Tibolone has tissue -selective estrogenic effects, with desirable effects in bone , the brain , and the vagina , and lack of undesirable action in the endometrium and breasts .  Its tissue selectivity is the result of metabolism , enzyme modulation (., of estrogen sulfatase and estrogen sulfotransferase ), and receptor modulation that vary in different target tissues, and differs mechanistically from that of selective estrogen receptor modulators (SERMs) such as tamoxifen , which produce their tissue-selectivity via means of modulation of the ER.   As such, to distinguish it from SERMs, tibolone has been described as a "selective tissue estrogenic activity regulator" (STEAR),  and also as a "selective estrogen enzyme modulator" (SEEM). 
As for individual use of a personal nature, outside therapeutic treatment, this is where we will find the vast majority of anabolic steroids. It is here we will also find the biggest problems, not in terms of ill-effects of a physical or mental nature but of those surrounding legality. In places like the . anabolic steroids are controlled substances, and here we will find the strictest of laws. This has created a new class of criminal; most commonly an adult man with a family who is simply living an every day life like everyone else. These are issues that need to be discussed and you will find very few are willing to touch them unlike .