TTO are the eggs of the human whipworm, Trichuris trichiura (TT). In helminthic therapy, these eggs are referred to as “ova”, hence the abbreviation, “TTO”.
Once inside a human host, the ova hatch and mature to adulthood, typically surviving for periods ranging from a few months to a couple of years.
Dosing with TTO
The evolution of TTO dosing
When TTO was first introduced for sale, in 2009, it was recommended that self-treaters take an initial course of three increasingly larger doses - for example, 100, 200 and 800 ova at monthly intervals - but this level of dosing can cause significant side effects.
A new approach to dosing with TTO was introduced in 2014, which used much smaller doses taken on a regular, ongoing basis, typically 25 ova every week, or 50 ova every two weeks. The dosing intervals in this approach are more in line with those used in the dosing protocol for TSO (the ova of the pig whipworm), although TTO do not die after two or three weeks, as TSO do, so the number of TTO that are inoculated are necessarily much smaller than those used in therapy with TSO.
The advantages of taking TTO more frequently, in smaller doses, are:
- 1. This helps to reduce the risk of side effects, and, if these do appear, dosing can be paused until they resolve.
- 2. A possible additional therapeutic benefit from more regular exposure to the larval stage of helminths. 
- 3. The members of the resulting colony will be at many different life stages, thus reducing the risk of a sudden return of disease symptoms due to a large die-off of older worms at around the same time.
Considerations for TTO dosing
- Due to the relatively small number of self-treaters who are using TTO, and the consequently limited feedback on the effects of different dose sizes, dosing with this species is still somewhat experimental. However, it has been established that it is safe to inoculate with up to 1,500 ova per year - which is considered by health authorities to be a “light” infection - and that, when this number is spread across multiple doses, the serious adverse effects that are associated with “heavy” TT infections - such as bleeding and rectal prolapse - are prevented.
- Only an estimated 10-20% of the ova in a dose of TTO will develop into mature worms, but, since it is not possible to accurately determine the hatching rate, current dosing practice is based on the number of ova in a dose rather than on a theoretical number of worms that might result from it.
- As in self-treatment with other species of therapeutic helminth, there is considerable variation in individual response to TTO. Therefore, each self-treater needs to carefully observe their own response over time and modify their dosing practice accordingly.
- Anyone with a lot of intestinal inflammation may be taking an immunosuppressant medication such as prednisone/prednisolone. By controlling the inflammation, this type of drug will help the worms become established. For more about this, see Combining helminthic therapy with drug treatments.
TTO dosing recommendations
Many self-treaters are likely to achieve the best results by taking doses of 25 TTO every week, or 50 every two weeks, especially when beginning treatment with this species.
However, a few people react quite strongly to even small doses. So, at least for this minority, taking 300 TTO every 12 weeks (or even larger doses at commensurately longer intervals) may provide the best compromise and limit the total amount of time spent dealing with side effects. One doctor who recommends the use of TTO in cases of ulcerative colitis prefers his patients to start with a dose of 500 TTO, based on this paper. Some patients who have commenced with this size of dose have apparently reported transient abdominal pain or other symptoms after dosing, but this has not always been the case.
It is also possible that someone who is experiencing severe colonic inflammation might benefit from taking larger doses less frequently because, while this may cause more severe side effects for a while after each dose, it might also be more effective at subduing the inflammation.
In general, if side effects are experienced after taking a dose of TTO, the next dose should be delayed until they have subsided.
Inoculation with TTO
TTO are supplied in a small vial and are taken orally, either swallowed directly from the vial, or added to a little cold or cool water. Hot drinks should be avoided for at least 2 hours after taking TTO.
The timing of doses in relation to meals is not important, except that taking TTO on an empty stomach does allow the eggs to move through the digestive tract a little more quickly and hatch a little earlier than if they are delayed while a meal is being digested. However, this small saving of time is the only benefit of taking them between meals.
Days 1 and 2
Following inoculation, the ova reach the small intestine where they are stimulated to hatch by the indigenous microflora. This process may cause mild dizziness or vertigo, possibly with some indigestion and nausea.
Days 3 to 9
The emerging larvae then enter the crypts of Lieberkühn, which are glands lying between the finger-like villi that line the inner surface of the small intestine. Here, they will moult four times as they continue to grow - a stage that may not present any noticeable reaction in the host.
Day 10 to 3-4 months
The young worms emerge after 10-14 days and migrate to the caecum, where they partially penetrate the mucosal lining and complete their development into adult worms during the reminder of the first three months. They eventually spread throughout the caecum and the ascending and transverse sections of the large intestine, where the females begin producing eggs from approximately three months. Their attachment to the colon lining during this stage can cause IBD-like symptoms, described in more detail in the Possible TT side effects section below.
Possible TT side effects
Any side effects encountered following inoculation with TTO are likely to be mild (less severe than those produced by hookworms), subside quickly, and be limited to the first few weeks after inoculation. Since they are largely dose-dependent, the side effects can be minimised by conservative dosing.
