A topical gel is a gel material, which often contains some form of medicine and is applied on the skin or the mucus membranes. While we think of topical gel as meant only for the skin, there are many gels for toothaches and teething, and for various conditions affecting the vagina, like vaginal dryness. Many people choose gel forms when they are applying topical medications, especially over lotions or ointments. In a majority of cases a topical gel is clear and it has the tendency to be more readily absorbed by the skin in comparison to a lotion or an ointment. You usually won’t find traces of the applied gel after you’ve placed it on the skin.

Topical Gels: Topical gels are different from creams in that they generally have an alcohol base. They have a tendency to dry fast and are fairly less messy than creams. Testosterone is absorbed very effectively by the use of a topical gel. In fact, I find that excess testosterone levels can be very easily achieved. Their dosage may be just half or even one fourth of the oral doses. Some physicians have suggested using testosterone directly on the clitoris for sexual enhancement. One must use a vaginal cream.

Ointments: Ointments are Vaseline based. They form a wall against water. When treating vulvar irritation, frequent urine leakage is part of the main problem. Placing the treatment hormones in an ointment given protection to the vulvar skin from the urine and also prevents the treatment hormones from being washed away. You can also use Colbetasol (Temovate) ointment 0.05% as a base. Estrogen or testosterone can be combined with this ointment by the compounding pharmacist.

Topical Liquids: Some pharmacies make a topical liquid taking propylene glycol as the base. The fat-soluble steroid hormones quickly dissolve into this liquid and are effectively carried through the skin. Hormones can be dissolved into this base in high concentration, so an entire day’s dose can be carried in only a few drops that swiftly sink into the skin.

The patient can get a large supply of hormone in a small bottle. There is just one pharmacy in my knowledge that makes this type of preparation and I only have a few patients who have already used them. There was at least one patient who was quite happy with the process and her hormone blood levels were right in the required range. I have a little doubt with the constant use of the propylene glycol, but it is actually a very common ingredient in many, if not majority of commercial creams and lotions of all types used in the US.

Oral Troches: Oral troches are small tablets that tend to dissolve under the tongue or in the cheek. In case of patients where creams are not successful, using the buccal mucosa is a good substitute for topical skin. Some troches have a waxy texture and take time to dissolve. Others are quickly dissolved. Some pharmacies make smaller troches than others; about one centimetre square. To bring about a variation in the dose, troches are generally kept soft and can be cut into smaller doses with the help of a knife.

Troches are generally absorbed through the skin of the mouth. I am assuming, however, that much of the dose ends up in the stomach and thus, the liver. They stimulate the production of a large amount of saliva. I have been told that Progesterone does not taste good. So many different flavours have to be added in a desired ratio. Since Progesterone is a tranquillizer, it is usually prescribed before bed. Some patients complain that the troches with a waxy touch take up almost twenty minutes to dissolve and they have to wait for their mouth to be clear so that they can lie down.

Sublingual Tablets: Sublingual tablets are just like troches but they dissolve much faster than the waxy troches and are relatively smaller. But not all compounding pharmacies make them.