How a troche gets testosterone into your blood
You hold the troche in your mouth and let it dissolve completely. Your pharmacy label says where to place it and how often to use it.
Blood from the lining of the mouth drains to the superior vena cava, the large vein that returns blood to the heart. Testosterone absorbed there circulates through the body before the liver can clear it. FDA’s label for Striant, a buccal testosterone product approved in 2003, describes this route as the reason buccal delivery works.
Swallowed testosterone takes the other path. Plain testosterone is well absorbed from the gut and then cleared by the liver on its first pass, which is why oral testosterone needed very large doses for decades. The testosterone capsules FDA has approved since then use testosterone undecanoate, which is absorbed largely through the lymphatic system and so avoids that first pass through the liver. Those capsules are covered in oral TRT, what to know. For a troche, the practical rule is simple: let it dissolve in place, and avoid chewing it or swallowing it whole.
What happens to your testosterone level after a dose
The closest evidence comes from fast-dissolving testosterone tablets and lozenges studied from 1991 to 2001, plus Striant, a 12-hour system that sticks to the gum, approved by FDA in 2003.
| What was studied | Who | Dose | Peak | After the peak | Source |
|---|---|---|---|---|---|
| Sublingual tablet with an absorption enhancer (cyclodextrin) | 5 men with low testosterone | 5 mg | At 20 minutes, about 2,460 ng/dL on average | Below the normal range by 2 hours | Stuenkel 1991 |
| The same tablet, 60-day trial | 63 men with low testosterone, split between the tablet and injections | 2.5 or 5 mg, three times a day | At 20 minutes | Back to baseline by 6 hours | Salehian 1995 |
| Buccal tablet | 7 men with testosterone under 250 ng/dL | 10 mg | At 30 minutes, 2,688 ng/dL on average | Back to baseline in 4 to 6 hours | Dobs 1998 |
| Lozenge | 10 women after removal of the ovaries | 1 mg | At 1 hour | “Fell precipitously” | Slater 2001 |
| Striant 12-hour gum system | 98 men with low testosterone | 30 mg, twice a day | 970 ng/dL on average at day 84 | 86.6% of 82 men who finished averaged 300 to 1,050 ng/dL over 24 hours | FDA label |
Three things in that table matter for a troche.
- The dissolving forms peaked high and briefly. In the 1991 study the 5 mg peak averaged about 2,460 ng/dL (our conversion of the paper’s 85.4 nmol/L). That is more than twice the top of the 300 to 1,050 ng/dL range FDA used for Striant, and levels fell below that range within 2 hours.
- A bigger dose did not always mean a bigger effect. The 2.5 mg tablet behaved much like the 5 mg one, which the authors read as a limit on how much the mouth absorbs at once. Over a 20-day cycle, injections of testosterone enanthate delivered 2 to 4 times the total testosterone exposure of the sublingual tablets.
- Striant was a different design. It stayed stuck to the gum for 12 hours and released testosterone slowly, so its numbers describe that system. FDA withdrew its approval in 2020 at the maker’s request because it was no longer sold, and the notice cites no safety finding.
Compounded troches today are made at strengths well above the doses in those studies. One 503A pharmacy’s catalog runs from 2.5 mg to 200 mg, and the troches in PepScribe’s pharmacy catalog come in 50, 100 and 200 mg. Our searches of PubMed and Europe PMC in October 2026 found no study that measures what those strengths do to blood levels in men. A compounded troche studied in six women showed what the National Academies called “substantial intersubject variability” in hormone levels. So the strength on the label is where treatment starts, and follow-up labs set where it settles.
Troche, injection or cream: how they compare
| Troche | Injection (testosterone cypionate) | Gel or cream on the skin | |
|---|---|---|---|
| How it is used | Dissolves in the mouth on the schedule your label sets | Injected, typically 75 to 100 mg weekly or 150 to 200 mg every 2 weeks | Rubbed into the skin once a day |
| What levels do | Studied dissolving forms rose within an hour and fell within hours | Levels rise above the normal range after a shot and drift toward the low range by the end of the interval | In AndroGel 1.62%’s trial, 81.6% of men averaged 300 to 1,000 ng/dL over 24 hours at day 112 |
| The main practical issue | It has to dissolve in place. Gum or mouth irritation was the most common side effect of Striant (9.2%) | Needles, plus “peaks and valleys” that the Endocrine Society notes may track symptoms | Skin contact can pass testosterone to a partner or child. FDA requires a boxed warning on gels after children were virilized |
| When labs are drawn | No guideline time; keep the gap since your last troche the same each test | Midway between injections | 2 to 8 hours after application in the Endocrine Society guideline; the AndroGel label uses a morning level before the day’s dose |
The one head-to-head trial is Salehian 1995. Injections produced 2 to 4 times the testosterone exposure of the sublingual tablets, and the authors suggested the sublingual form may suit older men because its effects reverse quickly and its total exposure is lower. Injection technique is covered in our injection site guide, and the daily topical in testosterone cream, compared.
When to draw labs on a troche
Before treatment, the Endocrine Society’s 2018 guideline diagnoses low testosterone from symptoms plus consistently low levels, measured on two separate mornings while fasting. During treatment it checks testosterone and hematocrit at 3 to 6 months, at 12 months and then yearly, aiming for the middle of the normal range.
