values that guide our work today.

This was at the top of our founding values, and it’s still here. In fact, our resolve to put patients first has only gotten stronger — not because it’s what is best for the business, but because it is our only reason for being in business. Each member of our team strives to build a world where healthcare companies truly prioritize the needs of their patients, and we’ll do everything in our power to make that a reality.

My personal favorite of all our new values, dancing in the storm is about embracing the bumps in the road — and there are many when you’re taking on challenges within healthcare — and recognizing that you can always choose joy. We strive to help our teammates do the same by infusing a little bit of levity and laughter into the workday. It only takes one person to start a dance party!

Humility is not thinking less of yourself, but thinking of yourself less. Nor is it the absence of strong opinions, but the willingness to learn and change our minds. Sometimes our ego takes over — that’s only human. But we try to be mindful of it, and willing to let go of our ego and instead put our mission, customers, and teammates ahead of ourselves.

We view ourselves as creators of our circumstances, responsible for our actions and our own well-being. When we don’t like an outcome, we don’t project blame onto others or ourselves, but rather take radical responsibility for how we created the situation. More than any other value, this is an opportunity for deep internal reflection, and by practicing it consistently, we can maximize our own individual growth.

We say what is true for us in the moment, even when it is uncomfortable. We support our teammates to do the same by recognizing the validity of their experience and not taking it personally. Leading with candor isn’t always easy, but it feels much better to live authentically and honestly and to work with others who do as well. Candor doesn't have to be angry or hurtful - it can be kind and binding, compassionate and respectful.

It’s easy to become paralyzed by fear, overwhelmed by all of the possibilities in a complex situation. So unless a decision involves customer or employee safety, we don’t wait for perfect information. We trust our intuition and common sense and simply forge ahead, knowing that mistakes are in fact one of the best ways to learn.

There are no shortcuts or silver bullets in an industry as complex as healthcare. The way to achieve transformational change is through continuous improvement over a long period of time. When we’re overwhelmed by the magnitude of what we’re trying to accomplish, we remember that what each of us does adds up — one step at a time, one customer at a time — and that with small but steady progress we can accomplish great feats.

As a company grows, issues no longer affect a few customers, but a few thousand. It’s tempting to only look at trends and aggregates, but we know this is a trap. Greater distance from individual examples creates more opportunity for misunderstanding, bias, and incorrect assumptions. So we look beyond surface-level data and dive deep into the details. Only then can we fully understand an issue to its core.

Values themselves are just words, and the words themselves are not that important. What’s important is how we live them day in and day out, and the culture they support. In the months ahead, we’ll continue to integrate these values into the fabric of our company processes, our products, our customers’ experiences, and our work lives. And this work is not something just a few leaders or HR team members do - every Altoid has a hand in bringing these values to life and co-creating our culture.

Build Tomorrow’s Pharmacy with Us — Join Our Team

If you are passionate about creating a great company culture, 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.

View open roles in design, engineering, IT, sales, patient care, and more.

The Providers Team at Alto is charged with building the tools and service components necessary to deliver an exceptional pharmacy experience for healthcare providers. Read on to learn more.

Get to Know the Team That Has Doctors Calling Alto “The Pharmacy of The Future”

Editor's Note: The post was updated on November 8, 2021 to reflect the rebrand of AltoMD to Alto Connect.

Alto Pharmacy’s mission is to fulfill medicine’s true purpose — to improve quality of life — for everyone who needs it. The healthcare professionals who prescribe medications to Alto and the clinical teams that support them are critical partners in making our mission successful. To this end, the Providers Team at Alto is charged with building the tools and service components necessary to deliver an exceptional pharmacy experience for healthcare providers.

Every day, clinical teams -  including prescribers and other clinical staff like nurses, practice coordinators, and billing specialists - spend hours tracking down insurance information, coordinating approvals and appeals, discussing options with their patients, and playing phone tag with pharmacies. The Providers Team enables these healthcare providers to spend more time on patient care and less time on back office tasks. 

Alto’s provider communications platform, Alto Connect, and related services, including insurance benefits coordination and prior authorization management, remove clinical blockers that traditionally slow down or prevent an individual’s access to treatment. Practices that share Alto with a majority of their patients can save three or more hours per day on pharmacy and insurance administration tasks, with less time spent waiting on hold, fewer faxes and improved employee satisfaction (not to mention happier patients!). 

