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Medical Aesthetic Treatments > Biote Test Questions > Flashcards

Biote Test Questions Flashcards

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USMLE® Step 1 flashcards
1
Q

Symptom reduction over time with pellets for both men and women

A

Men: 4-5 months
Women: 3-4 months

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2
Q

What should PSA be to pellet (unless had urology work up)

A

PSA must be <2.5 ng/mL

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3
Q

Does testosterone therapy affect PSA in normal prostate?

A

Minimally (<0.1)

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4
Q

What 3 hormones do we balance

A

Estrogen
Testosterone and thyroid

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5
Q

If female is on estrogen cream and getting a biote lab work up what should be done

A

If on cream, hold cream in the AM of lab draw

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6
Q

After first round of pelleting what should be the follow up labs for women

A

FSH, estradiol, and total testosterone
*6 weeks of doing well
4 weeks if non responder
*if thyroid labs only, can be done at 4 weeks

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7
Q

What should FSH levels be at the follow up labs (after 1st pellet)

A

FSH should decrease by 50% or <23 if given replacement does E2 (not 6mg)
*because FSH will not change in testosterone only and will not change with E2 6mg

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8
Q

What should total testosterone levels at 6 weeks be for women

A

150-250

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9
Q

What about premenopausal E2 dosing for women

A

Premenopausal women make their own E2 AND progesterone so they do not need that.
Premenopausal women ONLY get E2 if they have menstrual migraines and the dose is 6mg!

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10
Q

Biote initial work up in men

A

CBC CMP
PSA (age 55-69)
TSH, Free T4, Free T3, TPO
Testosterone- total and feee
Estradiol
25-OH vit D and vit B12
Prolactin if she <40 and if T <300
Consider semen alalysis if no children
Sleep study?

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11
Q

For initial work up for men, what should be held prior to blood draw

A

If on shots, test on day 4 or 5 (post injection)
If on creams, hold cream AM of lab draw

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12
Q

Biote follow up labs for men

A

Free and total testosterone AND estradiol
Thyroid if on meds
*4 weeks

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13
Q

What should be the total testosterone in males with follow up labs

A

At 4 weeks
Total testosterone 900-1100
Free testosterone (upper end of range over the median)

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14
Q

What is the normal total testosterone ranges

A

300-900 is what most labs use for total testosterone
900-1100 is “optimal” level at which most men feel their best
<500 symptoms appear
<300 patient has significant symptoms

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15
Q

What is the normal PSA in men currently on 5a reduxtase inhibitor for BPH or balding

A

<1.25

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16
Q

If male testosterone is very low for age and no illegal anabolic steroids use, what lab test would be important to get

A

Prolactin

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17
Q

If make testosterone is very low for age and no anabolic steroid use, what clinical condition should be ruled out

A

Sleep apnea

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18
Q

What are the 6 estradiol pearls

A

NOT recommended in women with epilepsy
NEVER given to men
Do NOT give men aromatase inhibitors based on pre pellet lab results
do NOT give estradiol to breast cancer survivors
Maximum E2 given to women with uterus on FIRST dose is 12.5mg
FSH should go down by half or <23 if women gets replacement dose E2

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19
Q

What is a boost

A

Extra amount of either E2, T or both

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20
Q

When should a boost be given

A

<8 weeks (but not before 4 weeks)

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21
Q

Does the client get charged for a boost

A

No charge to patient or to clinic

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22
Q

Is estrogen given when there is a history of breast cancer

A

No!

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23
Q

Is progesterone given with a history of breast cancer

A

No!

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24
Q

If female is needing a testosterone boost what is it typically

A

Boost if needed before 8 weeks
37.5-50mg

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25
Q

If male is needing a testosterone boost what should it be

A

Boost if needed before 8 weeks
200-400mg

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26
Q

What is male aromatizer

A

When too much testosterone is converted to estradiol

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27
Q

If male has an estradiol level >70 pg/mL AND symptomatic what needs to be done

A

Given aromatase inhibitor
Femara (letrozole) 2.5mg (half tab every week or every 2 weeks)
Arimidex (anastrozole) 1mg (every week or every 2 weeks)
DIM SGS+ 150mg - 1 pill 2x day

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28
Q

Don’t get tricked on aromatization

A

Wait for follow up labs to determine aromatization, not initial labs

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29
Q

What should be done for a pellet that is infected, red/cellulitis

A

Apply heat
Clindamycin 300mg TID x 7 days OR
BACTRIM DS BID x 7 days

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30
Q

When will extrusions typically occur

A

6 or more weeks after insertion
If occurring within 1-2 weeks that is usually a technique error

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31
Q

How are pellets made and absorbed

A

Pure estradiol and testosterone
Compressed into pellets using thousands of pounds of pressure
E beam for sterility NOT autoclaved
Absorbed based on cardiac output not time released
Not depot
503b facility

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32
Q

What does normal menstrual bleeding mean in regards to progesterone

A

Progesterone withdrawal bleeding

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33
Q

Dose adjustment for progesterone?

