Troches

So you and your doctor have decided to replace your decreasing hormones with natural instead of the synthetic alternatives.  Congratulations!  But don’t stop here.  The next puzzle piece is how to get the  inside your body where they can exert their beneficial effects.

And don’t be too quick to swallow the obvious:  a capsule or tablet.  The problem is, many of the benefits of natural HRT will be lost as the hormones go through the process of digestion.

None of your circulating hormones are secreted into your digestive tract as a means of total body distribution.  Glands typically secrete hormones into the local circulation where, eventually, they reach complete systemic circulation.  This is physiologically natural.  Hormone delivery via the digestive tract is not.

When hormones are swallowed, they are exposed to digestive acids and enzymes and metabolism as they are absorbed through the gut wall.  Then, like virtually everything absorbed by the digestive process, they are carried directly to the liver in what is called first-pass metabolism.

As a total day’s amount of hormones reach the liver in a very short period of time, this does several things.  First, it is just plain hard on the liver.  And if other medications are being taken, this adds to the liver’s burden and increases the risk of liver toxicity, injury and gall bladder disease.

Next, the liver does not know that this rapid rise in hormone concentration is short-term.  It operates on the basis that hormone levels are way too high, and begins to make changes to counteract this effect.  The net result is that it affects the way your body has access to the hormones.  It affects the estrogen and progesterone you might be taking, but also affects other circulating hormones and chemicals as well.  This includes thyroid hormone, cortisol and a substance called antithrombin III that helps to protect you from strokes and heart attacks.

These changes can increase your blood pressure and cholesterol, affect your mood, lower your thyroid and cortisol potential and increase your risk for a stroke or heart attack.

At this time, viable options to swallowing your hormones include injections and trans dermal (across the skin) delivery.  Injections have their obvious drawbacks.

However, trans dermal delivery of medications has gained rapid popularity during the last 10 or 15 years.  Estrogen, testosterone, nitroglycerin and nicotine are just some of the different medications in a patch form that are applied to the skin for absorption.  Creams, suppositories and troches are other forms of trans dermal absorption, all of which bypass the digestive system and first-pass metabolism.  This is good.

Creams can be very effective, but because of the extreme variation in skin type (thickness, fat content, water content, etc.), their absorption is erratic and unpredictable.

Suppositories, vaginal and rectal, are very effective and dependable for drug delivery, but lack convenience.

Troches, however, offer the best of all worlds.  A dosage form dating back to the 1800s, troches have regained tremendous popularity for the absorption of medications, especially hormones.  They are effective because the lining of the mouth is thin and rich in blood supply.

Troches are small lozenges that dissolve between the cheek and gum over a period of about 30 minutes.  As it dissolves, the hormones are gradually absorbed into the blood stream, resulting in physiologically natural hormone blood levels.  Also, because these are bio-identical to the hormones your body has produced, they are efficiently recognized, utilized, metabolized and excreted by the body.  Since your own hormones only last about 8 to 12 hours, your natural hormone replacement should be dosed about every 12 hours to give adequate, even blood levels.

Synthetic hormones, however, do not fit receptors exactly and are more difficult for your body to metabolize.  That is why they are usually dosed just once per day.

Because of the tremendous advantages in consistency, effectiveness and the ability to avoid the digestive process, we strongly recommend troches as the primary dosage form for hormone replacement therapy for both men and women.

This information is from http://www.obrienrx.com – a compounding pharmacy that has been doing this for 45 years.  A thank you to my reader, Linda.

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What Is A Troche And How Can It Help You?

What is a and how can it help you?   In case you are curious, it is pronounced (troh-key.)

Being in perimenopause or , you may be experiencing symptoms such as  not being able to sleep at night.  You wake up grouchy and have no energy because you are totally exhausted!

You have night sweats and wake up drenched!   You have to get up and actually put another night gown on, change the sheets and try to go back to sleep!   But now you are wide awake!

