Estradiol Cypionate
Long-acting estradiol injection for menopause and perimenopause symptoms and for gender-affirming hormone therapy, given every one to two weeks. Prescribed and dosed by a licensed physician.
Injection
from $139/mo
Taken by mouth · Twice a week
Estrogen controlGynecomastia
Tamoxifen Tablets
Tamoxifen (Nolvadex, commercial brand): selective estrogen receptor modulator (SERM) for breast tissue, used for gynecomastia or elevated breast tissue during testosterone therapy. Oral, daily or as needed.
- Blocks estrogen effects in breast tissue without lowering overall estrogen
- Reduces gynecomastia (enlarged breast tissue) during testosterone therapy
- Oral dosing, flexible scheduling
- Monthly$89/mo
- Every 3 months$207 billed up front$69/mo
- Every 6 monthsBest value$354 billed up front$59/mo
- Free, discreet shipping
- Licensed U.S. pharmacy
- Board-certified physicians
Disclaimer: Prescription products require an online evaluation with a licensed medical professional who will determine if a prescription is appropriate. Products are compounded by a licensed pharmacy. The FDA has not reviewed or approved compounded products for any use for safety, efficacy, or quality. Compounded medications are not FDA-approved brand-name products.
- How
- Taken by mouth
- How often
- Twice a week
- Each shipment
- 9 tablets
- Strengths
- 2 options · 10–20 mg
What is tamoxifen?
(ta-MOX-i-fen)
Tamoxifen is a selective estrogen receptor modulator (SERM) that blocks estrogen in breast tissue while allowing estrogen to work elsewhere in the body. It is used off-label when breast tissue enlarges or becomes tender during testosterone therapy, a condition called gynecomastia. Typical dose: 10–20 mg daily or as needed. Unlike aromatase inhibitors, tamoxifen does not lower overall estrogen; it only blocks it in the breast.
What's in it
- TamoxifenBlocks estrogen in breast tissue
Tissue-selective
blocks estrogen in breast tissue only, not systemically
Tamoxifen is prescribed when gynecomastia appears or worsens during testosterone therapy. It does not lower estrogen system-wide, which preserves bone and cardiovascular benefits of estrogen. Long-term use (>1 year) requires monitoring.
Is it right for you?
Who it's for
Men with breast tenderness or a tender lump behind the nipple.
What sets it apart
It blocks estrogen in breast tissue only, without lowering estrogen in the rest of the body.
Worth knowing before you start
A hard, painless or one-sided lump needs an in-person exam first.
What to expect
Lab-guided dosing
estradiol levels drive decisions, not symptoms alone
Reduced breast symptoms
tenderness and swelling typically improve in 2–4 weeks
Stable mood and energy
when estrogen is in range, mood and water retention often normalize
Bone and heart monitoring
avoiding over-suppression protects long-term health
How estrogen control works
Day 1
A US-licensed physician reviews your symptoms on testosterone (breast tenderness, mood changes, water retention). Estradiol lab is ordered; results guide decisions on aromatase inhibitors or tamoxifen.
1Week 1
Estradiol lab comes back. If high, your physician prescribes anastrozole 1 mg twice weekly or tamoxifen 10–20 mg daily, depending on the issue (high conversion vs. breast tissue sensitivity).
2Weeks 2–4
Symptoms from high estrogen (breast tenderness, mood swings, bloating) begin to improve. Some people feel better within days; others take 3–4 weeks.
3Week 6
Follow-up estradiol lab. If it is now in range, your physician adjusts or stops the AI/SERM. If still high, dose is increased or agent is switched.
4Beyond
Estradiol is monitored every 6–12 weeks. Your physician aims to keep estrogen in a healthy range, not suppressed, not elevated, to preserve bone and cardiovascular health.
5
Individual results vary. Benefits reflect what Zepym Health members commonly report to their physician at check-ins; they are not the results of a clinical trial.
How you use it
This is the starting dose the pharmacy prints on the label. Your physician sets yours and adjusts it with you.
- How
- Taken by mouth
- Dose
- 1 tablet (10 mg)
- How often
- Twice a week
- Each shipment
- 9 tablets
- Pharmacy label
- Take 1 tablet (10 mg) by mouth twice weekly for 30 days.
A sample week
- M
- T
- W
- T
- F
- S
- S
Twice a week
Strengths the pharmacy carries
- 20 mg
- 10 mg
The science of estrogen control
Tamoxifen is a SERM: it binds to estrogen receptors in breast tissue and blocks estrogen signaling there, while allowing estrogen to act in bone and cardiovascular tissue. This makes it ideal for breast-specific effects.
In testosterone therapy, gynecomastia can appear when estrogen conversion is high or sensitivity is elevated. Tamoxifen reduces breast swelling and tenderness without system-wide hormone suppression.
