Testosterone Troches for Men: The Dosage Form Explained
A troche is a molded lozenge that dissolves in the mouth rather than being swallowed. This guide covers how troches are made, how the base changes what the patient absorbs, how strength is specified, and the side effects that come with testosterone therapy.
What a troche actually is
A troche is a small molded lozenge, usually flavored, that is held in the mouth and allowed to dissolve slowly rather than swallowed or chewed. The word is pronounced TROH kee, and the dosage form is also called a medicated lozenge or a pastille.
Two placements are used. Buccal means the troche sits between the cheek and the gum. Sublingual means it sits under the tongue. Troches are most often used buccally, and the prescriber specifies which placement they want.
The point of the format is the route. The lining of the mouth is thin and well supplied with blood vessels, so a portion of the drug that dissolves against that tissue enters the bloodstream directly rather than passing through the gut and the liver first.
Only the portion absorbed through the oral tissue takes that route. Saliva that gets swallowed carries dissolved drug into the stomach, where it follows the ordinary oral path. That is why absorption from troches varies between people and depends on how the troche is used.
How a troche is made
Troches are molded rather than compressed. A tablet is made by pressing powder under high force. A troche is made by melting a base, mixing the active into it, pouring the mixture into a mold, and letting it set.
That difference matters practically. Molding needs no tablet press, which is why a compounding pharmacy can make troches at strengths and in combinations that no manufacturer produces. It also means the active has to be distributed evenly through the melted base before pouring, so that each cavity in the mold receives the same amount.
Troche molds come in standard cavity sizes, so the finished lozenges from a given mold are uniform in size and shape regardless of how much active they contain. A higher strength troche is not a bigger troche. It contains more drug in the same volume of base.
Base selection changes what gets absorbed
The base is the material the troche is made from, and the choice between base types changes how much drug is absorbed in the mouth versus swallowed. This is the most consequential formulation decision behind a troche.
Polyethylene glycol bases are sweetened blends that melt in a moderate heat range and dissolve relatively quickly in the mouth. They are more palatable, which matters for actives with a difficult taste.
Gelatin bases dissolve more slowly. That longer contact time means more drug is absorbed across the oral mucosa and less is swallowed and lost to the digestive tract, which is an advantage when oral absorption is the therapeutic goal. The trade off is that a slow dissolving troche keeps a bitter active in contact with the tongue for longer.
| Base type | Dissolution | Effect on absorption | Trade off |
|---|---|---|---|
| Polyethylene glycol | Faster | More of the dose is swallowed rather than absorbed in the mouth | Better tasting and easier to tolerate |
| Gelatin | Slower | More absorbed across the oral lining, less lost to the gut | Longer contact with a bitter active |
Prescribers can specify a base preference or write pharmacist's choice and let the pharmacy match the base to the active and the goal.
How strength is specified
Troche strength is written per troche, not per gram or per milliliter. A prescription should state the milligrams of active in each individual lozenge, along with how many troches to dispense.
Because troches are compounded to order, the strength is whatever the prescriber writes rather than a set of fixed manufactured options. That is the practical reason a prescriber chooses this format when the strengths available in approved products do not match what they want for a particular patient.
Mixwell compounds to the prescription. The pharmacy does not select the strength, and the appropriate strength for any patient is a clinical decision made by the prescriber after evaluation and laboratory testing.
Write the strength per troche and the quantity of troches separately, and state the placement in the directions. Those three details prevent nearly every clarification call we make on troche prescriptions.
Scoring and dose adjustment
Troches can be prepared scored, so a patient can divide one along a marked line when the prescriber wants a fraction of the strength in the mold. That gives a prescriber a way to titrate without a second prescription at a different strength.
A scored troche is most useful when a prescriber expects to adjust over time, or wants a patient to start below the full troche strength. Note on the prescription whether you want the troche scored and how the patient should divide it.
Patients should only divide a troche if the label directs it, and should follow the label rather than estimating.
Flavor and why it matters here
A troche has to sit in the mouth for several minutes, so taste is a functional property rather than a courtesy. An unpleasant troche gets chewed, swallowed early or skipped, and any of those changes what the patient actually absorbs.
Compounded troches can be flavored, and the pharmacy can suggest options that work with a particular active. Tell us the patient's preference on the prescription or when you call.
How troches compare to other testosterone forms
Testosterone is FDA approved in oral capsules, topical gels, a transdermal patch, a buccal system, a nasal gel, subcutaneous pellets and injections. Compounded troches are not FDA approved, and where an approved product fits the patient it is generally the appropriate choice.
| Form | How it is used | Practical notes |
|---|---|---|
| Compounded troche | Dissolved in the mouth, buccal or sublingual | Custom strengths, no needles, no skin transfer risk. Absorption varies with technique. Not FDA approved. |
| Topical gel | Applied to the skin daily | Approved products available. Carries a risk of transfer to others through skin contact. |
| Injection | Intramuscular or subcutaneous | Approved products available. Mixwell does not compound injectables. |
| Oral capsule | Swallowed | Approved products available. Subject to first pass metabolism. |
Question about strength per troche, base selection or scoring for a titration schedule?