What about hot flashes?  You are with a group of workers from your job and all of a sudden, everyone is staring at you – you have sweat running down your face, melting your make-up and causing your clothing  to stick to you!  You look like you just ran a five mile marathon in 90 degree heat!

Your symptoms may have to do with low libido or having mood swings!  Your relationship with your honey and your family has never been worse!

What is a troche 400x300 What Is A Troche And How Can It Help You?

You may experience these symptoms as many women do when they are in – the time when your hormones are decreasing, fluctuating and trying to readjust to the imbalance taking place  in your body.

You may have already discussed your issues with your doctor and you have come to the decision that you want to try the bio-identical hormones.  Are you going to take them in pill form or just what choices do you have on the delivery system of getting them into your body effectively?

First, I say good for you and your decision!  You came to that decision instead of caving into asking for or accepting a prescription for the . You must have done your research!

The synthetic are not one size fits all, they are not something “natural” to your body, and animals (horses) suffer in the process of the manufacturing of them.

Your choices of how to get the dose of hormones into your body are by using these forms:
  • creams
  • pills
  • suppositories
  • patch form
  • injections

There are advantages and disadvantages to each of those choices, mostly disadvantages.  Some of those disadvantages being inconvenient, unsafe and unreliable.

The trans-dermal option – applied through the skin, has become more popular in the last 15 years.  The bio-identical hormone dose for your specific needs would be in a patch form that would be put on your skin to be absorbed.

Using creams, suppositories and troches are also considered trans-dermal.  They bypass the important organs and that is always a good option.

What is a troche and how can it help you?  

You never hear much about troche being a choice of delivery for getting the hormones into your system.

When you use the  in a troche form, your body will recognize these as they are exactly like your own hormones.  Your  body accepts, applies and stabilizes these as your own hormones.

Troches can be different flavors so that they are easily taken like a little lozenge.  The dosage is placed between the gum and the cheek, so the hormones are dissolved into the blood stream.

To maintain levels of your hormones, you should dose every 12 hours as your own hormones last somewhere between 8 and 12 hours as well.
As the lining of the mouth is thin and rich in blood supply, it only takes the process of delivering the hormones about 30 minutes total, to be absorbed.

As you can see, it is a very convenient form and has been known to be reliable dating all the way back to the 1800’s for taking medications.

It seems to me from my research that the troche is the best form of taking bio-identical hormones.  If I were taking any, that is the form I would use.

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An Australian research paper about the effectiveness of troches (transbuccal – same thing)

Pharmacokinetics of estradiol, progesterone, testosterone and dehydroepiandrosterone after transbuccal administration to postmenopausal women.

Wren BG, Day RO, McLachlan AJ, Williams KM.

Sydney Menopause Centre, Royal Hospital for Women, Randwick, Australia.

OBJECTIVE: To evaluate the pharmacokinetic profiles of estradiol, progesterone, testosterone and dehydroepiandrosterone in postmenopausal women following single and multiple dosing using a troche and the transbuccal route of administration. METHODS: Each troche contained estradiol (0.5 mg), progesterone (200 mg), testosterone (2.0 mg) and dehydroepiandrosterone (10 mg). A half troche was administered to each of six women and the plasma concentration-time profiles determined over 24 h. Thereafter, a one-half troche was taken twice daily for 2 weeks and concentrations determined over a dosage interval (12 h). Blood and saliva samples were collected at specified time intervals on the first day and again after 2 weeks. RESULTS: Each of the hormones was readily absorbed via the buccal mucous membrane. Peak plasma concentrations of estradiol and progesterone were comparable to those found normally in young menstruating women. CONCLUSION: The transbuccal route is a novel approach to provide therapy for the management of menopause-related symptoms of postmenopausal women without the need to resort to conjugated or synthesized hormones, and may overcome the poor or erratic systemic availability associated with other routes of administration.

  1. I have had a total hysterectomy would troche hrt suit me, where can I get it in Ireland.

  2. Find your nearest compounding chemist (google it if necessary, or the telephone directory) and ask them to advise you of the nearest doctor using Bioidentical hormones.