A

Usually only needed for bleeding or intolerance

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34
Q

How can you minimize side effects of progesterone

A

First ensure proper use for absorption, take capsule with food at the SAME TIME every EVENING. If taking SL/RDT make sure dissolving not chewing

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35
Q

Will premenopausal women get progesterone?

A

They will NOT get progesterone unless for another indication

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36
Q

What is they had endometrial ablation and not period/bleeding at all?

A

Most likely no endometrium remaining (progesterone is optional once menopausal and getting E2)

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37
Q

What if they had endometrial ablation and still has had spotting

A

Still has endometrium (absolutely needs progesterone if receiving E2 in menopause)

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38
Q

With uterus on estrogen

A

Absolutely needs to take progesterone
(Continuous preferred, cyclic progesterone may be used short term for irregular bleeding)

39
Q

Normal lab range for progesterone

A

4-25ng/mL

40
Q

Optimal range of progesterone mid luteal

A

10-20 ng/mL

41
Q

When can we give perimenopausal patients E2

A

E2 6mg may be used in perimenopausal patients for mentrual migraines or when FSH >23 in presence of hot flashes (when patient still menatrating but FSH >23
*we do NOT use full replacement dose E2 in perimenopausal patients who have had a period in the last 12 months to avoid bleeding

42
Q

What is normal TPO range

A

Less than 30 IU/mL

43
Q

Normal TSH levels

A

0.3-2.0

44
Q

Optimal TSH levels

A

0.3

45
Q

Free T3 normal levels

A

2.3-4.3

46
Q

Free T3 optimal levels

A

4.0-4.3

47
Q

If the patient is asymptomatic, why do we care about treating their deficiency (T3)

A

T3 is needed for fat loss, and 40% of Americans are obese
T3 protects against arrhythmias and heart disease
T3 decreases with stress or dieting, prolonged hypothyroidism results in elevated cortisol levels resulting in further decreased conversion on T4 to T3 and increase amounts of RT3

48
Q

How does low thyroid lead to heart disease/arrhythmias

A

Mucin accumulation
Increased incidence of inflammation and infection
Diastolic hypertension
Swelling, dyspnea
Bradycardia, PVCs and A fib
V TACH is associated with Low T3, low ratio of T3/T4 and high reverse T3

49
Q

What TPO value is consistent with hashimotos

A

> 35

50
Q

Vitamin D desired range

A

60-80

51
Q

B 12 desired range

A

> 600

52
Q

What is the main difference in pre pellet labs that men get vs women

A

Men and women get the same lab drawn but men get Free testosterone and PSA

53
Q

Why do we check estradiol in men post pellet

A

Check aromatization (Testosterone converting to Estrogen)
*dont worry about lab results in pre pellet, that can trick you, wait until post pellet labs to decide on aromatization

54
Q

What is the range for estradiol levels in MEN (look at in POST pellet)

A

30-70
* this is a range because some will feel good at 70 some may have nipple tenderness at 70, some may feel not so good at 30 or feel good at 30. Everyone is different.

55
Q

When should the dosing site be used

A

For first pellet, boost (if needed), and 2nd round dosing

56
Q

Who should NOT receive estrogen

A

Men
Women with history of breast cancer
Women with history of seizures

57
Q

Will a woman get E2 if they are still menstruating

A

No

58
Q

What is a menstrual migraine and how is it treated

A

They are very cyclic and predictable, usually start at beginning of period
Can be given E2 6mg dose (this is not replacement dose of E2)

59
Q

What is it important to ask men prior to pelleting especially if they are younger

A

Ask if they are done having kids because testosterone replacement Lowers sperm count and lowers chances of conceiving

60
Q

Tell me more about aromatization inhibitors while injecting and while pelleting

A

Men on injections tend to convert more testosterone into estrogen and that’s why they are taking an aromatization inhibitor, when they start pelleting make sure to tell them to stop taking those inhibitors and use DIM instead because sometimes men don’t aromatize as much with the pellet method

61
Q

What is the importance of DIM

A

Improve metabolism of testosterone and estrogen in both men and women
Men take 2x daily
Women take 1x daily

62
Q

Who are testosterone with anastrozole for

A

Post menopausal Females only who have had a history of breast cancer
Not on letrozole, anastrozole, or tamoxifen
Only ONE pellet will be used with the combo and the other pellets will make up the remainder

