T Nation

Wife Just Got Prescribed Testosterone Sublingual Troches

Like me, she’s 55 and, like most women, suffering the effects of age in a multitude of ways.

The dose is 0.25mg test twice a day.

A couple of medical articles I found showed “significant” increases in test levels within 15 minutes of consumption lasting for a few hours before returning to baseline.

Anyone have any experience/knowledge with this?

I covered these a little bit on the EM forum a little while back (too bad we can’t post links). I was debating nasal gel vs troche to pulse once or twice a day with the goal of continuing TRT while trying to recover my HPGA.

TLWR
If one is methodical, the dosing above should put your wife in range for a few hours twice per day based on published data and discussions I’ve had with my provider who has experience with this administration method.

The details
Here’s some data from the literature:



Reference range for female TT: 9 - 55 ng/dL (ARUP LC/MS)

If you digitize the data above and estimate peak and AUC you can put some numbers together. Estimated peak and avg serum TT vs troche dosage (twice daily admin):

image

The challenge you can see is the huge peak-to-mean ratio of 6.3 for twice daily administration. One troche a day increases that ratio to 12.6. You could titrate Cavg up by increasing the number of daily doses. Given the rapid elimination, the doses don’t build up significantly even with thrice (3x) daily dosing.

From the plot above, with 0.25 mg twice daily, your wife will peak about double the upper limit then average 18 ng/dL over 24 hours (this is based on mean response of 6 women in study above).

Your wife’s provider seems prudent to me.

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Thank you for the reply. I seriously doubt that my wife will agree to increasing her dose. She is terrified about virilization.

She is willing to give this an initial try but I think I’d like to see her on something that prevents the peaks and valleys and releases at a slower rate.

transdermal cream would be the next step down on peak/trough:

This is the typical female mode of application that I am familiar with. Few providers seem to want to discuss use of sub-Q Test Ester with women, but if you know what you are doing it seems very reasonable. Issue is making sure you know what you are doing :-).

That seems like a way to take peaks and valleys to an extreme. I dunno, I’m curious to see how it turns out though, seems like it would be super up and down

Serious question, is the information I provided above

  1. not enough
  2. just right
  3. way too much detail?

I’d like a reality check so I can better interact on this forum and manage benefit vs opportunity costs moving forward.

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image

Are you saying they’re all over the place anyways or the measurements are difficult to make? You got me on this one, I’m missing your point, lol

Both :-).

Also, nice comparison of serum levels in “normal” compared to PCOS in the context of elevated T levels at peak.

Well, I guess I got your point after all, haha. I got the comparison between normal vs. PCOS part, which is pretty interesting, I’m still reading through the study.

I’ve been trying to get my wife to get some hormone testing done. She had a little bit of testing done a year or so ago and her total T and free T were well above the normal range for females. Whether it’s related to PCOS or not, I have no idea… but she doesn’t like to listen to me when it comes to hormone stuff. She thinks all of this is crazy.

I just looked it up… both total and free T were double the high end of “normal” on her last test.

From my perspective you couldn’t have done much better. You provided directly relevant research without spamming 20 “somewhat related” papers, and you gave your own opinion/interpretation concisely without trying to make it seem as if it was anything more than your opinion.

I always find your posts highly informative and very valuable; for example I learned a lot from the posts from @unreal24278 on heart health you linked in a reply to another poster in my thread.

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Even more reason to check whether her tests are RIA or LC/MS in the context of this paper.

Figure 2. Hormone Levels Assayed Using LC-MS/MS and RIA.

Testosterone (T), androstenedione (AD) and 17OH progesterone (17OHP) levels in individual subjects with PCOS (black circles) and controls (white circles) as measured in an RIA and LC-MS/MS. Linear regression is plotted for each hormone. Testosterone, androstenedione and 17-hydroxyprogesterone levels are consistently higher using the RIA.

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I appreciate you taking the time to provide feedback @disciplined_trt. Thank you. These types of posts I haven’t had a huge amount of success finding for these types of questions online. So when I come across one I really do appreciate the time the author spent. I really find myself challenged to strike a balance. It’s guys like you and @unreal24278 , @lordgains , @mnben87 and @iron_yuppie (balance of practical info combined with his elegant writing style) that keep me engaged on here. There’s a real hunger for knowledge in this little niche area.

I find the crude stuff really detracts from the learning and data on here but I understand it’s a forum and it takes all kinds.

Her total T was 100ng/dL via LC-MS/MS. No results to compare to the other two charts.

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The info you provided was great. Thank you again.

It also provided others to comment (like they have) which is always welcome.

I’m not too crazy about transdermal. Those receptor sites can become non responsive over time and they are not 100% efficient. I’d like to see her on subQ myself. There is a hormone clinic that is opening near us and she has mentioned checking them out. Maybe they would consider injectables to give that slower release. We’ll see.

This seems to be universal among women. Luckily, my wife recognized that she was changing and mentioned it to her Dr. They didnt even do any bloodwork, just prescribed the troche and said “see you in 8 weeks” or something.

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My pleasure. With cream, intra-vaginal or rectal (dermal or even slight intra) application seems very effective, although peak/trough may converge to the troche result with the enhanced absorption in those locations (skin thickness, vascular region, etc).

I’m with you on the sub-Q but every time I mention I get some strange looks :-).

And just to clarify, thrice daily dosing (keep dosage the same) would increase Cavg without increasing peak concentration given the short elimination. So peak stays around 100 ng/dL while Cavg would go from 18 to 27 ng/dL.

So not dosage per dose, but dosing frequency.

Hey stud did you factor in the diurnal variations in testosterone levels in women?

@readalot and i had a short discussion about this some time ago. The spikes throughout the day can be very beneficial compared to a slow release with stable levels.

In my estimation I wouldn’t discount the buccal tablets because of the spikes and falls but I would actually be inclined to try it for a good amount of time.

Another thing @readalot did you see the discussion I had with @mnben87 on boldenone?
Also, always good to have your testosterone therapy optimization and outlooks here. You’re really specializing there I see.

@readalot mind if I ask- what are your credentials? I’m assuming you are either qualified or a med student of some sort?

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