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 ofGreat 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

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

What to know about RESOLVE: The National Infertility Association

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

View RESOLVE’s guide to infertility coverage by state.

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

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

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

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

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

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

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

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

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

The importance of seeking support when experiencing infertility 

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

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

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

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

About RESOLVE: The National Infertility Association

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

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.

RESOLVE: The National Infertility Association

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 via text or phone at 1-800-874-5881, or in-app messaging.

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.

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) inidviduals 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. 

Transgender men can use their own eggs or those of their partner or a donor to have the fertilized embryo implanted into their own uterus. The sperm may come from their partner or a donor. Alternatively, their partner or a gestational carrier may have the embryos implanted into their uterus. (A gestational carrier carries and delivers a child for an individual or couple and is not genetically related to that child whereas a surrogate offers both her eggs and uterus.)

Transgender women can have their sperm fertilized with eggs from their partner or a donor. Then, their partner or a gestational carrier may have the embryos implanted into their uterus.

IVF is a more complicated process than IUI from a medical standpoint, as it involves more fertility medications and an egg retrieval process. However, IUI can be more emotionally and legally complicated if you are using a surrogate. Take time to research all of your options so that you can determine the best one for your needs and know what to expect going in.

If you are exploring using a donor or surrogate, it’s critical to research your state’s laws about legal parentage procedures once your baby is born. In some states, a surrogate may automatically receive parental rights after your child’s birth since she is the biological mother, which will have to be legally terminated. Explore Movement Advancement Project’s interactive map on parental recognition laws as a starting point. You should also speak with an experienced LGBTQ+ family lawyer in your state before starting the process.

Learn more about these paths to parenthood, including the related legal aspects.

Fertility treatment is a significant investment, both financially and emotionally. Determining how to pay for these expenses is an important part of planning your family. There are many resources such as EMD Serono’s financial assistance programs for fertility medications. Family Equality council also has a list of family-building grants that help LGBQ+ families afford fertility treatment. Be sure to ask your fertility clinic about available financial assistance programs and payment plans.

At Alto, we’re committed to doing whatever we can to minimize stress during fertility treatment, including supporting your financial well-being. If fertility medications are a part of your path to parenthood, 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.

Read our previous post on managing the costs of fertility treatment.

A fertility pharmacy partner you can rely on

Alto is here to support your journey with starting a family. We know that there are many paths to parenthood and that each individual or family’s needs are different. Our team of patient care pharmacists has experience working with the TGNB community, and we’ll be here at every step of the way if you choose to pursue any of the fertility treatments described above. We also offer discrete, private packaging and free, same-day delivery to keep stress at minimum during this special time in your life.

Reach out any time to get started via text or phone at 1-800-874-5881, or in-app messaging.

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

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

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

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

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

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

The EMDS Compassionate Care program provides income-based assistance for fertility medications that aren’t covered by insurance. Eligibility is based on your annual gross household income, number of people in your household, and cost of living and poverty index in your geographic area. 

Eligible individuals can save 25%, 50%, or 75% off of the following medications:

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

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

The program is available for multiple cycles each calendar year. You must reapply each year.

View additional program details and apply here.

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

Is infertile due to a service-related injury

Is not privately or publicly insured for infertility medications

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

Is not eligible for coverage under the Fertility Veterans Act

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

Download the Compassionate Corps application.

If you’re a veteran who does not qualify for Compassionate Corps, you may still be able to receive 25-75% off of your fertility medications through the Compassionate Care program.  

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

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

Start the application process on Livestrong’s website to learn if you are eligible.

Through the EMDS GO Direct Rebate program, eligible individuals paying out of pocket can receive a discount, via rebate, for the following medications:

Ovidrel® PreFilled Syringe 10% off per 250 mcg (or 1 syringe) 

Cetrotide® 10% off per 0.25 mg (or 1 kit)

GO Direct Rebate program discounts apply to cash pricing and cannot be combined with other EMDS offers you may receive through your clinic. 

The program requires receipts. View additional details about eligibility and terms. To start the process to submit a rebate request, create an account here.

Alto is here to make your experience with fertility preservation treatments as stress-free as possible. We offer free same-day delivery of your medications and fertility resources like personalized injection guide videos and one-on-one consultations with fertility-trained pharmacists.

Our team of fertility specialists is happy to create  a price quote  specific to your medication protocol. Please contact us at care@alto.com or complete the form online to get a quote started.

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.

EMD Serono’s Financial Assistance Programs for Fertility Medication

The arrival of your fertility medications can be a little overwhelming. Here’s a quick overview of what you can expect when unboxing your fertility medications from Alto Pharmacy.

Unboxing Your Fertility Medications from Alto Pharmacy

While the arrival of your medications is definitely a big milestone on the road to IVF or egg freezing, it can also be a little overwhelming. Many people are surprised to find just how much is packed inside the box — not only the fertility medications themselves, but all the ancillary supplies along with them. On top of that, many fertility medications have to be refrigerated or prepared a certain way, so it’s important to have a pharmacy partner that considers these additional factors during packaging.

Blog

What to know about RESOLVE: The National Infertility Association

Spotlight on Men Having Babies & Dr. Guy Ringler

What to Know About Transgender Hormone Therapy Side Effects

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

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

Unboxing Your Fertility Medications from Alto Pharmacy

3 Alto Pharmacy Resources to Ease Your Fertility Journey

Fertility Medications 101

Two Women Share Their Egg Freezing Journeys

National Infertility Awareness Week 2021

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

Managing the Costs of Fertility Treatment

Switch to a better pharmacy.