A new 1-hour CME-accredited didactic is now available in QueerCME Premium on the use of selective estrogen receptor modulators (SERMs) in gender affirming medicine.

This lecture explores the off label use of medications such as raloxifene and tamoxifen in patients whose physiologic goals are not well served by traditional estradiol or testosterone pathways.

SERMs are tissue selective. Depending on context, they may act as estrogen agonists in bone and antagonists in breast tissue. The pharmacology underlying this tissue specificity is well described in the literature (Martinkovich et al., 2014; Jordan, 2006) and has been applied clinically in osteoporosis, breast cancer risk reduction, gynecomastia, and prostate cancer related breast events.

Adjacent data relevant to gender affirming practice include:

• Raloxifene effects on gonadotropins, sex hormones, and bone turnover in men (Duschek et al., 2004; Uebelhart et al., 2004)

• Tamoxifen and raloxifene in pubertal gynecomastia (Lawrence et al., 2004; Nordt & DiVasta, 2008)

• Management of antiandrogen induced breast events (Kunath et al., 2012)

• Discussion of SERMs as a potential option in individualized gender affirming hormonal pathways (Xu et al., 2021)

We also review large safety datasets from cis populations, including fracture outcomes (Ettinger et al., 1999) and breast cancer risk data from the STAR trial (Vogel et al., 2006).

There are no large randomized trials of SERMs in trans populations. This lecture does not overstate the evidence. It focuses on physiology, extrapolation, risk counseling, and documentation for off label prescribing.

Topics covered include:

• Receptor pharmacodynamics

• Effects on bone, breast tissue, lipids, and gonadotropins

• Safety considerations and monitoring

• Informed consent language for off label use

The 2022 World Professional Association for Transgender Health Standards of Care Version 8 emphasize flexibility and individualized pathways within informed decision making. This didactic situates SERMs within that broader framework.

The video provides 1 hour of CME and is available on demand to Premium members!

This topic is for clinicians who want to expand their understanding of estrogen receptor modulation and think more precisely about how pharmacology intersects with patient goals.