Side effects following the initial dose
It’s easy to obsess about the process unfolding in one’s gut after ingesting TTO, to wonder whether the treatment is 'taking’, and to ascribe every tick and sniffle that develops in the first few weeks to the whipworms. But one's body continues to operate largely as usual in the early stages of any helminth colonisation. One still gets colds and other infections, and any physical changes experienced by new helminth hosts are far more likely to be manifestations of normal bodily functions than the action of the helminths. Colonisation follows a natural progression determined by evolution over millions of years, and it is largely hidden from immediate experience. For at least the first few weeks, the worms will be maturing, and mostly doing this in stealth mode, especially if smaller doses are taken initially. While some side effects are possible during this time, these are generally less troublesome than those encountered after inoculation with hookworms.
However, some people find that TTO produces a more pronounced response than hookworms.
Abdominal pain is possible in the first few days, possibly accompanied by gas and bloating. The pain is experienced in the lower right of the abdomen where the whipworms attach to the caecum and ascending colon. This pain may be sharp and will usually only last for a few hours, but it can recur intermittently at any point up to around 3 months, and, when it does appear, it may persist for a few days, even perhaps for a week or more in rare cases.
Asthma, exacerbation of
A positive association has been identified between Trichuris trichiura infestation and childhood asthma  and a few TTO self-treaters have observed an exacerbation - usually temporary - of this disease in the early stages of therapeutic colonisation.
Diarrhoea / diarrhea
Diarrhoea may occur in association with abdominal pain, although this is less likely. In rare instances, nausea and sickness have also been reported.
A few self-treaters have experiencing prolonged diarrhoea after even relatively small doses, as happened in this case.
Some self-treaters have reported brief episodes of diarrhoea after every dose.
Sometimes there is a worsening of the symptoms of existing diseases while the whipworms are becoming established, and anyone with ulcerative colitis or Crohn’s colitis will have difficulty distinguishing between the symptoms of their disease and those triggered by the whipworms, because both cause inflammation. A few people may get some bleeding, and any active colonic disease will make it harder for the whipworms to become established.
Constipation can be another short-term consequence of adopting human whipworms. (Two links expired)
Allergies may flare temporarily, and people who don't normally have allergies may experience transient allergic-type reactions. These may include asthma and skin reactions or rashes, which typically start a few days after taking the ova and may continue for 3-6 weeks but are usually mild and short-lived. In a few cases, these side effects can persist for longer, even up to 8 weeks after taking TTO. 
If necessary, NA can be hosted in addition to TT in order to help reduce the possibility of an allergic reaction to the latter and to provide additional systemic inflammation control,  although it is usually best to introduce one species at a time to avoid overstimulating the immune system, and to allow observation of which side effects relate to each species.
Occasionally, new hosts of human whipworms will report periods of insomnia, sometimes lasting for several weeks, and some other conditions may flare temporarily after taking TTO, including herpes. Someone who already suffers frequent or severe outbreaks of herpes may see these worsen and increase in frequency for up to three or four months after inoculation with TTO, (Link expired) before returning to the pattern seen before inoculation. (See Helminthic therapy and herpes.)
Mucus production, increase in
This “side effect” can be very beneficial and form part of the solution to treating some conditions, for example, inflammatory bowel disease.
TTO self-treaters have reported as follows.
Two TT hosts have also experienced a further oral phenomenon when taking their third doses of TTO. They reported independently that the liquid tasted “bad”, as if it were spoiled, but neither user suspected that their dose had been contaminated because they had both purchased 9 doses at one time and none of the others caused the bad taste they experienced with their third dose.
Psoriasis-like skin eruptions
In general, any side effects following inoculation with TTO are likely to be mild, subside quickly, and be easier to cope with than those experienced by hosts of NA, but side effects can appear intermittently for up to three or four months, or even longer in rare cases.
Severe side effects
Rarely, TTO can cause side effects that are sufficiently severe to necessitate termination, but this needn't be the end of the line because one of the other worm species may be able to deliver the desired benefits.
For further insight into the short-term side effects that are possible after inoculating with TTO, see the following paper concerning the side effects experienced by subjects who inoculated with the closely related species, TSO.
- Symptoms after Ingestion of Pig Whipworm Trichuris suis Eggs in a Randomized Placebo-Controlled Double-Blind Clinical Trial -- Full text | PDF
Side effects from supplementary doses
The side effects following supplementary inoculations with TTO typically become less severe with each successive dose.
In a few people, side effects may continue to appear briefly after each new dose in the long term, especially in those who are taking larger doses.