Anu Kashyap, a Product Manager on the team says, “I joined Alto to make a contribution to people’s health using technology, and the Providers Team is working on specific, painful healthcare problems that are critical to solve. These challenges have been incredibly fulfilling to work on.”

How does the Providers Team play into the overall growth of Alto Pharmacy?

The Providers Team is fairly new, as they were originally part of a larger Growth team within Alto. Kjersten Elias, Engineering Manager, explains: “Alto's growth model is driven by conversations about pharmacy choice in the doctor’s office, and in the fall of 2020, we dedicated an engineering team to optimizing our product offerings and improving the experience for the healthcare providers having those conversations.”

Anu adds, “The key for our business’ continued growth is having healthcare providers trust that we are the best pharmacy for their patients and leverage us as their pharmacy of choice. This type of growth channel is much more powerful than anything direct to the consumer. We can only do this however, if our providers have an excellent experience with us, and we’ve only scratched the surface here.” 

Being part of a newer team has distinct advantages. Software Engineer Dereck Quock notes, “We have unique opportunities to modernize how we build apps and define our infrastructure and technical needs. With the freedom to utilize cutting edge tech and new frameworks, there is so much room for innovation.”

What is the culture of the Providers Team like?

The engineers each raved about a small-but-important recurring calendar invite each Friday: Team Time. This protected time is a space to catch up, banter about anything other than work, and, if folks are feeling brave, face off with Anu, former Teen Tournament champion, in a rousing game of Jeopardy.

It's not hard to see why Kjersten and her team light up when they talk about team culture. Amy Chen, a Software Engineer on the team, shared that  “Kjersten is an incredible manager. Everyone is empowered to ask for and share feedback, fine-tune our processes, and check in with each other.”

“When I joined, I could tell right away this team really lifted each other up and had each other’s backs,” said Dereck. “It’s one of the greatest teams I’ve worked on.”

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

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. To learn more or get started, reach out any time via text or 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.

With effective treatment, including blood pressure medications, you can live an active life. Learn about the common blood pressure medications and their side effects.

Common Types of Blood Pressure Medications

High blood pressure, which affects nearly half of all U.S. adults, occurs when the force of the blood flowing through your arteries is consistently too high, forcing the heart to work harder. Over time, high blood pressure can damage major organs including the heart, brain, kidneys, and eyes and lead to life-threatening issues like heart disease, heart attack, and stroke.

With effective treatment, including both heart-healthy lifestyle habits and prescription blood pressure medications, you can control your blood pressure and live an active life. There are a variety of blood pressure medications, and it may take some time for you and your doctor to determine the best treatment for your needs. The good news is that with so many available and effective medications, you’re likely to find one that’s right for you. Read on to learn more about the most common classes of blood pressure medications and their side effects.

Diuretics lower blood pressure by helping the body get rid of excess sodium and water, reducing the volume of fluid in blood vessels. They are often a frontline treatment for high blood pressure, as research studies have found them to be one of the most effective blood pressure medication classes at preventing stroke and heart attack fatalities.

Diuretics commonly used to treat high blood pressure include:

Chlorthalidone (Thalitone®, Tenoretic®, and Clorpres®)

Hydrochlorothiazide (HydroDiuril®, Microzide®, and Esidrix®)

Common side effects of diuretics include dehydration, thirst, low sodium levels, headaches, and dizziness. In some cases, drinking more fluids isn’t enough to treat dehydration. Contact your doctor if you experience severe thirst, mouth dryness, or constipation; if your urine is a deep yellow; or if you have a bad headache. Taking multiple medications may exacerbate these side effects. To minimize medication interactions, speak with your doctor about the ideal timing of doses for each medication.

Some diuretics decrease your potassium levels, in which case you may experience weakness, leg cramps, or fatigue. Eating potassium-rich foods can help combat these side effects. Consult with your doctor about taking potassium supplements if you experience any of these symptoms.

Diuretics may increase blood sugar levels in people with diabetes. Adjusting your diet or the dosages of your diabetes medication(s) often addresses this issue. Learn more about how Alto can support your diabetes treatment.

Beta blockers cause the heart to beat more slowly and less forcefully, lowering your blood pressure. They also help improve overall blood flow by opening up your veins and arteries.