Learn moreImportant safety information and common side effects
Aromatase inhibitors (anastrozole, exemestane) and selective estrogen receptor modulators (tamoxifen) are prescribed off-label to manage estrogen during testosterone therapy. Estradiol must be tested before starting: over-suppression can reduce bone density and harm cardiovascular health. Common side effects: mild joint aches, hot flushes, mood changes. Tamoxifen carries a small risk of blood clots and endometrial changes with long-term use (>1 year). Tell your physician about bone health, prior thrombosis, or family history of clots. Stop and seek care for leg pain/swelling, chest pain, or signs of stroke.
Every plan includes
- Personalized, physician-guided plan
- Monthly, 3-month and 6-month plans
- Dispensed by a US-licensed compounding pharmacy
- Unlimited protocol adjustments and messaging
- Ongoing support and check-ins
- Pause or cancel anytime
- Reviewed by our in-house physicians
How it works
1.Connect with a physician
Answer a few questions online and a US-licensed physician reviews your health, history and goals to make sure treatment is right for you. 100% online. No in-person visit required.
2.Get your discreet shipment
If approved, your treatment is compounded by a US-licensed, LegitScript-certified pharmacy, inspected for quality, and shipped discreetly to your door.
3.Receive continuous support
Start with one goal, then keep building over time. Unlimited physician messaging, easy refills and dose adjustments, all from the Zepym Health app.
Tamoxifen educational content reviewed by our physician
Scott Nass, MDDoctor of Medicine, board-certified in Family Medicine
Charles R. Drew University and David Geffen School of Medicine at UCLA. Family Medicine residency at Ventura County Medical Center.
Frequently asked questions
How do I take Tamoxifen Tablets?
Taken by mouth, twice a week. The starting prescription is 1 tablet (10 mg) each time. Your physician sets your own dose and it is printed on your label.
What strengths does Tamoxifen Tablets come in?
The pharmacy carries 2: 10 mg, 20 mg. Your physician chooses which one you get.
How much arrives in each shipment?
9 tablets at the starting strength, shipped to your door from a licensed US pharmacy.
How long does tamoxifen take to reduce breast swelling?
Noticeable reduction in breast tenderness and swelling usually appears within 2–4 weeks of starting 10–20 mg daily. Full resolution may take 2–3 months. Continue regular check-ins with your physician; if gynecomastia worsens despite tamoxifen, you may need estradiol testing or dose adjustment.
Do I always need an aromatase inhibitor on testosterone?
No. Many men convert testosterone to estrogen at a normal rate and do not need an AI. Your physician orders an estradiol lab; if it is normal, no AI is needed. Only if estradiol is high and causing symptoms does your physician prescribe one.
Can I use tamoxifen and aromatase inhibitors together?
Not typically. They work differently (tamoxifen blocks estrogen in breast tissue; AIs lower overall estrogen). Your physician chooses the right tool for your issue: high overall estrogen calls for an AI; breast tissue sensitivity calls for tamoxifen.
What if I need an AI long-term?
Long-term aromatase inhibitor use can reduce bone density over time. Your physician may recommend bone density screening (DEXA scan) and calcium/vitamin D supplementation if AI use extends beyond 1–2 years.
How often do I check estradiol levels?
Initial check: before starting any AI or SERM. After starting or adjusting dose: 6 weeks. Then: every 3–6 months once stable, or when symptoms change. Annual bone health screening is recommended with long-term AI use.
Testosterone without unwanted estrogen effects.
Gonadorelin
A copy of the brain's own GnRH signal that keeps the testes producing testosterone and sperm, used alongside testosterone therapy and in fertility care. Prescribed and dosed by a licensed physician.
Injection
from $159/mo
7-Keto DHEA Capsules
7-Keto DHEA, a metabolite of DHEA that does not convert to testosterone or estrogen. Supports energy and metabolism without hormonal side effects.
Capsule
from $79/mo
Anastrozole - Men
A low-dose aromatase inhibitor for men on testosterone therapy whose blood work shows high estradiol, easing breast tenderness and water retention. Slow-release capsule, prescribed and dosed by a licensed physician.
Capsule
from $54/mo
The above statements have not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure, or prevent any disease. Prescription products require an online evaluation with a licensed medical professional who will determine if a prescription is appropriate. Individual results vary.
Sources
- 1
Endocrine Society Clinical Practice Guidelines for testosterone therapy: managing estrogen with aromatase inhibitors.
J Clin Endocrinol Metab, 2018 - 2
Tamoxifen for gynecomastia in testosterone replacement therapy: a review of evidence.
J Clin Med, 2021
Tamoxifen Tabletsfrom $59/mo