  3. Thank you Dr Holloway, I will keep you updated when I can find the right chemist and GP.
    Best wishes, Olive McConnell.

  4. Does progesterone Torche raise/lower your blood pressure? I take lisinopril 40 mg & 25mg metoprolol in the am, and 25mg metoprolol in the pm.

  5. Thanks Dr. Holloway. I appreciate it.

  6. Hi Dr. Holloway, I am wonder if you could explain this: Since your own hormones only last about 8 to 12 hours, your natural hormone replacement should be dosed about every 12 hours to give adequate, even blood levels.

    Why would we not want to mimic our own hormones and take troches only once a day? and not take them 2 times a day. I was under the understanding that estrogen peaks at 6-9 am then decreases until the next morning? There is not a lot published on this so I am trying to find out more information as I am taking my troche in the am only. I also thought that the SHBG would carry the hormones through the 24 hours until I take another dose. If we take another troche 12 hours after the first one, then we get another peak and that is not what our body does naturally. Taking it after 12 hours can give me too much stimulation for sleep.

    Thank you.

    • You are correct of course. After taking a troche, your levels increase for a few hours, stabilise for the next 6-8 hours, then gradually decrease. The best way is to take them is twice daily. However, use of them over many years shows that it does not seem to make a big difference, as women taking them once daily did as well as those taking it twice daily. So it proves that theory and practice don’t always match. If someone has insomnia as a major symptom, then taking the 1/2 troche once at night helps with sleep, as progesterone has a calming and sedative effect.

  7. Dr Holloway,
    How long before or after a meal should I take my troche? Also, can I drink water after taking it? Lastly, how long before I can kiss my husband after taking one as to not pass on the hormones to him?

  8. Having had breast cancer (eosterogen positive )15 years ago I am struggling with poor sleep patterns, my energy levels are at an all time low,I am increasingly becoming more unhappy, mood swings are constant and libido is poor. Overall not a nice place to be in right now. I am 55 years old. Might troches be an option for me?
    I tried them briefly about 7 years ago but the nurse at the breast screening clinic said they were not a good idea for me. Please what are your thoughts!

  9. Hi Dr I have been dealing with menopause for the last 2 years with trial and error of products. The night sweats and hot flushes are over the top! I even succumbed to trying HRT (Advil?) for a short time. My Dr guaranteed I would not get my period of which I did. I am a horse lover and really against the mare lots and would rather suffer than they. My personal trainer told me about dhea and I was willing to give it ago. Trying to find a Dr in my area to prescribe this is very frustrating. I have managed to track down someone who would prescribe dhea and the dose is 2% dhea 4% progesterone 0.8% testosterone cream. She waffled on with all this scientific stuff about what my body is doing during menopause for 45 minutes!! I am not sure I can go back to her as it did my head in a bit. This dose is not working very well but has had some effect after I have decided to use it twice a day. I am still suffering night sweats at least waking up 3 times a night and a few day time flushes. I am guessing this dose is too low?? I felt when I left the surgery that she really didn’t want me to have dhea as she made me choose at the end of the session. Do you or is there somewhere online that can help me? I would have thought a blood test at least would tell me what my hormones are doing? She didn’t order one. Very frustrated.

    • You are suffering the same as many other women do – the inability to find a sympathetic doctor who knows about natural HRT. I suggest you look for a compounding chemist in your area and ask them to recommend a doctor who uses the Bioidentical(natural) HRT.

  10. Yes I have already done that either they have closed books or a very long waiting period ! That is why I am looking elsewhere ! Perhaps Sydney if someone can point me in the right direction

  11. Hi Dr Holloway, I am in 23rd day into my first month of troche. I have been feeling amazing. I did write to you telling you this that I am soo happy. This morning I actually got period pains and thought ooh am I getting my period?? last period was 19th October 2013. I did get it today and I think you said this could happen. Can you tell me if this is all ok? will it come back to stay???

