What the hell is a Troche?
The Role of the Pharmacist in Women’s Hormones and Medications
This week on the You Are Not Broken podcast, I sat down with pharmacist Tara Thompson to discuss a critical but often overlooked topic: the role of pharmacists in women’s medications and hormone therapy (and the tragic current state of not enough of them supporting women and their prescriptions they got from their doctor). If you’ve ever picked up a prescription and wondered why your pharmacist seems hesitant or misinformed about hormone replacement therapy (HRT), you’re not alone. Pharmacy education often lacks in-depth training on women’s hormones, and misinformation runs rampant—both in the medical community and in the media. Let’s break down some of the biggest takeaways from this important conversation on episode 302 on my “you are not broken” podcast with pharmacist Tara Thompson.
Why Pharmacists Need More Education on Women’s Hormones
Pharmacists are the last healthcare professionals a patient interacts with before starting a medication, yet they are often missing key education on hormones and women’s sexual health. This gap in training can leave women confused or even scared when they pick up their prescriptions, especially when it comes to hormone therapy. It is very unpleasant to have someone disagree with your and your prescriber's plan and be the gatekeeper. We discussed how crucial it is for pharmacists to have accurate, evidence-based knowledge to counsel patients effectively instead of contributing to misinformation.
The Media’s Influence on Hormone Therapy
It’s no secret that the media loves a hormone therapy horror story. From the infamous misinterpretations of the Women’s Health Initiative (WHI) study to sensationalized headlines warning of exaggerated risks, misinformation is everywhere. Tara and I discussed how this has led to unnecessary fear surrounding HRT, discouraging women from accessing treatments that could improve their health and quality of life. In fact, the warning stickers on medications have their roots in the WHI. Pharmacists have a role to play in cutting through the noise and providing patients with accurate, science-backed information.
The Testosterone Prescription Battle
One of the most frustrating topics we covered? The unnecessary struggle women face when trying to get a testosterone prescription. Despite its benefits for women’s health, in particular the well-established data on libido, many healthcare providers and pharmacists hesitate to prescribe or dispense it. Labeling testosterone as a “hazardous medication” only adds to the stigma, making it even harder for women to access a hormone that could significantly improve their well-being.
Compounding Pharmacies: A Lifeline for Women’s Hormone Therapy
Not all hormone therapies come in one-size-fits-all packaging, and that’s where compounding pharmacies come in. These specialized pharmacies create customized hormone therapies tailored to each patient’s needs, whether it’s a unique dosage form, a combination of hormones, or an alternative delivery method. Tara and I explored how compounding pharmacies play a vital role in making HRT more accessible and effective for women.
Generic vs. Brand Name Medications: Does It Matter?
A common question patients have is whether they should stick with a brand-name medication or opt for the generic version. While generics can be a cost-effective option, they aren’t always identical in absorption or effectiveness. This can be especially true with hormone medications, where small changes in formulation can impact how well a drug works. Every patient should have a conversation with their pharmacist to ensure they’re getting the best possible outcome. Sometimes, this is just trial and error, and sometimes, it is out of your control when pharmacies change what brand they carry.
The Best Forms of Progesterone and Why Delivery Methods Matter
Not all progesterone is created equal. We broke down the differences between topical and oral progesterone, highlighting why oral extended-release formulations may offer better patient outcomes (but this is compounded as not commercially available in the US). Additionally, we dove into innovative compounded delivery methods like troches with buccal absorption, which can provide unique benefits for certain patients but are very under-studied. Troche: A small medicated lozenge designed to dissolve.
The Importance of Monitoring Hormonal Interactions
Many women on HRT are also managing thyroid conditions, which means understanding how hormones interact is crucial. Estrogen, for example, can impact thyroid medication absorption, likely more common with the oral version, which is why patients and healthcare providers need to work together to monitor levels and adjust dosages as needed. We also touched on the benefits of injectable estrogen for steady-state delivery, which can be a game-changer for some women but is a more rare option.
The Bottom Line: There Are Always Options
The biggest takeaway from this episode? Troches, injections, long-acting options, compounded versus commercially available products - women deserve better education, better access, and better options when it comes to hormone therapy. There is always a path forward, whether it’s overcoming misinformation, fighting for testosterone prescriptions, or working with a compounding pharmacy to find the right solution. Pharmacists, when properly educated, can be powerful allies in helping women navigate their hormonal health with confidence.
If you haven’t listened to this episode yet, don’t miss it! Tune in to You Are Not Broken, and let’s continue empowering women with the knowledge they need to take control of their health.
Things discussed in the episode:
Sedona in October: https://www.ascendretreats.com/menopause-and-sexual-health-2025
Order my book "You Are Not Broken: Stop "Should-ing" All Over You Sex Life"
Listen to my Tedx Talk: Why we need adult sex ed
Take my Adult Sex Ed Master Class:
Interested in my sexual health and hormone clinic? Starts 2025.