Beta blockers commonly used to treat high blood pressure include:

Common side effects from taking beta blockers include:

Beta blockers may block signs of low blood sugar such as a rapid heart rate in people with diabetes. If you have diabetes and take insulin, it’s important to check blood sugar levels often while taking beta blockers.

These medications may also affect your cholesterol and triglyceride levels. Most often, they cause a modest increase in triglycerides, a type of fat found in your blood, and a slight decrease in HDL (high-density lipoprotein), or “good” cholesterol. These changes are usually temporary.

Beta blockers aren’t typically used by people with asthma, as they may trigger severe asthma attacks. Abruptly stopping use of beta-blockers may increase your risk of a heart attack or other health complications, especially if you have been taking the medication for a long time. Consult with your healthcare provider about the potential risks and benefits of treating your hypertension with beta-blockers.

ACE inhibitors lower blood pressure by blocking production of a hormone called angiotensin II, which causes blood vessels to narrow. These medications help constricted blood vessels expand so that more blood can flow through.

ACE inhibitors commonly used to treat high blood pressure include:

A chronic dry, hacking cough is one of the most common side effects of ACE inhibitors, affecting as many as 35% of people who take these medications. Researchers aren’t entirely sure why some people experience this side effect and not others, but the following factors may contribute to it:

Gender — women tend to be more susceptible

Studies have found that a combination of two or more of the factors above is needed to produce the side effect.

Cough medicines typically aren’t effective at treating an ACE inhibitor-related cough. In some cases, this side effect may improve on its own. If you are experiencing a cough from taking ACE inhibitors, the best course of action is to discuss the pros and cons of switching to another medication with your doctor.

Additional possible side effects of ACE inhibitors include:

ACE inhibitors can harm both mother and baby during pregnancy. If you’re taking an ACE inhibitor and think you might be pregnant, speak with your doctor immediately.

Like ACE inhibitors, angiotensin II receptor blockers (ARBs) also protect blood vessels from the hormone angiotensin II. Angiotensin II must bind with a receptor site to constrict blood vessels. ARBs block the receptors to prevent blood vessels from tightening, which lowers blood pressure.

ARBs commonly used to treat high blood pressure include:

ARBs may produce harmful interactions with other medications. This medication class should not be taken with an ACE inhibitor, as the combination can lead to a greater risk for low blood pressure, kidney damage, and high potassium levels. Speak with your doctor before taking painkillers like ibuprofen or naproxen, as these medications may interact with ARBs to increase your potassium levels.

ARBs are not safe to take during pregnancy, as they can severely harm a developing fetus. If you think you might be pregnant, consult with your doctor immediately.

Calcium channel blockers prevent calcium from entering the smooth muscle cells of the heart and blood vessels. Decreasing the calcium in these cells makes the heart beat with less force, opening up narrowed blood vessels and lowering blood pressure.

Calcium channel blockers commonly used to treat high blood pressure include:

Diltiazem (Cardizem CD®, Cardizem SR®, Dilacor XR®, Tiazac®)

Verapamil (Calan SR®, Covera HS®, Isoptin SR®, Verelan®)

Possible side effects of calcium channel blockers include:

The body releases hormones called catecholamines in response to stress. When these hormones bind to parts of cells called alpha-receptors, blood vessels narrow, causing the heart to beat faster and more forcefully. This leads to an increase in blood pressure.

Alpha blockers prevent catecholamines from binding to alpha-receptors so that blood can flow more freely, which also helps the heart beat more normally. This helps control blood pressure.

Alpha blockers commonly used to treat high blood pressure include:

Possible side effects of alpha blockers include:

A drop in blood pressure when you stand up

Consult your doctor about the potential risks and benefits of taking an alpha blocker. These medications have been known to interact with other medications like beta blockers, calcium channel blockers, and medications for erectile dysfunction, increasing or decreasing their effects. Make sure your doctor is aware of any other medications you take.

When combined, alpha blockers and beta blockers prevent catecholamine hormones from binding to both alpha and beta receptors. These medications decrease the constriction of blood vessels and make the heart work less forcefully.

Alpha-beta blockers commonly used to treat high blood pressure include:

Common Types of Blood Pressure Medications 

With effective treatment, including both heart-healthy lifestyle habits and prescription blood pressure medications, you can control your blood pressure and live an active life. Read on to learn more about the most common classes of blood pressure medications and their side effects.

When used in tandem with healthy lifestyle habits and additional preventive measures to avoid triggers, asthma medications can help you control symptoms and prevent asthma attacks. Read on to learn more.