  12. Hi once again Dr Hollaway. Sylvia again. Period ended up just a showing and by that night period seemed to be gone. I will write down whats happening and will be seeing you end of the month. Not concerned. Kind regards

  13. Renay Van Moolenbroek

    Hi Dr Colin
    Where do I start. I am nearly 41 and I am going through Menopause.
    I was 25 when they gave me a Hysterectomy, they left a small amount of my ovary but end up having to have that taken out as well.
    For these last 15 years I have struggled terribly. Every doctor I have been to has told me it’s depression and wanted to put me on tablets.
    2 years ago I found a doctor who dug deeper and found I should be on some sort of HRT, I have been on Livial, Premarin, Ovestin and now on Patches, each time I have had a blood test my Estrogen hasnt come up, it sits on 37 to 39.
    The last visit she wanted to put me on Pristiq and told me that would help, I havent taken them as this is not my problem.
    The following are my symtoms:
    Hot Flashes
    Moody
    Tiredness
    Loss of sexual desire
    Fatigued
    Depressed
    Weight gain
    Terrible Anxiety to the point where I have to go to the hospital because I think I am having a heart attack
    And the list goes on……
    I want something natural as I worry what these drugs are doing to my body on top of the Menopause
    I am coming to Brisbane around the 14th March and would like to come and see you, if this is possibly I would be very glad.
    Thank You
    Renay

    • I too am experiencing the same thing. anxiety is horrid. had a hysterectomy 4 months ago. tried pills, patches, and now i am on a pellet 75E. nothing has changed. two nights ago i tried taking 200mg prometrium per doctors order and my anxiety went through the roof. I am extremely sensitive to all medications and have had bad reactions to other medications when given the generic form due to whatever it was filled with. would really like to have an answer too. is prometrium just not good for my body or is it the filler and would troches make a difference?

  14. What doctors in Portland oregon can I get testosterone troche’s from?

  15. HI Dr. Holloway, I have been on estradiol troches now for 4 month and at the end of Dec I got my levels check and my estradiol has come up nicely, but my SHBG is high. It is 171 and it should not be over 100. Have you seen this with troche use? I also drank 16 oz of green tea each day for the 3 1/2 weeks prior to my testing. I have now since read that green tea raises SHBG. So this could be the cause, but I have also read that troches can raise SHGB. Do you have any suggestions as this high SHBG is binding with all my other hormones too to make them inactive.

  16. Hi Dr . Holloway. Donna here. In your opinion is bioidentical progesterone cream more affective than the torche? Thx

  17. Can you tell me what is considered a high dose of progesterone in a troche. I am currently taking 75mg from Day 12-21 and then 150mg from 22- 28. Is this a high level?

    • The dose varies from person to person. so there is no such thing as a correct dose. Some women need high doses to get the same effect as others on low doses. This is due to our genetic makeup and how each person disposes(metabolises) medications differently.

  18. Brenda Thomason

    I am taking the the troche Bi est 50:50/Test mini 0.15/.5 mg and two 50 MG capsules of time released progesterone. I did have progesterone in the troche, but was too fatigued, so she discontinued it in the troche I am 53 and have been on them for 2 years All of my symptoms of perimenopause are great; however, I have developed acid reflux. I am wondering if this has anything to do with the progesterone capsules? Have you ever heard of the connection? I am seeing my internist for the acid reflux and he wants me to take Prilosec. I am not wanting to do that.

  19. Hi Dr Holloway

    I’ve just started on troche 175 mg of progesterone 1/4 twice a day. Only been on it 6 days but have found that my sleep pattern has changed I wake in the middle of the night and can’t get back to sleep tossing and turning for hours. Is this normal? I am perimenopausal and obviously estrogen dominant I have the the symptoms but I slept well.

  20. Can it also throw off my cycle? I have been taking it for 5 weeks and noticed my menstrual cycle stopped. Should I be worried

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