What is a Troche?
So, What is a Troche?
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 transdermal (across the skin) delivery. Injections have their obvious drawbacks.
However, transdermal 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 transdermal absorption, all of which bypass the digestive system and first-pass metabolism.
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 another option. 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.
Artificial 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, many doctors and patients prefer troches as the primary dosage form for hormone replacement therapy for both men and women.