DHEA / Estradiol / Estriol / Pregnenolone / Testosterone Troche

DHEA / Estradiol / Estriol / Pregnenolone / Testosterone Troche
Usage
This compounded troche is a multi-hormone replacement therapy (HRT) formulation designed to support hormonal balance, particularly in patients with estrogen and androgen deficiency. It is commonly used in women’s health and menopause management, but may also be prescribed in other hormone deficiency states under specialist supervision.
It may be used for:
• Menopausal and perimenopausal symptoms (e.g., hot flushes, night sweats, mood changes)
• Low libido and sexual dysfunction
• Fatigue, reduced energy, and wellbeing
• Hormonal imbalance or deficiency states
• Other practitioner-directed uses in individualised HRT programmes
Troches allow buccal absorption, helping bypass first-pass metabolism and enabling more consistent hormone delivery.

Dosage
Dosage should be individualised and prescribed by a qualified healthcare practitioner based on symptoms, clinical response, 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 sites in the mouth to minimise irritation
Regular clinical review and dose adjustment are important in hormone therapy.

Mechanisms of Action
This formulation combines multiple hormones and precursors that act on different endocrine pathways:
Estradiol & Estriol (Estrogens)
• Bind to estrogen receptors, helping regulate reproductive, vascular, and bone health
• Reduce menopausal symptoms such as vasomotor instability and vaginal dryness
Testosterone
• Supports libido, energy levels, mood, and muscle mass
• Plays a role in sexual function and overall vitality
DHEA (Dehydroepiandrosterone)
• Acts as a precursor for both estrogens and androgens
• Contributes to hormonal balance, energy, and wellbeing
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 hormonal balance across multiple systems.

Contraindications
This formulation should not be used in patients with:
• Hypersensitivity to any component of the formulation
• Hormone-sensitive cancers (e.g., breast, endometrial, or prostate cancer), unless under specialist care
• Undiagnosed abnormal vaginal bleeding
• Active or history of thromboembolic disorders (e.g., DVT, pulmonary embolism)
• 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
• Endocrine or metabolic disorders
Additional considerations include:
• Hormone therapy should be individualised and regularly reviewed
• Monitoring may include clinical assessment and hormone levels
• Possible side effects may include:
• Breast tenderness
• Fluid retention
• Mood changes
• Acne or hair changes (androgen effects)
• Avoid exceeding prescribed doses to minimise risk of hormonal imbalance
Patients should seek medical advice if they experience unusual bleeding, severe headaches, chest pain, or signs of thrombosis.

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