Key takeaways
- A troche is a small lozenge that dissolves slowly in your mouth rather than being swallowed.
- Because it absorbs through the lining of your mouth, much of the dose largely bypasses the first pass through the liver.
- How you use it matters a great deal. Swallowing your saliva sends the dose down the ordinary oral route instead.
- Absorption from troches varies more than some other routes. That is a known limitation, not a selling point.
- Compounded troches are not FDA approved and require a valid prescription. Your prescriber decides what is right for you.
What this guide covers
If your prescriber has mentioned a troche and you nodded along without being entirely sure what that meant, you are in good company. It is not a word most people encounter until a compounded prescription shows up.
The short version: it is a lozenge you let dissolve in your mouth. The longer version, including why the way you use it genuinely changes how it works, is worth a few minutes of your time.
What a troche actually is
A troche, pronounced "TROH kee," is a small solid lozenge, usually flavored, designed to dissolve slowly between your cheek and gum or under your tongue. It is not a pill. You do not swallow it whole and you do not chew it.
Compounding pharmacies make troches because the format lets a prescriber put a specific hormone, or a combination of hormones, into a single dose at a strength that no manufacturer produces. Estradiol, estriol, progesterone, testosterone and DHEA can all be prepared this way when a prescriber writes for them.
How sublingual and buccal absorption works
The tissue inside your mouth is thin and rich with blood vessels sitting close to the surface. When a hormone dissolves against that tissue, a portion of it can move directly into your bloodstream from there.
Two terms come up, and the difference is just placement. Sublingual means under the tongue. Buccal means tucked between your cheek and gum. Troches are most often used buccally, though prescribers sometimes direct sublingual placement instead.
What makes this route notable is where the dose goes next. A swallowed capsule travels through your gut to your liver, which processes a portion of it before the rest reaches general circulation. That is called the first pass effect. Absorption through the mouth largely skips that step for the portion that goes in through the oral tissue.
The catch is right there in that sentence. The portion that goes in through the oral tissue. Whatever you swallow takes the ordinary route instead, which is why technique matters so much here.
How to use a troche properly
This is the part worth reading twice. A troche used casually and a troche used correctly are not delivering the same thing.
Step by step
Always follow the specific directions on your prescription label. These are general best practices.
- Check your prescription firstSome troches are scored so a dose can be split. Confirm whether yours is meant to be used whole or divided, and where your prescriber wants it placed.
- Place it where directedUsually between the cheek and gum, or under the tongue if your prescriber specified sublingual. Alternating sides between doses is commonly suggested to reduce local irritation.
- Let it dissolve slowlyDo not chew it and do not suck on it aggressively. Slow contact with the tissue is the entire point. This typically takes several minutes.
- Try not to swallow while it dissolvesThis is the single most important habit. Saliva you swallow carries dissolved hormone into your stomach, where it takes the ordinary oral route instead.
- Wait before eating or drinkingGive it time after the troche has fully dissolved before you eat, drink or brush your teeth. Your prescriber or pharmacist can tell you how long they prefer.
- Stay consistentUse it at roughly the same times each day and in the same way, so your prescriber is evaluating a consistent routine rather than a moving target.
Do this, not that
Helpful habits
- Let it dissolve on its own time
- Alternate cheeks between doses
- Keep swallowing to a minimum until it is gone
- Store as directed on the label
- Tell your prescriber if your mouth feels irritated
Habits that work against you
- Chewing or crunching it
- Swallowing it whole like a tablet
- Drinking water to help it go down
- Eating or drinking right away
- Using it in a different way each time
Why a prescriber might choose a troche
Several hormones, one dose
A prescriber can combine estradiol, estriol, progesterone, testosterone or DHEA into a single troche rather than separate products.
No swallowing required
Useful for patients who have trouble with capsules or tablets, or who simply do not want another pill.
Nothing on the skin
Some patients prefer not to apply a cream daily, or want to avoid transfer to a partner or child.
A strength that is not made
Troches can be prepared at custom strengths and ratios that commercial products do not offer.
The honest limitations
You will find plenty of pages online describing troche absorption as smooth or steady. We are not going to tell you that, because the evidence does not really support it.
Absorption from a troche varies. It depends on how long you hold it, how much saliva you swallow, and differences in individual oral tissue. Two people using the same troche the same way can absorb different amounts, and the same person can vary day to day. The 2020 National Academies report on compounded bioidentical hormone therapy specifically raised absorption variability as a concern with compounded dosage forms including troches.
Why we are telling you this
Because it is useful to know. Variability is exactly why technique matters, why consistency matters, and why your prescriber monitors how you are doing rather than assuming a dose behaves identically for everyone. A troche is a legitimate option that a prescriber may choose for good reasons. It is just not a magic delivery system, and anyone telling you otherwise is selling something.
