DHEA / Estradiol / Estriol / Pregnenolone / Progesterone / Testosterone Troche

DHEA / Estradiol / Estriol / Pregnenolone / Progesterone / Testosterone Troche
Usage
This compounded troche is a multi-hormone replacement therapy (HRT) formulation designed to support hormonal balance in patients with hormone deficiencies or imbalances, typically under specialist supervision.
It may be prescribed for:
• Menopausal and perimenopausal symptoms (e.g., hot flushes, night sweats, mood changes)
• Hormone deficiency states
• Low libido and sexual dysfunction
• Fatigue and reduced wellbeing associated with hormonal imbalance
• Other practitioner-directed uses in individualised hormone therapy programmes
Troches (lozenges) allow buccal absorption, which may bypass first-pass liver metabolism and provide more consistent hormone delivery.

Dosage
Dosage should be individualised and determined by the prescribing practitioner based on clinical assessment and, where appropriate, hormone levels.
Typical dosing considerations include:
• Place the troche between the cheek and gum and allow it to dissolve slowly
• Usually administered once daily, or as directed
• Do not chew or swallow whole
• Rotate placement in the mouth to reduce local irritation
Hormone therapy requires regular review and monitoring, and doses may be adjusted over time.

Mechanisms of Action
This formulation contains multiple hormones and hormone precursors that act synergistically:
Estradiol & Estriol (Estrogens)
• Bind to estrogen receptors to regulate reproductive, cardiovascular, and bone health
• Help relieve menopausal symptoms such as hot flushes and vaginal dryness
Progesterone
• Balances estrogen effects and supports endometrial protection
• Has roles in mood regulation and sleep
Testosterone
• Contributes to libido, energy, and muscle mass
• Supports overall wellbeing in both men and women (when appropriately prescribed)
DHEA (Dehydroepiandrosterone)
• A hormone precursor that can be converted into androgens and estrogens
• Supports energy, mood, and hormonal balance
Pregnenolone
• A precursor hormone involved in the synthesis of steroid hormones
• May support cognitive function and stress response
Together, these hormones aim to restore physiological balance across multiple endocrine pathways.

Contraindications
This formulation should not be used in patients with:
• Hypersensitivity to any hormone or formulation component
• Hormone-sensitive cancers (e.g., breast, endometrial, prostate cancer) unless under specialist care
• Undiagnosed abnormal vaginal bleeding
• Active or history of thromboembolic disorders (e.g., DVT, PE)
• Severe liver disease
• Pregnancy

Precautions
Use with caution in patients with:
• Cardiovascular disease or risk factors
• History of hormone-sensitive conditions
• Liver impairment
• Migraine disorders
• Metabolic or endocrine disorders
Additional considerations include:
• Hormone therapy should be individualised and regularly reviewed
• Monitoring may include clinical assessment and hormone levels
• Potential side effects may include:
• Breast tenderness
• Fluid retention
• Mood changes
• Acne or hair changes (androgen-related effects)
• Avoid exceeding prescribed dose to reduce risk of hormonal imbalance or adverse effects
Patients should seek medical advice if they experience unusual bleeding, chest pain, severe headaches, or signs of thrombosis.

Storage
• Store below 25°C unless otherwise directed
• Keep troches in a tightly closed container
• Protect from heat, moisture, and direct light
• Avoid exposure to excessive heat, as troches may soften or melt
• Keep out of reach of children and pets
Patients should follow the specific storage instructions provided on the dispensing label supplied by the pharmacy.