Selective estrogen receptor modulator

And then on our estrogenic level, we actually see that there is some estrogen receptor beta activation.

And when we're looking at estrogen receptor modulation, we look at the compound CIRM, Selective Estrogen Receptor Modulator.

So like soy is a CIRM, phytoestrogens or plant-based estrogens can be considered CIRMs.

And CIRMs themselves, we want to know, well, which receptor? Does it equilaterally impact the alpha and beta? Does it just upregulate the beta? Does it just upregulate the alpha? Because this matters because the alpha receptors of our estrogenic tissue are going to be more proliferative.

So, you know, everybody has different values and preferences, a different medical background, different lifestyles, so it's important to know that there's different options.

So ospemifene, which is a estrogen agonist/antagonist so-called SERM, is available, Osfena, as an oral pill daily.

Now, like an oral estrogen or oral SERM like raloxifene, Evista, tamoxifen, Nolvadex, tibolone, which is not available in the United States but is in Europe, it still has an increased risk potentially of deep vein thrombosis, whereas vaginal estrogen, vaginal DHEA, uh, does not.

So assuming there's been no history of blood clot or any-- no upcoming immobility, then that is available.

And previously, through coupons, we could get it relatively inexpensive for some of our Medicare patients.

What's up, Evan? Good to see you

... for Serm today.

This guy left his keys in an Uber, got a new phone.

The phone didn't work, wasn't getting texts.

I think about 70% of you guys that listen aren't subscribed on Apple Podcast or following us on Spotify.

So to help our mission of helping millions of frustrated golfers enjoy the ride again, all we'd ask from you guys is to take two seconds, tap Subscribe, tap Follow, because what that does is it tells the algorithms to recommend our show to more people like you.

You know, Serm, we've got our first ever live show next week-

Oh, yeah

Mm-hmm.

And they've added to it what we call a selective estrogen receptor modulator, or SERM, which basically if pe- the one that people know is tamoxifen, which is given-

Yeah

... after breast cancer.

And what these molecules do th- is at some places, they behave like estrogen, and at other places, they behave as an anti-estrogen.

And the big deal with the SERMs is they all behave as an anti-estrogen at breast cells.

Mm-hmm.

So they block the estrogen receptor-

So, um, you know, Clomid is a tricky one 'cause not everyone feels better on Clomid.

And also the increased clotting, the SERMs, huh?

Yeah.

And potential clotting with SERMs, yeah.

One of Dr.

Mark Gordon's programs for TBI, he is a big proponent of Clomid.

Primo, metabolite of Primo acts like an aromatase inhibitor and will lower estradiol, whereas Masteron does not seem to lower estradiol.

It acts more like a SERM.

So it really depends on what you're trying to get.

Primo is going to be a bit more anabolic than Masteron.

But you're told that over the last two months, the person tells you that she has had very heavy menstrual periods and, uh, you know, she has been soaking through multiple pads.

Um, if you see something like this, and they ask you, like, "What's the most likely mechanism behind the person's presentation?" I'd really hope you're picking the answer that talks about, um, um, unopposed estrogen exposure in, uh, endometrial tissue, right? You're like, "Again, Divine, what's the link? What's going on here?" Well, hopefully, this makes you think of tamoxifen toxicity, right? Remember, tamoxifen is a SERM.

It's a selective estrogen receptor modulator that we use as breast cancer chemoprophylaxis.

So why is it called a SERM? Well, it's called a SERM or again, selective estrogen receptor modulator because it does different things depending on the estrogen receptor that, um, it's exposed to, right? So, like, for example, in the breast, it's a very, very potent estrogen receptor antagonist.

In the bone, how does it act? It doesn't act as an antagonist of estrogen receptors in the bone.

It acts as an agonist.