How troches compare to other routes
| Route | How it is used | Liver first pass | Worth knowing |
|---|---|---|---|
| Troche or sublingual | Dissolves in the mouth over several minutes | Largely bypassed for the portion absorbed orally | Technique dependent. Absorption varies. Mostly compounded. |
| Transdermal cream or gel | Applied to skin once or twice daily | Bypassed | FDA approved estradiol patches, gels and sprays also exist. |
| Oral capsule | Swallowed with water | Yes | Familiar and simple. FDA approved oral options exist. |
| Vaginal cream or suppository | Inserted, often for localized use | Largely bypassed | Several FDA approved products available. |
No route is universally better. They differ, and which one suits a particular person is a clinical decision your prescriber makes with you.
What goes into a compounded troche
A troche needs a base that holds its shape, dissolves at a reasonable rate, and tastes acceptable enough that someone will actually keep it in their mouth for several minutes. Flavor is not vanity here. It affects whether the troche gets used the way it should be.
As a PCCA member pharmacy, we prepare troches from professionally developed formulation resources, and we can flavor them to preference within what the formulation allows.
What we can adjust
Strength and combination
Compounded to the exact hormones, strengths and ratios your prescription specifies.
Flavor
Flavored to support comfortable use, since a troche needs to sit in the mouth for several minutes.
Scored dosing
Troches can be prepared so a dose can be divided when the prescriber wants that flexibility.
Ingredient conscious
Dye or ingredient conscious options where the formulation allows and the prescriber requests it.
Important regulatory information
Please read this part
Compounded hormone troches are not FDA approved drug products. They are prepared pursuant to a valid, patient specific prescription. FDA approved hormone therapy products are available in other dosage forms and are appropriate for many patients.
No promise of results. Under federal law, promotion of prescription drugs, including compounded drugs, must be truthful, non misleading and accurate. Nothing in this article claims that a troche produces any particular outcome, or that a compounded preparation is safer or more effective than an FDA approved product.
FDA recommends that patients talk with their health care professional about their specific circumstances before taking any medication.
For licensed prescribers. Hormone therapy carries individual risks and benefits requiring prescriber assessment, and absorption from buccal and sublingual dosage forms can vary between patients. Compounded preparations are not a substitute for clinical judgment. Mixwell is a non sterile compounding pharmacy in Chino, CA.
Sending a prescription to Mixwell
- Note the hormones, strengths, troche count, flavor preference and placement directions on the prescription.
- Fax or e prescribe to our Chino, CA pharmacy.
- Call (909) 378-7301 if you want to talk through the formulation or check turnaround time.
- Your patient can pick up in Chino, or we can deliver. We serve patients across California.
Related from Mixwell
Common questions
What is the difference between a troche and a sublingual tablet?
Mostly placement and format. A troche is a soft lozenge usually placed between the cheek and gum, which is called buccal. A sublingual tablet goes under the tongue. Both dissolve in the mouth rather than being swallowed, and both rely on absorption through the oral tissue.
What happens if I swallow it by accident?
The hormone still gets absorbed, but through your gut and liver like a regular capsule rather than through your mouth. Do not double up or take extra. Mention it to your prescriber or pharmacist if it keeps happening, since it may mean the format is not a good fit for you.
How long should a troche take to dissolve?
Usually several minutes. It should not be rushed, chewed or crunched. Follow the specific timing your prescriber or the label gives you.
Do troches really absorb better than pills?
They absorb differently, not necessarily better. Oral absorption largely bypasses the liver first pass, but the amount absorbed varies with technique and between individuals. Your prescriber weighs those trade offs for your situation.
Can several hormones go into one troche?
Yes. Estradiol, estriol, progesterone, testosterone and DHEA can be combined in a single troche when a prescriber specifies the combination and strengths.
Should I talk to my provider first?
Yes. FDA recommends that patients talk with their health care professional about their specific circumstances before taking any medication, including compounded preparations.
Does Mixwell take insurance?
We do not accept insurance. Call (909) 378-7301 and we can go over current pricing with you.
Questions about troche formulations? Give us a call.
Mixwell Compounding Pharmacy
13788 Roswell Ave, Ste 158, Chino, CA 91710
PCCA Member · CA Licensed · USP <795> · Non Sterile Compounding · Delivery Across California
Call (909) 378-7301References: National Academies of Sciences, Engineering, and Medicine. The Clinical Utility of Compounded Bioidentical Hormone Therapy: A Review of Safety, Effectiveness, and Use. 2020. | Files JA, Ko MG, Pruthi S. Bioidentical Hormone Therapy. Mayo Clin Proc. | The Menopause Society. Position statements on hormone therapy. | Standard pharmaceutics references on buccal and sublingual drug delivery. | This article is educational information and is not a substitute for clinical judgment or medical advice, and is not a promise of results. Always follow the directions on your prescription label. Reviewed by the Mixwell Compounding Pharmacy compounding team, Chino, CA.