There is an extremely small possibility that therapeutic doses of human whipworms might cause anaemia (anemia) over time. However, the type of anaemia involved may not due to low iron levels, so might not respond to treatment with iron supplements. It has been speculated that this form of anaemia might be due to active suppression of the formation of blood cellular components in the bone marrow, rather than as a result of bleeding. The likelihood of this phenomenon occurring in someone using therapeutic doses of human whipworm is thought to be vanishingly small, and, if it were to occur, it may - according to one physician member of the helminthic therapy community - be amenable to remediation by taking Erythropoietin (EPO).
Treating the side effects
Side effects encountered after inoculation with TTO can be treated using whatever appropriate over-the-counter or prescription medicine is available, as directed on the packaging or by the prescribing doctor. What works to calm hookworm side effects will also effectively relieve those caused by whipworms.
Therapeutic response to TT
Once the TT host has got past any transient side effects, s/he can look forward to the possibility of significant benefits.
The benefits of hosting TT can often be enhanced by combining this species with hookworms.
For more on combining TT and NA, see Selecting a therapeutic helminth: TTO.
TTO storage and survival
TTO are robust organisms that are very resistant to freezing and may remain viable and infective in the natural environment for as long as five years.  They are therefore able to withstand the rigours of shipping extremely well.
Once received by a self-treater, vials containing TTO should be stored in a refrigerator, ideally in a dark container. (For further details from the scientific literature about the life expectancy of the eggs in storage, see Note 47 in this Notes section.)
Provided that TTO have not been frozen or exposed to extreme heat, and that the liquid containing them remains clear rather than cloudy, TTO stored in a domestic fridge had been thought to remain viable for a couple of years, but one user has reported a drop-off of benefit when using ova stored for around 18 months. This is still a long period of time, however, and allows TTO self-treaters to purchase doses when convenient and keep them in reserve until required.
Whipworms need bacteria to stimulate hatching, but no specific bacterium is required for this. The role is performed by any one of a wide range of bacteria that are already present in the gut. 
Where whipworms live
After temporarily inhabiting the small intestine (the duodenum, jejunum and ileum) during most of the first two weeks, TT then move to, and settle in, the cecum  and the ascending and transverse sections of the colon, as shown by the red text in the following representation.
It has occasionally been suggested by ill-informed commenters that TT might mis-migrate to organs outside the intestine, but the human whipworm remains reliably within the gut.
What whipworms eat
Whipworms graze on tissue secretions present in the colonic mucosa. They do not feed on their host’s blood, as hookworms do.
It is not possible for TT to multiply within a host because its eggs need to be deposited in soil, where, given suitable conditions, they will embryonate after two to three weeks. It is only at this point that they become infective so, unless a user of TTO ingests further embryonated eggs, their colony will never increase.
Helminth providers who supply TTO ensure they are embryonated before shipping.
Confirming a TT infection
There are two practical options for determining the presence of human whipworms in the gut.
1. Stool test
From about three months post inoculation with TTO, the adult whipworms will begin to produce eggs that will be detectable in the host's stool. Checking a stool sample for these eggs is the best way to establish that whipworms are present. Unfortunately, while most pathology labs will have a faecal (stool) test called something like "Ova, Cysts, and Parasites" or "Ova and Parasite", they typically do not have sufficient experience to accurately identify helminth eggs, a problem that is exacerbated by the relatively low numbers of worms used in helminthic therapy. Testing is therefore best carried out by a helminth provider who offers a stool testing service, a laboratory associated with a school of tropical medicine, a veterinarian (who will have experience with helminth eggs), or at home using a microscope and fecalyzer. For more details about these options, see the following page.
2. Blood test for eosinophils
Another way to determine whether or not someone is hosting whipworms is to have a blood draw to see if their eosinophil level is elevated. Although this is not a foolproof test for the presence of helminths (eosinophils are not always raised), it is fairly reliable. It is also quick, and is a method that a medical insurer might pay for.
Caring for TT
Some substances can have an adverse effect on TT, although whipworms (TT and TS) are far less susceptible to harm than hookworms.
One reason for the greater resilience of TT in comparison with NA might be that whipworms feed on tissue secretions harvested from their immediate environment in the colon, where no digestion takes place and where most harmful molecules have already been broken down and/or absorbed. This is in contrast to NA, which feed on their hosts' blood, so are rapidly exposed to whatever has been absorbed into the blood stream,  and are also located in the small intestine in direct contact with the many undigested, and partially digested, proteins found at the beginning of the digestive tract. 
See the following page for more details about the care of TT.
Once ingested, TT can survive in humans for several years.
There have been two reports of TT being seen during a colonoscopy at 7 and 8 years post-inoculation. However, their longevity is determined by the strength of the individual host’s immune response, and they may not survive past the first year in some people.
TTO can be incubated at home, although this requires more equipment than hookworm incubation, and the process takes longer and is technically more challenging. See the following page for full details.
- TTO compared with other therapeutic helminths
- Suppliers of TTO and other therapeutic helminths
- Personal stories from users of TTO and other helminth species. Use the search function on your device (Control+F on a PC, or Command+F on a Mac) to search the page for "TTO".