So you and your doctor have decided to replace your decreasing hormones with natural hormones instead of the synthetic alternatives. Congratulations! But don’t stop here. The next puzzle piece is how to get the hormones 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.
What Is A Troche And How Can It Help You?
What is a troche and how can it help you? In case you are curious, it is pronounced (troh-key.)
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!
You may experience these symptoms as many women do when they are in perimenopause – 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 synthetic hormones. You must have done your research!
The synthetic hormones 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.
- patch form
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 bio-identical hormones 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.
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.
Here is further recent research into the effectiveness of troches (sublingual) hormones.
The effectiveness of sublingual and topical compounded bioidentical hormone replacement therapy in postmenopausal women: an observational cohort study.
Prior studies demonstrated improved menopausal symptom relief following treatment with compounded bioidentical hormone replacement therapy; however, clinical effectiveness studies evaluating different routes of bioidentical hormone replacement therapy administration are lacking. The objective of this study was to determine the effectiveness of sublingual and topical compounded bioidentical hormone replacement therapy for the treatment of vasomotor, mood, and other quality-of-life symptoms in post-menopausal women. This was a prospective, observational cohort study of women > or = 18 years of age who received a compounded sublingual or topical bioidentical hormone replacement therapy preparation between January 1, 2003 and October 1, 2010 in a community pharmacy. Data collection included patient demographics, comorbidities, hormone regimens, and therapeutic outcomes. Patients rated their vasomotor, mood, and quality-of-life symptoms as absent, mild, moderate, or severe at baseline, at one to three months follow-up, and three to six months follow-up. Baseline characteristics were compared using the chi-square test for categorical variables and the Wilcoxon rank sum test for continuous variables. Symptom intensity between baseline and follow-up periods were compared using the Wilcoxon signed-rank test. A total of 200 patients met study criteria; 160 received topical bioidentical hormone replacement therapy, and 40 received sublingual bioidentical hormone replacement therapy. Most sublingually-treated patients (70%) received an estrogen combination and 100% received progesterone. Nearly half (43%) of the topically treated patients received an estrogen combination (43%) and 99% received progesterone. The percentage of sublingually treated patients reporting “moderate” or “severe” symptoms was significantly reduced at one to three months follow-up for the following target symptoms: hot flashes (31%, P = 0.04), night sweats (38%, P < 0.01), irritability (36%, P = 0.01), anxiety (42%, P < 0.01), emotional lability (38%, P < 0.01), sleep disturbances (35%, P < 0.01), memory loss (35%, P = 0.04), fatigue (33%, P = 0.04), and libido (26%, P = 0.03). Similar reductions were seen at three to six months follow-up compared to baseline. Patients who received topical therapy did not experience significant symptom reductions at one to three months follow-up; however, significant symptom reduction was seen at three to six months for the following: emotional lability (31%, P < 0.01), irritability (29%, P = 0.02), and night sweats (20%, P = 0.04).
Compounded sublingual bioidentical hormone replacement therapy is effective in reducing vasomotor, mood, and quality-of-life symptoms experienced in post-menopausal women. Topical therapy does not appear to improve symptoms as extensively or rapidly as sublingual therapy.