Testosterone Buccal (Striant): The Gum Patch Option

Written by Adam Maggio | Medically reviewed by Dr. Mitchell Ross, MD, ABAARM

Striant is a buccal testosterone system applied to the gums twice daily, offering discreet, consistent hormone delivery without the risk of secondary transfer.

Testosterone Buccal (Striant): The Gum Patch Option

Testosterone Replacement Therapy (TRT) has seen a continuous evolution in delivery methods, each designed to optimize patient experience and therapeutic outcomes. Among the less common, yet distinct, options is buccal testosterone, marketed under the brand name Striant. This unique formulation offers a discreet and convenient way to deliver testosterone, bypassing some of the challenges associated with other methods. Understanding its mechanism, advantages, and limitations is key to determining its suitability for men with hypogonadism.

Striant is a mucoadhesive buccal system, essentially a small, flat tablet designed to adhere to the gum (buccal mucosa) above the incisor tooth. Once applied, it continuously releases testosterone over a 12-hour period. The typical dosing regimen involves applying one patch twice daily, usually in the morning and evening, ensuring a relatively consistent delivery of testosterone throughout the day. The testosterone is absorbed directly through the buccal mucosa into the systemic circulation, bypassing the gastrointestinal tract and the liver's first-pass metabolism.

How Buccal Testosterone Works and Its Pharmacokinetics

The buccal mucosa is a thin, highly vascularized membrane, making it an effective site for drug absorption. When Striant adheres to the gum, it slowly releases testosterone, which diffuses across the mucosal lining and enters the bloodstream. This direct entry into the systemic circulation avoids the hepatic metabolism that can occur with oral ingestion, thereby reducing the risk of liver strain associated with 17-alpha-alkylated oral steroids.

Clinical studies have demonstrated that buccal testosterone effectively elevates serum testosterone levels into the normal physiological range (typically 300-1000 ng/dL) in hypogonadal men. The twice-daily application helps maintain relatively stable testosterone concentrations, avoiding the sharp peaks and troughs that can sometimes be observed with less frequent dosing methods. The mucoadhesive property ensures the patch stays in place during normal activities, including eating and drinking, though care must be taken to avoid dislodging it.

Pros of Testosterone Buccal Gel (Striant)

• Consistent Delivery: The twice-daily application provides a relatively stable and sustained release of testosterone, contributing to consistent symptom relief.
• Discreet and Convenient: Once applied, the patch is largely unnoticeable and does not interfere with daily activities. It offers a discreet alternative to injections or topical gels.
• Bypasses First-Pass Metabolism: Like other non-oral TRT methods, buccal delivery avoids the liver's first-pass effect, reducing concerns about hepatotoxicity.
• Reduced Transfer Risk: As the testosterone is absorbed internally, there is virtually no risk of secondary transfer to partners or children, a significant advantage over transdermal gels.
• No Skin Irritation: For men who experience skin irritation with patches or gels, Striant offers an alternative that avoids cutaneous application.

Cons of Testosterone Buccal Gel (Striant)

• Local Side Effects: The most common side effects are local to the application site and can include gum irritation, tenderness, pain, or inflammation. Some users may also experience an altered sense of taste.
• Adherence Issues: While convenient, remembering to apply the patch twice daily and ensuring it remains adhered can be a challenge for some individuals.
• Potential for Dislodgement: Although designed to adhere firmly, the patch can occasionally become dislodged, especially during vigorous eating or oral hygiene practices.
• Limited Dosing Flexibility: Striant comes in a fixed dose (30mg per patch), which may limit the ability to fine-tune dosage for individual needs compared to injectable or gel formulations.
• Cost: Buccal testosterone can be a more expensive option compared to generic injectable testosterone.

Who is Striant For?

Buccal testosterone (Striant) is a suitable option for hypogonadal men who: prefer to avoid injections; experience skin irritation with transdermal gels or patches; are concerned about the risk of secondary transfer with other topical formulations; or seek a discreet and convenient delivery method. It may be particularly appealing to those who find daily gel application cumbersome or have difficulty with needle phobia. However, men with pre-existing gum disease or significant oral health issues may find this method unsuitable. As with all TRT options, a comprehensive discussion with a healthcare provider is essential to determine if buccal testosterone is the most appropriate treatment choice, considering individual health status, lifestyle, and preferences.