63
Q

When must women receive progesterone

A

Must be given to post menopausal women who receive estrogen replacement dose with an INTACT uterus because it protects the uterus
*estrogen will cause growth of the lining of the uterus while progesterone inhibits that
Estrogen is the fertilizer
Progesterone is the lawnmower
If you give replacement dose estrogen the lining will grow and grow and it needs something to come in and trim it up before it gets out of hand

64
Q

Why does Biote not use synthetic progesterone- progestin

A

Those are the compounds that have adverse risks such as breast cancer and hypercoagability

65
Q

Why do we tell patients to take their progesterone oral pills at night

A

Most common side effect is drowsiness

66
Q

Why should progesterone be taken at the same time every night and not missing a dose

A

If they miss a dose they will bleed

67
Q

What if a patient is taking progesterone oral pill and they are too drowsy on it and don’t like it

A

Change to sublingual rapid dissolving tablets of progesterone, this will not cause drowsiness so they can take it morning or night

68
Q

What is the most important hormone to look at for the thyroid

A

Free T3
4.0-4.3

69
Q

Why do a lot of patients prefer and feel better on dessicated thyroid (NP thyroid)

A

It has both T3 and T4

70
Q

What medication should someone not have if they have a religious restrictions or is vegan

A

NP thyroid (dessicated thyroid) because it is porcein
But they Can be on compounded because it is a synthetic T3 and T4 combination

71
Q

If patients return do to testosterone related symptoms and its only been 3 months since last pelleting what should you do to prevent stacking

A

Skip the estradiol portion until next time to avoid build up (could build up and cause bleeding)

72
Q

What if a patient is doing another form of estrogen but gets pellets

A

Estrogen takes 3 days to come on board so stop all other estrogen methods 3 days after pelleting

73
Q

What does it mean by absorption is based on cardiac output

A

Couch = blah
You get what you put out of it, get moving and be active, you will feel better with exercise and eating healthy, as well as sleep

74
Q

Optimal progesterone range

A

10-20

75
Q

Why is it important to go really conservative with estrogen replacement especially in first year of menopause

A

We dont want to overstimulate the endometrium, this could lead to problems

76
Q

How can a thyroid issue cause arrhythmias

A

Inflammation causes the inability to convert T4 to T3 and that inflammation also causes mucin build up which is this nasty stickiness that adheres to everything in our vessels and causes heart issues

77
Q

Estrogen levels in men

A

30-70

78
Q

What does DIM do for men

A

Helps testosterone NOT convert to estrogen as much
Helps testicles from shrinking

79
Q

What if a male has a post pellet estrogen lab of 70

A

Ask if they are taking DIM, if they are taking the recommended dose (2 pills) have them add another because they are aromatizing testosterone too much

80
Q

Why is it important to take ADK with food

A

Fat soluble, if you dont take it with food you just wasted it

81
Q

What is the importance of ADK

A

Helps immune system an thyroid
Increase bone density (Vit D and Vit K together)
Vitamin K helps fight off cancer by turning of cancer genes
Vitamin d decreases cancer by 60%

82
Q

What this the importance of methylfactors

A

Energy and neurotransmitters
These are our B vitamins, if they have low energy check their B12
Our neurotransmitters are what make us happy and sad if we aren’t methylating right we can have anxiety and very debilitating, want to feel better so give these

83
Q

If pt b12 is less than 300 how many methylfactors should be given

A

3

84
Q

If patients b12 is between 300-500 how many methylfactors should be given

A

2

85
Q

How should methylfactors be taken

A

1-3 daily with food

86
Q

What if patients b12 is greater than 500 how many methylfactors be given

A

1
(A little bit of anxiety and depression give 1 a day)

87
Q

How should you take probiotic

A

1 in the morning

88
Q

What is the importance of probiotics

A

To restore out gut health and prevent leaky gut from zonulin being depleted or altered

89
Q

What is bacillus coagulans

A

This is a spore former that PROTECTS the gut it does not grow or kill like probiotics its more for just preventing the good from dying and best for travelers diarrhea or short term issues like that

90
Q

How should you take bacillus coagulans

A

1 daily with food jus like probiotic

91
Q

What is the importance of iodine

A

For the thyroid, this supp has selenium and zinc in it- important for conversion of T4 to T3
Selenium deficiency is in hashimotos patients
*important to start other supplements first then 4-6 weeks introduce iodine slowly

92
Q

Importance of arterosil

A

They restore the glycocalyx which means it goes in and restores the lining of the blood vessel and increases nitric oxide

93
Q

Wha rage do we check psa

A

Age 40! But really in every men

Medical Aesthetic Treatments (8 decks)

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