A Guide to Common Asthma Medications | Alto Pharmacy

If you’ve ever had an asthma attack or watched a friend or family member experience one, you know how uncomfortable it is when you are struggling to breathe. But while asthma, a chronic disease that affects more than 25 million Americans, may not be curable, it is certainly manageable. Whether your symptoms are mild, moderate, or severe, you can live an active life by working with your doctor to establish a treatment plan.

When used in tandem with healthy lifestyle habits and additional preventive measures to avoid triggers, asthma medications can help you control symptoms and prevent asthma attacks.  However, because there is lots of variation in how different people experience asthma, there isn’t a standardized, one-size-fits-all approach to asthma medications. For some people with mild cases of asthma, rescue medications that offer quick relief from acute asthma symptoms are enough, while moderate to severe cases often involve long-term maintenance medication.

Read on to learn more about the main types of asthma medications that your doctor may prescribe.

First, let’s discuss how to tell if you have asthma. The condition doesn’t look the same in each person, and an individual’s asthma symptoms may change over time, but common signs include:

Trouble sleeping because of coughing, wheezing, or shortness of breath

Coughing or wheezing intensified by the cold or flu

If you experience persistent coughing or wheezing for more than a few days or any of the symptoms above, consult with your doctor. An asthma diagnosis is based on your medical history, an evaluation of your symptoms, a physical exam, and lung tests.

You may find that your symptoms flare up in certain situations, like during exercise, or that they are intensified by environmental triggers like allergies. In these cases, you may have to take extra precautions when engaging in specific activities or supplement your asthma medication with allergy treatment. Your doctor can help you determine your specific treatment needs.

Learn how to prevent seasonal allergies and reduce symptoms of allergy-triggered asthma.

Quick-relief asthma medications for acute symptoms

People with asthma often need immediate relief when symptoms flare up. Quick-relief or “rescue” asthma medications help in these situations. Used on an as-needed basis, these medications relax airway muscles to open the lungs and relieve shortness of breath and wheezing within minutes. They can stop an asthma attack in progress or help prevent exercise-induced asthma.

Common quick-relief asthma medications include:

Albuterol (branded options include ProAir® HFA, Proventil® HFA, Ventolin® HFA)

Inhalers are the most common form of quick-relief asthma medications. Albuterol and Levalbuterol are also available as a liquid solution for nebulizer use.  Common side effects of this medication class include nervousness or shakiness, headache, throat or nasal irritation, and muscle aches. There are also some known severe side effects, including allergic reactions like hives, a rapid heart rate, or heart palpitations. If you have any concerns, contact your doctor to discuss treatment options.

You may be able to manage mild or exercise-induced asthma symptoms with quick-relief medications alone. However, treatment for more persistent asthma symptoms often involves long-term control medication.

While rescue medications can help treat acute asthma symptoms during an asthma attack, long-term control medications are taken regularly to prevent symptoms from escalating in the first place. They are a very important component of asthma treatment for those with more serious symptoms.

There are two main types of long-term control medications for asthma: inhaled corticosteroids and combination inhalers that contain both corticosteroids and long-acting beta agonists (LABAs).

Inhaled corticosteroids like Flovent® HFA and Qvar Redihaler® reduce inflammation and swelling in the airways, making them less likely to react to asthma triggers. They are primarily taken via inhaler. Their effectiveness depends on daily use, and they are not effective at treating acute asthma attacks. It may take several months to see improvement in asthma symptoms from using inhaled corticosteroids.

Inhaled corticosteroids typically do not cause serious long-term side effects, but long-term use in children has been linked to slight delays in growth. However, the benefits generally outweigh the risks. If you have any concerns, your doctor can help you make the best choice for your child’s asthma treatment.

Read our previous blog for more information on managing your child’s asthma.

Mouth and throat irritation and oral yeast infections have also been known to occur as a result of using inhaled corticosteroids. As a precaution, rinse your mouth with water after each dose to prevent infections.

Long-acting beta agonists (LABAs), a type of bronchodilator medication that opens airways and reduces swelling, can be used on an ongoing basis to control moderate to severe asthma. However, some research has linked this medication class to serious asthma attacks. The risk is strongest when a LABA is used on its own. For that reason, they are typically taken in combination with an inhaled corticosteroid (ICS).

Common ICS/LABA combination inhalers include:

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