National Custom Compounding recommends the following procedure for the use of bio-identical products that has prescribed:

Dosage

These are small lozenges that come in a flat pack marked with quarters, usually you will need to take a quarter each day into the mouth, either under your tongue or into the cheeks cavity. Leave the troche there until it is dissolved, usually 10-15 minutes after you have finished eating/drinking.

NB move the position of the troche to a different part of the mouth each day as the cells in one location may become saturated and will not absorb any more hormones. By moving the troche around, other cells will absorb the hormone and give the original sites a break.

At least 4 different sites in the mouth must be used, in either cheek or under each side of the tongue.

The troche will last 4 months, but the expiry date may say 3 months. This is not really a concern as we know that the troches last well beyond their expiry date.

Timing

The troches are dissolved in the cheek cavity daily. If your troche contains oestrogen (biest or triest) it is important to have an interrupter cycle of using them, your body’s cells are used to having a break from your hormones when you have your periods. Although we do not expect that you will have any bleeding, it is still a good thing for cells to get a break.

We recommend that any troches containing oestrogen are used from the 1st of each calendar month to the 25th or 28th inclusive. The stop the troches and restart on the 1st of the following month. If you follow your own 25 day system, we have no idea whether you are on or off the cream on the date of the test, so it is better to follow the calendar.

If you start your first month on the troches later than the 15th of the month, we recommend going through until the 25th of the following month to get a reasonable start. Then follow the usual 1st25th system as usual.

Most common mistakes made by patients using troches:

  1. Not using at least 4-5 different sites in the mouth. Simply placing the troche against one part of the gum will ensure that you fill up the cells locally on the first or second day and after that hardly any hormone will be absorbed. To ensure absorption, make sure to vary the position in the mouth.
  2. Placing the troche in the mouth in the morning when the patient is distracted by being busy, or snacking. If the troche does not have a good amount of time to dissolve, the patient will unconsciously swallow the saliva before it has had a chance to fully absorb into the membranes of the mouth.
  3. Taking the troch just before eating. This results in the patient swallowing most of the saliva created by the flavour of the troche.
  4. Taking the troche more than 24 hours before testing. This results in a falsely low reading.
  5. The best time to take the troche is in the evening between 8-l0pm and to have any testing done early the following morning.
  6. Taking the troche just before testing. This results in a falsely high reading.

Background

Troches are a medicated lozenge that easily dissolves in the mouth. This route of administration makes it easier for the hormone to enter the body directly into the blood stream whilst avoiding the liver. This allows the hormone to work quickly on the body.

Troches can be tailored to your liking with a large range of flavours to choose from. Due to Troches being compounded after your appointment, it usually can take a couple of days to be ready. The pharmacist needs to measure your exact dose, combine it with the appropriate base and add your requested flavour. Finally, after waiting for the troche to set, the pharmacist must ensure that there are no air bubbles, and each troche contains the same amount of active ingredient.

Troches contain the Bio-identical hormone in a base that can be easily cut into 1/2’s and 1/4’s. The usual dose is 1/2 or 1/4 of a troche up to twice daily (refer to your personal prescription for your recommended dose). They may take up to 40 minutes to dissolve, but is usual sped up by having a hot drink prior to your dose. Do not eat or go to sleep with a troche as it will be wasted.

Storage:

Keep in a cool, dry place, away from light. In summer it is best to keep in the refrigerator in an air tight container.

Flavours:

Aniseed, Banana, Butterscotch, Bubble Gum, Caramel, Chocolate, Creme de Menthe, Marshmallow, Orange, Peppermint, Vanilla, Raspberry, Spearmint, Strawberry, Tutti-Frutti, Pina Colada, Grape, Cheesecake, Peach, Apple and Peanut Butter.