Timing is where a troche differs. For Striant the guideline says to measure “immediately before or after application of fresh system.” It gives no timing for troches. In the studies above, a dissolving dose peaked within an hour and faded within hours, so a level drawn one hour after a troche and one drawn six hours after can describe the same dose in very different numbers. Tell your clinician when you took your last troche, and keep that gap the same from one test to the next.
The guideline’s safety lines apply to every form:
- Hematocrit. A level above 54% means pausing treatment until it falls. A baseline above 48% (50% for men living at high altitude) is a reason to hold off starting.
- PSA. In the first year, a confirmed rise of more than 1.4 ng/mL above baseline, a confirmed PSA above 4.0 ng/mL, or an abnormal prostate exam calls for a urology referral.
PepScribe’s monitoring checks hematocrit, estradiol, PSA and lipids every three to six months. The full panel is explained in the lab tests TRT requires.
Side effects and risks
- Mouth. With Striant, gum or mouth irritation affected 9.2% of men and a bitter taste 4.1%; the gum irritation cleared in 1 to 8 days.
- Red blood cells. Erythrocytosis is the most frequent adverse event in randomized trials of testosterone. In the meta-analysis behind the 2018 guideline, a hematocrit above 54% was about 8 times as common with testosterone as without it.
- Fertility. Testosterone from outside the body suppresses the signals that drive sperm production. In the 1991 study a single sublingual dose lowered LH by 19% within 2 hours. The guideline recommends against testosterone for men planning a pregnancy in the near term; more in TRT and fertility.
- Heart and blood pressure. The TRAVERSE trial followed 5,246 men aged 45 to 80 with heart disease or high risk. Major cardiac events occurred in 7.0% on testosterone gel and 7.3% on placebo, which met the trial’s test for noninferiority; atrial fibrillation, acute kidney injury and pulmonary embolism were more common on testosterone. In 2025 FDA removed the cardiovascular language from the boxed warning on testosterone products and added a blood pressure warning to products that lacked one. TRAVERSE studied a gel, and no outcome trial has studied troches.
- Hair. Hair changes on testosterone are covered in TRT and hair loss.
Getting a troche prescribed by telehealth
Testosterone is a Schedule III controlled substance. Under a rule from DEA and HHS published December 31, 2025, a DEA-registered clinician can prescribe Schedule III medications by telemedicine without an in-person exam through December 31, 2026, when the listed conditions are met. State law still applies, and some states do not allow telehealth to start a Schedule III medication. We will update this page when DEA publishes its next rule.
What testosterone troches cost
These are ongoing prices from each provider’s own page, read October 3, 2026. Where a membership is required, it is part of the real monthly cost.
| Provider | Ongoing price | Membership | What else the page states |
|---|---|---|---|
| Hone Health | Medication from $60/mo | $25 Basic or $155 Premium a month; the page does not say which a troche needs | A $65 biomarker test to start |
| Ulo | $189/mo for the oral option, which the page calls oral troches | None separate | Includes consultations, lab testing, medication and supplies |
| PepScribe | $387 every 3 months with $50 off every order, so $337 every 3 months | None | Covers the medication, clinician care and shipping. Recent labs upload free; a baseline panel is $129 at a LabCorp location |
How to get a testosterone troche through PepScribe
- Start the free online visit at /book/trt. Upload labs from the last 6 to 12 months at no charge, or have a baseline panel ordered for $129 at a LabCorp location near you.
- A DEA-registered clinician reviews your labs and history in a video visit and decides with you whether a troche, cream or injection fits.
- If a troche is prescribed, it is compounded in the USA by a licensed 503A pharmacy and shipped to you, with follow-up labs every three to six months.
Plan details are on the testosterone troche page.
Frequently asked questions
Do testosterone troches work?
They raise blood testosterone: studies of similar dissolving forms measured peaks within 20 to 60 minutes of a dose. Whether a given troche keeps you in the normal range is something your own labs show, because no published study has measured compounded troches in men.
How long does a testosterone troche stay in your system?
In studies of similar forms, levels fell back to baseline within about 2 to 6 hours of a dose, with half-lives of roughly 1 to 2 hours.
Should a troche go under the tongue or against the gum?
Follow your pharmacy label. Both places absorb testosterone through the lining of the mouth. What matters is letting the troche dissolve completely in place.
Is a troche better than injections?
Neither is better for everyone. In the one head-to-head trial, injections delivered 2 to 4 times the testosterone exposure of a sublingual tablet, and the sublingual form wore off within hours, which its authors saw as an advantage for some older men. Your labs, your routine and how you feel decide it.
Do testosterone troches shut down your own production?
They can. Testosterone from outside the body suppresses the hormones that drive sperm production, and a single sublingual dose lowered LH by 19% within 2 hours in a 1991 study. Men planning a pregnancy soon should raise it with a clinician before starting any form of testosterone.
Are testosterone troches FDA-approved?
No troche is FDA-approved. Compounded troches are prepared for one patient on a prescription by a licensed 503A pharmacy. Striant, the only FDA-approved buccal testosterone, left the market, and FDA withdrew its approval in 2020 at the maker’s request.
Can I get testosterone troches online?
In most states, yes. Testosterone is Schedule III, and current DEA and HHS rules let a DEA-registered clinician prescribe it by telehealth through December 31, 2026, subject to state law.
Provider prices: each provider’s own page, read October 3, 2026 (Hone Health, Ulo). PepScribe’s price: its booking page, read the same day. Prices change; check before you compare.