Call (909) 378-7301Side effects to know about
Changing the dosage form does not change the drug, so the side effects associated with testosterone apply to a troche as they do to any other route.
Testosterone can raise red blood cell counts, and an elevated hematocrit is a common reason therapy is adjusted or paused. Product labeling carries a warning that testosterone products increase blood pressure, and warnings about blood clots in veins including the legs and lungs. Other reported effects include acne and oily skin, breast tenderness or enlargement, fluid retention, worsening of sleep apnea, mood changes or irritability, reduction in testicular size, and reduced sperm production, which matters for men who want to father children. Testosterone labeling also carries a warning regarding abuse and dependence. Troches specifically can cause irritation of the gums, mouth or throat and an altered or bitter taste. This list is not complete. Report any new symptom to your prescriber, and do not stop or change a dose without speaking with them first.
Sending a prescription to Mixwell
State the strength per troche, the quantity, the placement and the flavor preference on a patient specific prescription. Testosterone is a Schedule III controlled substance, so the prescription must be transmitted in a manner that meets controlled substance requirements.
- Write the strength per troche and the number of troches to dispense.
- State buccal or sublingual placement and the frequency in the directions.
- Note the base preference or write pharmacist's choice, and say whether you want the troche scored.
- Call (909) 378-7301 to confirm the formulation and current turnaround time.
Testosterone troche, strength per troche as specified, quantity of troches, base preference or pharmacist's choice, scored or unscored, flavor preference, directions stating buccal or sublingual placement and frequency.
- Pharmacy
- Mixwell Compounding Pharmacy
- Address
- 13788 Roswell Ave, Ste 158, Chino, CA 91710
- Phone
- (909) 378-7301
- Fax
- (909) 378-7071
- info@mixwellpharmacy.com
The wording above is a formatting example only. All clinical parameters are determined by the prescriber.
Serving prescribers and patients in California
Mixwell Compounding Pharmacy is located in Chino, CA and works with men's health, urology and primary care prescribers across the Inland Empire, Los Angeles County and Orange County. Patients can collect their preparation at the Chino pharmacy, and delivery is available across California.
- Chino
- Chino Hills
- Ontario
- Rancho Cucamonga
- Upland
- Pomona
- Diamond Bar
- Corona
- Riverside
- Eastvale
- Brea
- Fullerton
Common questions
What is a troche?
A troche is a small molded lozenge, usually flavored, that is held in the mouth and allowed to dissolve slowly rather than swallowed or chewed. It is placed either between the cheek and gum, which is called buccal, or under the tongue, which is called sublingual.
How is a troche different from a tablet?
A tablet is made by compressing powder under high force and is swallowed. A troche is made by melting a base, mixing in the active, pouring it into a mold and letting it set, and it dissolves in the mouth. Because molding needs no tablet press, a compounding pharmacy can make troches at strengths a manufacturer does not produce.
How is troche strength written on a prescription?
Strength is written per troche, meaning the milligrams of active in each individual lozenge, along with the number of troches to dispense. The prescriber determines the strength based on evaluation and laboratory testing.
Does the base affect how much I absorb?
Yes. A gelatin base dissolves more slowly, so more of the dose is absorbed across the lining of the mouth and less is swallowed. A polyethylene glycol base dissolves faster and is more palatable, but more of the dose tends to be swallowed. Your prescriber or our pharmacists select the base to suit the active and the goal.
Can a troche be split?
Troches can be prepared scored so a patient can divide one along a marked line, which gives a prescriber a way to adjust the dose. Only divide a troche if your label directs it, and follow the label rather than estimating.
Are testosterone troches FDA approved?
No. Compounded testosterone troches are not FDA approved. Testosterone is FDA approved in other forms including oral capsules, topical gels, a transdermal patch, a buccal system, a nasal gel, subcutaneous pellets and injections. A valid prescription is required for a compounded preparation.
Does Mixwell accept insurance?
Mixwell does not accept insurance. Call (909) 378-7301 to discuss current pricing.
Key Takeaways
- A troche is a molded lozenge held in the mouth to dissolve, placed either between the cheek and gum or under the tongue.
- Troches are molded rather than compressed, which is why a compounding pharmacy can prepare strengths and combinations no manufacturer produces.
- Base selection changes outcomes, because a slower dissolving gelatin base delivers more across the oral lining while a polyethylene glycol base is faster and more palatable.
- Strength is written per troche alongside the quantity, and troches can be scored so a dose can be divided during titration.
- Compounded troches are not FDA approved and require a valid prescription, and testosterone side effects apply regardless of the dosage form.
Sources
- University of North Carolina Eshelman School of Pharmacy. Lozenges and medication sticks, compounding laboratory exercises. pharmlabs.unc.edu
- U.S. Food and Drug Administration. Testosterone product labeling, including warnings regarding increased blood pressure, venous thromboembolism, and abuse and dependence.
- U.S. Food and Drug Administration. FDA issues class wide labeling changes for testosterone products. February 28, 2025. fda.gov
- United States Pharmacopeia. General Chapter 795, Pharmaceutical Compounding, Nonsterile Preparations.
- U.S. Food and Drug Administration. Compounding and the FD&C Act, Section 503A.